Prognostic factors for a change in eye health or vision: A rapid review

Background

Within Wales and the UK, the general public is advised to have regular eye examinations. However, advice on when or how regularly these tests should take place is not evidence-based.

The purpose of this review was to look at existing literature to formulate updated guidance on when and how regularly eye tests are required.

Existing research from January 2009 to August 2023 was reviewed. The evidence was taken from countries with similar populations to the UK, such as USA, Canada, Netherlands, Sweden, Germany, Australia.

Method

A rapid review looks at all the available evidence relating to the proposed research question. It includes a review of studies both nationally and internationally where available, subject to the inclusion criteria. It operates within a limited time scale, identifying studies that can inform the provision of health services to Wales.

Evidence Base

19 studies were reviewed, including: 2 systematic reviews, 9 prospective cohort studies, 3 retrospective cohort studies, 2 longitudinal studies, 2 case-controlled studies, 1 cross-sectional study.

Key findings

Some of the factors reviewed included:

• Gender
• Ethnicity
• Intraocular pressure
• Family history of glaucoma
• Length of time between eye tests
• Hypertension
• Heart disease

In the review, it was noted that only two of the studies took place in the UK. There was also a lack of evidence relating to the under 40s. Therefore, there are insufficient data to make decisions regarding future provision of care. The review also looked at information surrounding:

• Household net worth
• Visual acuity
• Visual field mean deviation
• Spherical equivalent refraction
• High myopia
• Age-related muscular degeneration
• Glaucoma
• Cataracts

Life style choices, such as diet, smoking, alcohol intake, exercise and reading were also reviewed.  Other factors reviewed included cholesterol, diabetes, peripheral arterial disease, hypercoagulable state, stroke, pregnancy, age at menarche, oral contraceptive use and atrophy. A range of different populations was looked at. Again, very limited evidence was found.

Conclusion

A great deal of future research is needed to inform decision-making around treatment in this area. Some of the factors that appear to have an effect on the health of our eyes include:

• Age
• Disease
• Life-styles choices

Future considerations

More research is needed from population datasets. Understanding the needs of the public on an individual basis, ensuring good communication between GPs, Opticians and the patient, could also help establish the most appropriate intervals between eye tests. This will also help to inform the need for referral to secondary care.

Author: Bob Hall

The full report is available on pre-print publication here: https://medrxiv.org/cgi/content/short/2024.01.18.24301468v1