Discordance between measured and perceived vision in older adults: the need for objective screening despite health consciousness.

Perceived visual problems in older adults do not always align with measured vision, potentially delaying diagnosis and timely intervention. In this cross-sectional analysis of baseline data from the Proactive Ophthalmic Examination Cohort (Guangzhou, 2023-2024), we evaluated the prevalence and correlates of discordance between objective vision impairment (OVI, presenting visual acuity <20/40) and subjective visual disturbance (SVD, self-reported visual symptoms) among 829 health-conscious adults aged ≥65 years without prior intraocular interventions. Discordance was defined as two conditions: OVI without SVD or non-OVI with SVD. Associated factors were examined at the eye level using generalized linear mixed-effects models. Within this cohort, the prevalences of OVI and SVD were 42.8% and 44.6%, respectively (53.1% and 47.9% at the participant level). Discordance was substantial: 47.2% of OVI eyes did not report SVD, whereas 38.5% of non-OVI eyes reported SVD. SVD demonstrated limited accuracy for identifying OVI (sensitivity, 0.53; specificity, 0.64). The proportion of OVI eyes attributable to uncorrected refractive error was higher in OVI without SVD than in OVI with SVD (83.0% vs. 66.8%, p < 0.001). Higher income and lower Self-Rating Anxiety Scale (SAS) scores were associated with OVI without SVD, while lower income and higher SAS scores were linked to non-OVI with SVD; unilateral OVI was also associated with OVI without SVD. These findings indicate that SVD incompletely reflects OVI and underscore the need for routine objective vision screening in older populations, irrespective of perceived symptoms.