Who participates in population based studies of visual impairment? The Salisbury Eye Evaluation project experience

To describe characteristics of respondents and nonrespondents to a home questionnaire and comprehensive clinical examination in a population of elderly Americans.

The SEE project is a population-based study of age-related eye diseases, visual impairment, and functional status of individuals aged 65 to 84. Potential participants were identified using the Health Care Financing Administration Medicare data base for Salisbury, MD: After sending out an introductory letter, a trained interviewer visited potential participants in their homes, obtained their consent to participate, administered a short screening interview that included questions about their general health and vision, and administered an extensive questionnaire on their diet, medical history, and difficulty performing activities related to vision. The interviewer then scheduled an appointment for the participants to visit a central site for an exam. Potential participants could fall into one of two refusal groups; refusal to take part in the study before the home questionnaire or prior to the clinic visit.

The overall response rate for the clinic visit was 65%. Compared to individuals with complete exams, the two groups of refusals were older, less likely to have any college education, more likely to report poor health status, and more likely to need help with Independent Activities of Daily Living (IADL's). Participants with complete home questionnaires that failed to come to the clinic were more likely to have Mini-Mental scores below 25. There were not significant differences by race, gender, or self reported vision status among the three groups.

Population-based studies requiring an in-clinic examination may selectively under-sample those with health and mental difficulties. These differential responses may introduce bias in the study results and need to be addressed when assessing the burden, type and severity of disease in the community. However, self-report of visual status was similar among refusals and participants in this study on vision.