Viewpoint

You couldn’t find evidence?

FROM THE CHIEF MEDICAL EDITOR
Larry E. Patterson, MD

In a March 1 JAMA article, the U.S. Preventive Services Task Force stated that when elderly people visit their primary care doctor, the doctor needn’t assess their patients’ vision. The reason: “Current evidence is insufficient to assess the balance of benefits and harms of the service.” The group wrote: “[We] found inadequate overall evidence on the benefits of screening, early detection and treatment to provide a coherent assessment of the overall benefit.”

Hmm. Inadequate evidence? How about that nearly 50% of Medicare enrollees, nine years after enrollment, will have vision-threatening diagnoses like glaucoma or age-related macular degeneration? Let alone cataracts. Or that 30% of Medicare patients go five years without a single visit to any type of eye doctor?

These data came in the AAO’s response in March’s JAMA Ophthalmology. David Parke, MD, Academy CEO and lead author, noted the task force admitted that it limited “its methodology in placing most weight on large, randomized clinical trials,” and that the task force knows that these “policy decisions involve more considerations than this body of evidence alone.”

Is money involved? Please. Under the Affordable Care Act, most insurance companies must cover certain preventive services, without copay, that the task force deems worthy. But, with the task force’s methodology and its subsequent conclusion, the elderly would have to pay for a screening.

To me, this is solely about patient care. Primary care physicians and nurses can take some time to screen those who likely need it to see if their vision is substandard. It won’t pick up all diseases and there will be false positives, but it will help many.

Dr. Parke told me, “While the Academy respects the mission and the general methodology employed by the [task force], we think that it substantively discounts the relevant studies already existing in the ophthalmic and geriatric literature — and it draws a conclusion about the value of a safe screening test by examining only a fraction of the diseases it may uncover. The ultimate test should be the impact of screening on a holistic view of quality of life. Loss of vision in those over age 65 has been scientifically demonstrated to be associated with cognitive decline, depression, falls, falls with injury and motor vehicle accidents. This is in addition to the daily life impact of increased difficulty reading, walking on uneven surfaces, watching television, [and so on].”

Maybe it would have helped if the task force had asked one of us to testify. None of the 16 volunteers in that group is an ophthalmologist or an optometrist. I need to scratch my head on that one. OM

GUEST EDITOR With this issue, Ophthalmology Management welcomes Guest Editor Cynthia Matossian, MD, whose integrated ophthalmology and optometry practice has three locations in Pennsylvania and New Jersey. A cataract surgery and OSD specialist, Dr. Matossian, who has participated in many clinical trials, is a published author, instructor at three medical schools in the New Jersey-Philadelphia areas, and well recognized by business groups nationwide for her entrepreneurial leadership. And it is April, so we must mention a very important service that Dr. Matossian provides: She is the official team ophthalmologist for the Trenton Thunder, a Class AA Affiliate of the New York Yankees. Thank you, Dr. Matossian.