Need to Check for Uncorrected Refractive Errors
By Lynda Seminara
Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors
Journal Highlights
JAMA Ophthalmology, July 2020
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Guo et al. measured the degree of visual acuity (VA) improvement attained in adults with previously uncorrected refractive error who also had glaucoma or retinal disease. Nearly 28% of patients in their study (mean VA, 20/100) had improvement of at least 2 lines, and more than half improved by 1 or more lines. Overall, African Americans and middle-aged working adults experienced the greatest visual benefits.
This study was a retrospective review of patients who were new to low vision rehabilitation (defined as no visit to address VA in the preceding three years) and were receiving care for glaucoma or a retina-related condition. Uncorrected refractive error was defined as absent, inaccurate, or outdated correction of refractive error. Habitual VA of the 2,923 patients ranged from 20/40 to counting fingers. Patients younger than 20 years of age were excluded from the analysis, as were those with habitual VA of 20/40 or better or counting fingers or worse.
The mean habitual VA of included patients (n = 1,773) was 20/100. Refraction showed improvement of at least 2 lines in 27.8% and at least 1 line in 57.7%. Improvement of 2 or more lines was more common in the older subset (40-64 vs. 20-39 years; odds ratio [OR], 1.57), in African American than in white patients (OR, 1.41), and with moderate versus mild visual impairment (OR, 1.36). Patients with corneal disease had greater refractive benefit than those with other conditions, despite having poorer habitual VA. Improvement of 6 or more lines occurred in 1.2%, and VA of at least 20/40 was attained for a third of the study group.
These findings show that uncorrected refractive error is prevalent among patients with ocular disease. The authors encourage routine refractive checks to maximize social, psychological, and occupational functioning. Moreover, optimally corrected VA can reduce the need for magnification and enhance quality of life. Understanding how patients become connected to low vision care would help in designing outreach programs that improve delivery of refractive care, the authors said. They also suggested that future work include assessing the effects of refractive correction on patient-centered outcomes in those with ocular disease.
The original article can be found here.