Visual and hearing impairment
| Age | 0 - 9 | 10 - 14 | 15 - 19 | 20 - 24 | 25 - 29 | 30 - 34 | 35 - 39 | 40 - 44 | 45 - 49 | 50 - 54 | 55 - 59 | 60 - 64 | 65 - 69 | 70 - 79 | >80 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| X | X | X |
Visual acuity should be assessed from 65 years of age using the Snellen chart (B). However, there is no evidence that screening of asymptomatic older people results in improved vision.157
Hearing loss is a common problem among older people and is associated with significant physical, functional and mental health consequences. Annual questioning about hearing impairment is recommended for people 65 years of age and over (B).
In some Australian states there are legal requirements for annual assessment, eg. driving over 70 years of age.158 (See Assessing fitness to drive, commercial and private vehicle drivers: Medical standards for licensing and clinical management guidelines. Sydney: Austroads Inc, National Road Transport Commission, 2003. Available at www.austroads.com.au/aftd/index.html).
Eye disease and visual impairment increase 3-fold with each decade of life after 40 years of age. They are often accompanied by isolation, depression and poorer social relationships, and are strongly associated with falls and hip fractures. People at greater risk of visual loss are older people, those with diabetes, and those with a family history of vision impairment. Cataracts are the most common eye disease (42% of cases of visual impairment), followed by age related macular degeneration (AMD) (30%), diabetic retinopathy and glaucoma. The leading causes of blindness in those over 65 years of age are AMD (55%), glaucoma (16%) and diabetic retinopathy (16%).159
| Who is at higher risk of visual impairment and hearing loss? | What should be done? | How often? | Level of evidence and references |
|---|---|---|---|
| People 65 years of age and over | Screen for visual impairment |
Every 12 months | II B |
| Screen for hearing impairment | III B 44,160 |
| Intervention | Technique | References |
|---|---|---|
| Visual impairment screening | Use a Snellen chart to screen for visual impairment in the elderly (see also Chapter 12 Glaucoma) | 161 |
| Hearing impairment screening | A whispered voice out of field of vision has a high sensitivity for hearing loss, as does a single question about hearing difficulty | 162 |
© The Royal Australian College of General Practitioners
Printed from www.racgp.org.au/redbook