Preventing visual loss from chronic eye disease in primary care: scientific review.

CONTEXT Vision loss is common in the United States and its prevalence increases with age. Visual disability significantly impacts quality of life and increases the risk of injury. Although at least 40% of blindness in the United States is either preventable or treatable with timely diagnosis and intervention, many people with vision loss are undiagnosed and untreated. OBJECTIVE To review the evidence regarding screening and management of eye disorders and visual disability among adults in the primary care setting. DATA SOURCES AND STUDY SELECTION MEDLINE, HealthSTAR, EMBASE, The Cochrane Database of Systematic Reviews, and the National Guidelines Clearinghouse were searched for articles and practice guidelines about screening and management of eye diseases and vision loss among adults in the primary care setting using key words and free-text terms, such as vision screening, glaucoma prevention and control, from 1985 to 2003. References in these articles and those suggested by experts in eye care, vision loss, and vision screening were reviewed as well. DATA EXTRACTION Articles were searched for the most clinically important information and emphasized randomized controlled trials where available. DATA SYNTHESIS Most major guidelines recommend periodic referral of older adults to an eye care professional for comprehensive evaluation to detect eye diseases and visual disability. The value of routine screening for vision loss in the primary care setting has not been established. Timely identification and treatment of eye diseases can substantially reduce the incidence and prevalence of visual disability among older adults. Optimizing management of systemic diseases, such as diabetes, hypertension, and hyperlipidemia, significantly reduces the risk of related eye disorders. CONCLUSIONS Primary care clinicians can play a vital role in preserving vision in their patients by managing systemic diseases that impact eye health and by ensuring that patients undergo periodic evaluations by eye care professionals and receive needed eye care.