Visual screening in an orthogeriatric rehabilitation setting: a feasibility evaluation.

Abstract

Background and objectives: Vision loss is a significant risk factor for falls. Given the associated morbidity and mortality, proactive risk-reduction strategies are warranted. This evaluation aimed to assess the feasibility and potential clinical value of bedside visual screening in an orthogeriatric rehabilitation setting and to estimate the proportion of previously unrecognized visual deficits among older inpatients admitted following a fall.

Research design and methods: In this prospective, single-center feasibility evaluation, 21 patients aged ≥65 years admitted post-falls were assessed. Eligible participants scored >6 on the Abbreviated Mental Test Score. Bedside assessments included unaided vision, visual acuity (VA), low-contrast VA, and visual fields using Logarithm of the Minimum Angle of Resolution (LogMAR) charts and the Melbourne Rapid Fields web-based platform. Ocular history and participant feedback on the screening experience were also collected.

Results: Unaided vision or habitual VA worse than 0.3 LogMAR (<6/12 Snellen equivalent) in at least one eye was observed in 67% of participants; 88% showed impaired low-contrast VA. Only 33% had been examined by a primary care optometrist in the year preceding admission. A proportion of deficits were potentially modifiable. Screening was well tolerated, with participants reporting a good understanding of the procedures.

Discussion and implications: Bedside visual screening by trained non-ophthalmic specialists is feasible and potentially clinically informative in the orthogeriatric setting. The high proportion of undetected visual deficits suggests missed opportunities for falls prevention. Routine standardized visual assessments may enable timely referrals, improve visual outcomes, and reduce falls-related morbidity in older adults.