[Vision Impairment in Retirement Homes? Healthcare Research in Inpatient Care Homes].

The demographic change in Germany has led to an increasing number of elderly and dependent persons being cared for in nursing homes. Additionally, public health insurance has tried to save money on home visits made by general practitioners and specialists. This has led to significant deficits in ophthalmic care. To relieve the stress on the health care system, we tested the ACTO eye test as part of our study. This test can be performed after a short introduction; even by laypeople. For our study, we assessed the vision of 218 persons, aged 60 or above, in four nursing homes in Germany. Both eyes were examined individually, with reading glasses if required. The nursing staff applied the ACTO eye test for vision testing. The classification of the ACTO test ranges from 1 to 10, where 2 corresponds to a decimal visual acuity of 0.8 and 10 to a decimal visual acuity of 0.05. Three weeks later, an ophthalmologist visited the care homes and employed the Birkhäuser reading boards to determine the visual acuity. The ophthalmologist also did a general medical history and a history of ocular diseases. She also examined the eyes using a handheld slit lamp and did a fundoscopy in miosis. Two-thirds of the residents stated at the beginning of the study that they did not suffer from any eye disease. However, the ophthalmologist's examination showed that nearly half of the subjects needed urgent treatment. The comparison of the different eye tests showed that the results of the ACTO reading test correlated with the results from the Birkhäuser panels with a coefficient of r2  = 0.8443. The ACTO test determined that 40% of the subjects did not have enough residual vision for reading (> 7); whereas, the Birkhäuser panels reported 35% (< 0.4). The study clearly showed the lack of ophthalmological care for the residents of nursing homes. Neither they, nor the home management, were aware of visual deficiencies. By using a simple reading test and suitably-trained staff, reading ability can be regularly checked every three months without much effort. If the reading ability decreases, the person should be quickly presented to the ophthalmologist to prevent deterioration of the eyesight or to diagnose and treat a degenerative eye disease. In this way, the home residents needing treatment can be specifically recognized.