Open Access Research article

Health risk appraisal in older people 6: factors associated with self-reported poor vision and uptake of eye tests in older people

Steve Iliffe1, Kalpa Kharicha1*, Danielle Harari2, Cameron Swift3, Gerhard Gillmann4 and Andreas E Stuck5

Author Affiliations

1 Research Department of Primary Care and Population Health, UCL, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK

2 Department of Ageing and Health, St. Thomas’ Hospital, London, UK

3 Clinical Age Research Unit, Kings College London, London, UK

4 Department of Social and Preventive Medicine, University of Bern, Bern, Switzerland

5 University Department of Geriatrics, Spital Bern-Ziegler, Inselspital and University of Bern, Bern, Switzerland

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BMC Family Practice 2013, 14:130  doi:10.1186/1471-2296-14-130

Published: 3 September 2013



Although free eye testing is available in the UK from a nation-wide network of optometrists, there is evidence of unrecognised, tractable vision loss amongst older people. A recent review identified this unmet need as a priority for further investigation, highlighting the need to understand public perceptions of eye services and barriers to service access and utilisation. This paper aims to identify risk factors for (1) having poor vision and (2) not having had an eyesight check among community-dwelling older people without an established ophthalmological diagnosis.


Secondary analysis of self-reported data from the ProAge trial. 1792 people without a known ophthalmological diagnosis were recruited from three group practices in London.


Almost two in ten people in this population of older individuals without known ophthalmological diagnoses had self-reported vision loss, and more than a third of them had not had an eye test in the previous twelve months. In this sample, those with limited education, depressed mood, need for help with instrumental and basic activities of daily living (IADLs and BADLs), and subjective memory complaints were at increased risk of fair or poor self-reported vision. Individuals with basic education only were at increased risk for not having had an eye test in the previous 12 months (OR 1.52, 95% CI 1.17-1.98 p=0.002), as were those with no, or only one chronic condition (OR 1.850, 95% CI 1.382-2.477, p<0.001).


Self-reported poor vision in older people without ophthalmological diagnoses is associated with other functional losses, with no or only one chronic condition, and with depression. This pattern of disorders may be the basis for case finding in general practice. Low educational attainment is an independent determinant of not having had eye tests, as well as a factor associated with undiagnosed vision loss. There are other factors, not identified in this study, which determine uptake of eye testing in those with self-reported vision loss. Further exploration is needed to identify these factors and lead towards effective case finding.

Older people; Vision loss; General practice; Case finding; Educational level