Eye screening in the elderly

Poor vision is considered to be a common unreported illness in the elderly population. To determine its prevalence we carried out an eye screen on 150 randomly selected co-operative elderly subjects attending St James's Hospital. A database [mean age 78.2 years (range 65 to 97)], medical history, mini-mental test score [mean score 9.1 (range 2 to 10)], mobility assessment and history of eye problems was gathered. A visual test of both eyes together (standard N6 and N8), inspection of the eyes, tonometry (Perkin's handheld tonometer) and fundoscopy were performed on each subject and the need and reason for referral to an optician or an ophthalmologist was documented. Results show that 64% of subjects could read N6 or N8. Tonometry revealed no subject with raised intraocular pressure, including 4 subjects who were currently on treatment for glaucoma. Fundoscopy showed that 57.3% of subjects had some evidence of cataracts, 16.6% moderate and 3% severe. The retina appeared normal in 58.6% of subjects, 20.6% of the population had hypertensive changes, 4.6% had diabetic changes, 3% had optic atrophy, 1.3% had macular degeneration and a further 10% could not be clearly visualised due to cataracts. 90% of subjects wore glasses and the average duration since the glasses were last changed was 3.7 years (range 2 weeks to 20 years). No glasses examined were in need of cleaning or repair. 36% of subjects could not read N8 (28 of these had forgotten their glasses and were advised to visit their optician if they could not read newsprint). 7.3% of subjects were referred to an optician for new glasses, 1.3% were referred to an ophthalmologist for newly diagnosed cataracts and 6.6% were regular attenders to an ophthalmologist. We conclude that the rate of new referrals for the occurrence of correctable undetected visual acuity deficit was lower than expected at 8.6% of subjects screened.