Sir,
Dr Squirrell's study involves a comparison of the visual screening test conducted by ophthalmologists and nursing staff in a group of elderly with history of fall.1 They reported a high level of consistency of the bedside test by nurse screeners.1 We have got queries for authors' enlightenment.
First, the sensitivity of the test in picking up the potentially remedial visual impairment was reported to be only 70%, which was attributed to misinterpretation of the red reflex.1 From the data cited, there was a significant number of patients who suffered from age-related macular degeneration (10 patients). The status of the age-related macular degeneration has not been elucidated fully and the proportion of early against advanced macular degenerative disease was not clear. Using the proposed bedside test, how the nurse screener could confidently detect the presence of age-related macular degeneration, which may or may not be coexisting with the cataracts?
Second, geriatric study has shown that diabetes mellitus is an independent risk factor for fall among elderly, and the prevalence of diabetes is ever rising worldwide.2 Therefore, in such a selected group of patients with history of fall, detection of diabetes mellitus from either history, physical examination, or investigation is not unusual. Surprisingly, the authors did not report any diabetic retinopathy or maculopathy affecting the vision. We were keen to learn the initial demographics and past health of the enrolled patients.
References
Squirrell DM, Kenny J, Mawer N, Gupta M, West J, Currie ZI et al. Screening for visual impairment in elderly patients with hip fracture: validating a simple bedside test. Eye 2005; 19: 55–59.
Maurer MS, Burcham J, Cheng H . Diabetes mellitus is associated with an increased risk of falls in elderly residents of a long-term care facility. J Gerontol A 2005; 60: 1157–1162.
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Liu, D., Li, CL. & Lee, V. Screening for visual impairment in elderly patients with hip fracture: validating a simple bedside test. Eye 20, 1429–1430 (2006). https://doi.org/10.1038/sj.eye.6702289
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DOI: https://doi.org/10.1038/sj.eye.6702289