The Most Important Question to Ask Older Clients About Their Vision

The most important question to ask your older client about their vision is, “Do you wear glasses?”, and here’s why:

Did you know that over eight million Americans experience unnecessary vision impairment due to uncorrected refractive errors (URE)?1 Refractive errors result from imperfections in the shape of cornea and eye or aging of the lens.2 Common refractive errors include hyperopia (far-sightedness), myopia (nearsightedness) astigmatism (uneven corneal surface) and presbyopia (loss of lens flexibility). Persons may be born with a refractive error or acquire one as they age. Hyperopia for example, increases sharply with age, especially among adults in their eighties.3

The good news is that nearly three quarters of persons with uncorrected refractive errors experience improved vision with properly prescribed eyeglasses, contact lenses or surgery.1

Low Hanging Fruit: Correctable Vision Impairment in Older Adults

Older adults make up the largest number of Americans with correctable vision impairment. Although Medicare covers the cost of an annual eye exam, many older adults never receive an exam due to health reasons or limited access to eye doctors.3 Other older adults cannot afford to update their eye glass prescription because Medicare does not cover the cost of eyeglasses.

These barriers are more likely to affect older adults residing in nursing homes and assisted living facilities where it is estimated that nearly a third of vision impairment can be corrected with glasses or surgery.4,5

Limitations of Uncorrected Vision Impairment

Persons with uncorrected refractive error experience blurred vision and difficulty seeing details. Visual blur can significantly limit an older adult’s ability to read, view television, engage in leisure activities like crafts and participate in social activities. Additionally, older adults with un or under corrected refractive error report greater psychological distress such as worry, frustration and anxiousness and show more signs of depression.6


New Eyeglasses: New Lease on Life

Owsley et al.6 compared nursing home residents who had received updated eyeglasses with residents who had not yet received new eyeglasses. The treated group were able to read and write better, use the telephone, watch TV, and play cards. The residents also reported that they more often visited other residents and participated in group activities and they experienced improved psychological well-being.

What You Can Do

Start by asking every older client these three questions:

  1. Do you wear eyeglasses? Or, have you ever worn eyeglasses?
  2. When was the last time you saw an eye doctor?
  3. When was the last time you had your eyeglasses updated?

Have them present you with their glasses and inspect the eyeglasses to see if they are dirty, scratched or broken. You should then screen the client’s distance visual acuity while wearing the eyeglasses. Here is a frame of reference for their results:

  • If visual acuity is less than 20/20 and the glasses are more than 3 years old, refer the client to an optometrist or ophthalmologist for an eye exam
  • If visual acuity is less than 20/60, the client has had a recent eye exam, and the glasses are one year old or less, refer the client for a low vision eye exam with a low vision specialist (optometrist or ophthalmologist).

These steps are easy to complete and can have a huge impact on the lives and activities of your older adult patients.

  1. Varma R, Vajaranant TS, Burkemper B, Wu S et al. Visual impairment and blindness in adults in the United States: Demographic and geographic variations from 2015-2015. JAMA Ophthalmology. 2016; 134(7) 802-809.
  2. National Eye Institute, Facts about refractive errors, n.d. retrieved from:
  3. Chou R, Dana T, Bougatsos C, Gursing S, Blazina I. Screening for impaired visual acuity in older adults: A systematic review to update the 2009 U.S. Preventative Services Task Force recommendation. Evidence Synthesis No. 127. AHRQ Publication No. 114-05209-EF-1. Rockville MD: Agency for Healthcare Research and Quality: 2016.
  4. Owsley C, McGwin G, Scilley K et al. The visual status of older persons residing in nursing homes. Arch Ophthalmol. 2007; 125(7);925-930.
  5. Elliot, AF, McGwin G, Owsley C. Vision impairment among older adults residing in assisted living. J Aging Health. 2013; 25(2): 364-378.
  6. Oswley C, McGWin, G, Scilley K et al. Effect of refractive error correction on health-related quality of life in older nursing home residents. Arch Ophthalmol. 2007;125(11): 1471-1477.