Comparison of adjustable spectacles and traditional optometry for elderly refractive correction in community-based primary eye care service

Background There is a large amount of elderly population with uncorrected refractive error in China.To seek a new and suitable correction technology is very urgent for public health.Objective This survey was to investigate the feasibility of adjustable spectacles for optometry and vision correction in community-based eye disease screening.Methods A prospective cross-sectional survey was performed.Random cluster sampling 6 blocks were included from 13 blocks in Baiyu community Putuo district of Shanghai eye disease screening site.The subjects with visual acuity (ETDRS LogMAR) ＜0.5 of either eye was included in the survey,and visual acuity was corrected with adjustable spectacles by trained volunteers,the corrected vision and optometry results were compared with ones of traditional autorefraction and subjective optometry procedure conducted by opometrists.General eye examinations were performed on the subjects to determine the causes of low visual acuity,and the affecting factors were analyzed.Writen informed consent was obtained from each subject prior to any medical examination.Results The optometry examination was carried out in 294 participants with the mean age of (70.4±8.6) years,and female were 64.3％.The subjects with visual acuity ≥ 0.5 in the better eye were 145 (49.3％).After self correction with adjustable spectacles and traditional subjective optometry procedure,the number of subjects with visual acuity ≥ 0.5 increased to 230 (78.2％) and 258 (87.8％),respectively.In 443 eyes with visual acuity ＜0.5,233 (52.6％) eyes had a better or equal vision after self correction in comparison with subjective optometry,and 82 eyes (18.5％) had a worse vision with one-line decline of eye chart.Logistic regression analysis revealed that relatively high spherical (high myopia,hyperopia) and cylinder (astigmatism) degrees were responsible for the eyes of vision being worse two or more lines of eye chart after self correction than that of subjective optometry (OR =1.11,95％ CI:1.02-1.20 ; OR=1.34,95％ CI:1.02-1.77).When self correction vision result was used as diagnosing indicator for visual impairment,the area under the ROC curve was 0.941 (95％ CI:0.907-0.965),with the best positive value ＜0.5,sensitivity 94.4％ (95％ CI:81.3％-99.2％) and specificity 88.4％ (95％ CI:83.8％-92.0％).The self correction diopter ranged from-5.63 D to +4.13 D,and those of subjective optometry and autorefraction were from -22.25 D to + 10.25 D and from-22.00 D to + 5.63 D,respectively,showing a statistically significant difference between them(P＜0.001).In range of self correction (-5.50 D to +4.50 D),the spherical equivalent showed a positive correlation between self correction and subjective optometry (r =0.68,95％ CI:0.59-0.76).Bland-Altman analysis showed that 95％ agreement limits between the two results was from-3.4 D to +2.6 D with the difference within ±0.50 D in 18.1％ subjects,within ±1.00 D in 47.0％ subjects,within ±1.50 D in 68.5％ subjects.Conclusions In the old population,the self correction spectacles for visual acuity is a simple indicator for determination of uncorrected refractive error and eye disease screening,but it is uncompatible for a quantitative determination of diopter. Key words: Spectacles;  Refractive error;  Visual impairment;  The aged;  Vision Screening;  Primary eye care;  Public health