Importance A 2016 review for the US Preventive Services Task Force (USPSTF) found that effective treatments are available for refractive errors, cataracts, and wet (advanced neovascular) or dry (atrophic) age-related macular degeneration (AMD), but there were no differences between visual screening vs no screening on visual acuity or other outcomes. Objective To update the 2016 review on screening for impaired visual acuity in older adults, to inform the USPSTF. Data Sources Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews (to February 2021); surveillance through January 21, 2022. Study Selection Randomized clinical trials and controlled observational studies on screening, vascular endothelial growth factor (VEGF) inhibitors (wet AMD), and antioxidant vitamins and minerals (dry AMD); studies on screening diagnostic accuracy. Data Extraction and Synthesis One investigator abstracted data and a second checked accuracy. Two investigators independently assessed study quality. Results Twenty-five studies (N = 33 586) were included (13 trials, 11 diagnostic accuracy studies, and 1 systematic review [19 trials]). Four trials (n = 4819) found no significant differences between screening vs no screening in visual acuity or other outcomes. Visual acuity tests (3 studies; n = 6493) and screening question (3 studies; n = 5203) were associated with suboptimal diagnostic accuracy. For wet AMD, 4 trials (n = 2086) found VEGF inhibitors significantly associated with greater likelihood of 15 or more letters visual acuity gain (risk ratio [RR], 2.92 [95% CI, 1.20-7.12]; I2 = 76%; absolute risk difference [ARD], 10%) and less than 15 letters visual acuity loss (RR, 1.46 [95% CI, 1.22-1.75]; I2 = 80%; ARD, 27%) vs sham treatment, with no increased risk of serious harms. For dry AMD, a systematic review (19 trials) found antioxidant multivitamins significantly associated with decreased risk of progression to late AMD (3 trials, n = 2445; odds ratio [OR], 0.72 [95% CI, 0.58-0.90]) and 3 lines or more visual acuity loss (1 trial, n = 1791; OR, 0.77 [95% CI, 0.62-0.96]) vs placebo. Zinc was significantly associated with increased risk of genitourinary events and beta carotene with increased risk of lung cancer in former smokers; other serious harms were infrequent. Conclusions and Relevance This review found that effective treatments are available for common causes of impaired visual acuity in older adults. However, direct evidence found no significant association between vision screening vs no screening in primary care and improved visual outcomes.

中文翻译：

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老年人视力障碍筛查：美国预防服务工作组的最新证据报告和系统审查。

重要性 美国预防服务工作组 (USPSTF) 2016 年的一项审查发现，对于屈光不正、白内障和湿性（晚期新生血管性）或干性（萎缩性）年龄相关性黄斑变性 (AMD) 有有效的治疗方法，但目前尚无有效的治疗方法。视力筛查与未筛查之间在视力或其他结果方面的差异。目的 更新 2016 年老年人视力受损筛查审查，并向 USPSTF 通报。数据来源 Ovid MEDLINE、Cochrane 对照试验中央注册库和 Cochrane 系统评价数据库（截至 2021 年 2 月）；监测截止至 2022 年 1 月 21 日。 研究选择 关于筛查、血管内皮生长因子 (VEGF) 抑制剂（湿性 AMD）以及抗氧化维生素和矿物质（干性 AMD）的随机临床试验和对照观察研究；筛选诊断准确性的研究。数据提取和综合 一名研究人员提取数据，另一名研究人员检查准确性。两名研究者独立评估研究质量。结果 纳入 25 项研究 (N = 33 586)（13 项试验、11 项诊断准确性研究和 1 项系统评价 [19 项试验]）。四项试验 (n = 4819) 发现筛查与未筛查在视力或其他结果方面没有显着差异。视力测试（3 项研究；n = 6493）和筛查问题（3 项研究；n = 5203）与次优诊断准确性相关。对于湿性 AMD，4 项试验 (n = 2086) 发现 VEGF 抑制剂与 15 个或更多字母视力提高的可能性显着相关（风险比 [RR]，2.92 [95% CI，1.20-7.12]；I2 = 76%；与假治疗相比，绝对风险差异 [ARD]，10%）和视力丧失少于 15 个字母（RR，1.46 [95% CI，1.22-1.75]；I2 = 80%；ARD，27%），风险没有增加的严重危害。对于干性 AMD，一项系统评价（19 项试验）发现，抗氧化复合维生素与进展为晚期 AMD 的风险显着相关（3 项试验，n = 2445；比值比 [OR]，0.72 [95% CI，0.58-0.90]）与安慰剂相比，视力下降 3 行或更多（1 项试验，n = 1791；OR，0.77 [95% CI，0.62-0.96]）。锌与前吸烟者泌尿生殖系统事件风险增加显着相关，β-胡萝卜素与肺癌风险增加显着相关；其他严重伤害并不常见。结论和相关性 本次综述发现，对于老年人视力受损的常见原因，有有效的治疗方法。然而，直接证据发现初级保健中的视力筛查与不筛查与改善视力结果之间没有显着关联。