In this cohort study, the investigators will test vision screenings in Danish general practice for patients over 70 years of age with minimum one chronic condition. The main outcome is detection of vision impairment and secondary outcome is detection of conditions needing ophthalmologic follow-up but not presenting vision impairment at present time.
+70 years
One or more chronic diseases
Are followed by GP du to chronic disease
Dementia diagnosis
Known eye-diseases or are currently followed by private ophtalmologist
Not able to understand Danish
Sequential
focus on vision impairment in older patients in general practice
Other interventionGP or GP nurse carry out the three vision tests. All patients visit optician shop collaborating with the project. An ophthalmologist review data from optometrists and provide an epicrisis to general practice. In case of acute conditions, the ophthalmologist is responsible for expedient treatment. If the patient needs further control by ophthalmologist within 12 month waiting time, general practice are responsible for referring the patient.
Recruitment feasibility
Total number of patients invited to participate in the study based on the exclusion sheet and the proportion of eligible patients included by GP staff
Adherence
Proportion of patients who complete the intervention elements in general practice.
Adherence
Proportion of patients completing vision tests in an optometrist setting.
Acceptability
Patient and health providers experiences and acceptability of the DETECT intervention
GP staff assessment of patient vision pre- and post-the three vision tests compared with ophthalmologist evaluation
pre- and post test assessment by GP staff. Pre-test assessment is based on prehand knowledge of the patient and observations in the clinic before the DETECT vision tests post-test assessment is based on the results of the DETECT visiontests Both assessments are entered into a questionnaire through surveyXact
Patient-reported assessment of vision in baseline questionnaire compared with ophthalmologist evaluation
Patient reported outcome measure compared with ophthalmologist evaluation
Patients with vision reduction or signs of eye diseases detected at the vision tests by GP staff
• Reduced vision: The proportion of patients with binocular near visual acuity \<0.7 (decimal value), assessed in a general practice setting using the Colenbrander near vision test while wearing habitual reading glasses. OR • Reduced contrast vision: The proportion with a difference of 4 or more lines between high-contrast and low-contrast Colenbrander near visual acuity with binocular vision. The normality cutoff defined as 2-3 lines difference. OR • Central visual defects indicating macular pathology e.g. wet AMD: The proportion of patients with a positive Amsler grid test, tested monocular. OR • Peripheral vision loss indicating e.g. glaucoma: The proportion of patients with abnormal findings on confrontational visual field testing, tested monocular. OR • Indication of reduced vision or eye disease: The proportion of patients with at least one of the above
Ophthalmologist assessment of potential benefit of new distance correction or need for ophthalmological review and possible treatment
The proportion of patients for whom the ophthalmologist, based on data provided by the optometrist, assessed that a new distance correction would provide clinical benefit. Benefit was defined as an improvement of more than two lines in visual acuity, with a baseline binocular distance visual acuity \<0.7. This includes the proportion of included patients requiring ophthalmological follow-up and possible treatment
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