Practical assessment of vision in the elderly

Ophthalmol Clin North Am. 2003 Jun;16(2):269-87. doi: 10.1016/s0896-1549(03)00008-7.


In this article we have demonstrated the significant visual impairments in elders with good vision by standard measures when the viewing conditions are less than ideal--low contrast, low or changing light level, or glare. Much of this impairment can be accounted for by the known age-related changes in the eye. We have emphasized that two people of the same age with the same standard acuity can have dramatically different vision under these nonideal conditions. Because one cannot predict vision under these conditions on the basis of standard acuity, it is important to use these additional measures. These other vision measures are more closely related to task performance (reading, face recognition) than standard acuity. We find that persons who perform poorly on these low-contrast measures are more likely to have significant losses of standard acuity in the future. Hence, these measures help identify persons who should be more closely monitored. Each of the vision functions shows significant decline across age. It is important to recognize that a 60-year-old with 20/30 acuity is different from an 80-year-old with the same acuity. The older person is more likely to be impaired under the conditions of daily life. Measurement and appreciation of visual function should allow better understanding of subjective visual symptoms and allow the clinician to offer appropriate advice for mitigating these impairments. Often simple interventions, such as correcting refractive error, improving lighting, avoiding large changes in light level, increasing contrast, and avoiding glare (perhaps through cataract surgery), can greatly improve not only vision function but quality of life. Many studies have reported that good vision allows for independent living, which is the goal for most elders.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Geriatric Assessment*
  • Health Status Indicators*
  • Humans
  • Vision Disorders / diagnosis
  • Vision, Ocular / physiology*