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Clinical guidelines

Guidelines for preventive activities in general practice 9th edition

5.4 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

Visual acuity should be assessed from 65 years of age using the Snellen chart (B) in those with symptoms or who request it. There is no evidence that screening of asymptomatic older people results in improved vision.50,51

Hearing loss is a common problem among older individuals and is associated with significant physical, functional and mental health consequences. Annual questioning about hearing impairment is recommended with people aged >65 years (B).

In some states and territories, there are legal requirements for annual assessment (eg driving aged >70 years).52

Eye disease and visual impairment increase three-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.53 It should be determined whether the patient is wearing up-to-date prescription spectacles, and whether there is a possibility of falls because the patient is no longer capable of managing a bifocal, trifocal or multifocal prescription. People at greater risk of visual loss are older people and those with diabetes and a family history of vision impairment; such history should be sought. Smoking (current or previous) increases the risk of age-related macular degeneration.54 Cataracts are the most common eye disease in Australians aged ≥65 years (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 aged ≥65 years are AMD (55%), glaucoma (16%) and diabetic retinopathy (16%).55,56

Table 5.4.1. Visual and hearing impairment: Identifying risks
Who is at risk?What should be done?How often?References
People ≥65 years of age Screen for hearing impairment (II, B) Every 12 months 57
Table 5.4.2. Visual and hearing impairment: Preventive interventions
InterventionTechniqueReferences
Visual impairment: Case finding Use a Snellen chart to screen for visual impairment in the elderly if requested, or indicated by symptoms or history. There is no evidence that screening asymptomatic older people results in improvements in vision

Also refer to Chapter 12. Glaucoma
50
Hearing impairment screening A whispered voice out of the field of vision (at 0.5 m) or finger rub at 5 cm has a high sensitivity for hearing loss, as does a single question about hearing difficulty 58

References

  1. Smeeth L, Iliffe S. Community screening for visual impairment in the elderly. Cochrane Database Syst Rev 2006;3:CD001054.
  2. US Preventive Services Task Force. Impaired visual acuity in older adults: Screening. Rockville, MD: USPSTF, 2016. Available at www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/impaired-visual-acuity-in-older-adults-screening#consider [Accessed 23 May 2016].
  3. Austroads. Assessing fitness to drive for commercial and private vehicle drivers. Sydney: Austroads, 2012 (as amended up to 30 June 2014). Available at www.onlinepublications.austroads.com.au/items/AP-G56-13 [Accessed 15 December 2015].
  4. Taylor H, Keeffe J. Updates in medicine: Ophthalmology. Med J Aust 2002;176(1):29.
  5. Smith W, Mitchell P, Leeder SR. Smoking and age-related maculopathy. The Blue Mountains Eye Study. Arch Ophthalmol 1996;114(12):1518–23.
  6. Australian Institute of Health and Welfare. Australia’s health 2006. Canberra: AIHW, 2006.
  7. Tapp RJ, Shaw JE, Harper CA, et al. The prevalence of and factors associated with diabetic retinopathy in the Australian population. Diabetes Care 2003;26(6):1731–37.
  8. US Preventive Services Task Force. Screening for hearing loss in older adults. Rockville MD: USPSTF, 2011. Available at www.uspreventiveservicestaskforce.org/uspstf/uspshear.htm#top [Accessed 15 December 2015].
  9. Moyer VA. Screening for hearing loss in older adults: US Preventive Services Task Force recommendation statement. Ann Intern Med 2012;157(9):655–61.
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