Two-thirds of nursing home residents in a new UAB (University of Alabama at Birmingham) study had no record of or reference to an eye examination in their medical charts, although more than half were visually impaired. In findings published in the July issue of Archives of Ophthalmology, UAB researchers examined 380 residents of 17 Birmingham-area nursing homes.

Fifty-seven percent of the residents were visually impaired, with visual acuity worse than 20/40 in the better eye. Older adults living in the community typically have a visual impairment rate between 10 and 20 percent. Three-fourths of the participants had abnormal binocular contrast sensitivity, or the ability to detect boundaries between objects and changes in brightness, which is important for mobility and reading.

"It appears that routine eye care may not be taking place for a substantial segment of the nursing home residents in our sample," said Cynthia Owsley, Ph.D., M.S.P.H., professor in the Department of Ophthalmology at UAB and the study's lead author. "Although 90 percent of the residents had some form of health insurance, 66 percent of them had no reference to eye examinations in their medical records. When asked about their most recent eye exam, 28 percent said it was in the previous year, 20 percent indicated that it was more than two years ago and one-third did not know."

Previous studies have estimated that nursing home residents have visual impairment rates anywhere from three to 15 times higher than adults of the same age living in the community, according to Owsley. The reasons may include attitudes among families and healthcare providers that persons with vision impairment do not benefit from treatments that improve vision, increased nursing home admission for those with visual impairment and a shortage of eye care professionals who routinely provide services for nursing home resident

"Previous studies have estimated that 37 percent of the visual impairment and 20 percent of the blindness among nursing home residents is correctable through proper eye care," Owsley said. "These 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."

This research was supported by the Retirement Research Foundation, the EyeSight Foundation of Alabama, the Pearle Vision Foundation, a National Institutes of Health grant and Research to Prevent Blindness, Inc. Dr. Owsley is a senior scientist for Research to Prevent Blindness.

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