Rowe Susannah, MacLean Catherine H, Shekelle Paul G
Department of Ophthalmology, Boston University School of Medicine, Boston, Mass 02119, USA.
JAMA. 2004 Mar 24;291(12):1487-95. doi: 10.1001/jama.291.12.1487.
Vision loss is common in the United States and its prevalence increases with age. Visual disability significantly impacts quality of life and increases the risk of injury. Although at least 40% of blindness in the United States is either preventable or treatable with timely diagnosis and intervention, many people with vision loss are undiagnosed and untreated.
To review the evidence regarding screening and management of eye disorders and visual disability among adults in the primary care setting.
MEDLINE, HealthSTAR, EMBASE, The Cochrane Database of Systematic Reviews, and the National Guidelines Clearinghouse were searched for articles and practice guidelines about screening and management of eye diseases and vision loss among adults in the primary care setting using key words and free-text terms, such as vision screening, glaucoma prevention and control, from 1985 to 2003. References in these articles and those suggested by experts in eye care, vision loss, and vision screening were reviewed as well.
Articles were searched for the most clinically important information and emphasized randomized controlled trials where available.
Most major guidelines recommend periodic referral of older adults to an eye care professional for comprehensive evaluation to detect eye diseases and visual disability. The value of routine screening for vision loss in the primary care setting has not been established. Timely identification and treatment of eye diseases can substantially reduce the incidence and prevalence of visual disability among older adults. Optimizing management of systemic diseases, such as diabetes, hypertension, and hyperlipidemia, significantly reduces the risk of related eye disorders.
Primary care clinicians can play a vital role in preserving vision in their patients by managing systemic diseases that impact eye health and by ensuring that patients undergo periodic evaluations by eye care professionals and receive needed eye care.
视力丧失在美国很常见，且其患病率随年龄增长而增加。视力残疾会显著影响生活质量并增加受伤风险。尽管在美国至少40%的失明通过及时诊断和干预是可预防或可治疗的，但许多视力丧失者未被诊断和治疗。
回顾关于基层医疗环境中成人眼部疾病筛查和管理以及视力残疾的证据。
检索了MEDLINE、HealthSTAR、EMBASE、Cochrane系统评价数据库和国家指南库，以查找1985年至2003年期间使用关键词和自由文本词（如视力筛查、青光眼预防和控制）关于基层医疗环境中成人眼部疾病筛查和管理以及视力丧失的文章和实践指南。还查阅了这些文章中的参考文献以及眼科护理、视力丧失和视力筛查专家推荐的文献。
在文章中查找最重要的临床信息，并强调现有可用的随机对照试验。
大多数主要指南建议定期将老年人转诊给眼科护理专业人员进行全面评估，以检测眼部疾病和视力残疾。在基层医疗环境中常规筛查视力丧失的价值尚未确立。及时识别和治疗眼部疾病可大幅降低老年人视力残疾的发病率和患病率。优化对糖尿病、高血压和高脂血症等全身性疾病的管理可显著降低相关眼部疾病的风险。
基层医疗临床医生可通过管理影响眼部健康的全身性疾病，并确保患者接受眼科护理专业人员的定期评估并获得所需的眼部护理，在保护患者视力方面发挥至关重要的作用。
