How can I effectively screen for visual impairment in elderly patients during routine health checks?

Effective screening for visual impairment in elderly patients during routine health checks involves a combination of simple vision tests and targeted assessments to identify those at risk of significant eye conditions.

Start with a basic sight test to determine if the patient has any sight defects and whether they require corrective lenses or further examination. This includes checking visual acuity and asking about any subjective decline in vision or visual function, as early visual impairment can be asymptomatic ¹.

For patients at higher risk or with suspected abnormalities, consider more detailed assessments such as intraocular pressure (IOP) measurement using Goldmann-type applanation tonometry, optic nerve head examination (preferably with stereoscopic slit lamp biomicroscopy), and visual field testing using standard automated perimetry ¹.

Do not rely solely on non-contact tonometry for IOP measurement as it is less accurate for glaucoma screening ¹. Repeat measurements of IOP and visual fields on separate occasions can help confirm abnormalities before referral ¹.

Referral to specialist eye services should be based on evidence of optic nerve damage, consistent visual field defects, or elevated IOP (≥24 mmHg) confirmed by appropriate methods ¹.

Additionally, enquire about symptoms suggestive of age-related macular degeneration (AMD), such as a decline in central vision, and consider referral for optical coherence tomography (OCT) or fluorescein angiography if indicated ².

Providing patients with information about their eye health, the importance of regular monitoring, and available support services is also essential to effective screening and management ¹.