Eye Exams Overlooked for Nursing Home Residents

BIRMINGHAM, Ala., July 9 -- Two-thirds of nursing home residents here did not receive regular eye exams despite the fact that 57% of the residents had evidence of visual impairment.

Moreover, about 90% had insurance that would have covered eye care, according to findings published in the July issue of Archives of Ophthalmology.

Cynthia Owsley, Ph.D., M.S.P.H., of the University of Alabama at Birmingham, and colleagues, studied habitual visual acuity, contrast sensitivity, spectacle use, and eye care utilization among 380 residents of 17 nursing homes.

Eighty-two percent of the residents had Medicaid or Medicare or both and "90% had some form of health insurance," Dr. Owsley wrote.

No more than 10% of the nursing home residents had good vision, whereas "about 46% of the sample had visual acuity worse than 20/60," and close to 10% had visual acuity of 20/200 or worse, Dr. Owsley wrote.

All residents were 55 or older, English-speaking, and had scores of 13 or more on the Mini-Mental State Examination.

About a third of the 380 study participants had MMSE scores of 23 or higher (scores of 23-26 are considered borderline dementia) and two-thirds had scores ranging from 13 to 23, indicating mild to moderate Alzheimer's disease.

When only residents with MMSE scores of at least 24 were considered, the vision impairment rate was about 34%, Dr. Owsley wrote.

Eighty percent of residents were women and more than half were 60 to 89 years of age; 42.6% were octogenarians.

In addition to a review of medical records to confirm vision exams, participants and a family member or guardian were interviewed about spectacle use and utilization of eye care services.

Among the findings:

• Ninety-six percent of participants said they had used spectacles at some point in their lives and 78% used them at the time of the study.
• For 66% of residents, there was no information about eye exams in their medical records.
• Based on the medical records, 8.2% had glaucoma in one or both eyes, 3.1% had diabetic retinopathy, 32.5% had cataracts, and 4.6% had age-related macular degeneration.
• Nursing home records indicated that 93% had agreed to permit the nursing home to provide eye care for the resident.
• Twenty percent of the residents said their most recent eye exam had occurred more than two years prior to the study interview, and 30% could not recall an eye exam. Only 43% said they had had an eye exam within the preceding two years.

Dr. Owsley conceded that asking nursing home residents -- especially a sample in which a high percentage had evidence of cognitive impairment -- to recall eye exams was unlikely to provide exact measurement.

But the fact that the medical record "contained no record of or reference to an eye examination for 66% of enrollees" adds credibility to the residents' recall she said.

A strength of the study was its use of multiple measures and a wide selection of nursing homes.

"The findings underscore the need to better understand the causes of high visual impairment rates in nursing home residents and to evaluate interventions to improve the visual status of this population," Dr. Owsley concluded.