Look after your eyes to look after your brain

Most recently, the Lancet Commission (Livingston et al., 2024) flagged that late life, untreated vision loss can be a modifiable risk factor for dementia. Although only a small percentage (2%) of cases of dementia could be theoretically prevented by taking action to prevent sight loss, there are lots of different risk factors for dementia and some of these can be consequences of advanced sight loss, such as reduced physical activity, loneliness and social isolation, and depression. For this reason, if you are starting to experience vision changes, seeking help and support at the earliest opportunity can also help to reduce your risk of developing dementia too. SeeWay is available to everyone with sight loss, so there’s no reason not to explore the platform and learn about ways to make the most of your vision, look after your mental health, and stay independent, active and social.

People living with dementia are more likely to experience preventable sight loss

People living with dementia are not any more likely to develop age-related eye problems that threaten sight, such as macular disease, glaucoma or diabetic eye disease. However, people with dementia are less likely to see eye care professionals regularly, or receive regular eye tests, cataract surgery, sight-saving eye injections for different eye diseases or eye drops for dry eye and glaucoma. Because people living with dementia are less likely to access eyecare, they are more likely to experience preventable sight loss from these age-related eye problems, as well as being more likely to have out of date, broken or missing glasses. A UK research study (Bowen et al., 2016) found up to 1 in 3 people living with dementia have vision that falls below driving standards, and this likelihood of poor vision is doubled for those living with dementia in residential aged care. Because of this, it’s really important to know about and advocate for the eyecare needs of people living with dementia and their families. This ensures everyone can access eyecare and sight loss support services as the condition progresses and support needs change.

The importance of a holistic approach to care

In my research, we interviewed people with dementia and their families about their experiences of having an eye test, as well as optometrists. In this research, we found that a holistic approach to eyecare was very important for people with dementia and their families. The main way dementia impacted the eye test was cognitive fatigue, and if the eye test wasn’t properly adapted, or the optometrist did not know anything about dementia, this could lead to a poorer eye test experience. There are lots of components to the eye test, and often many subjective judgements to be made: “Which is better, one or two?” This can be exhausting for some people with dementia, especially if they have communication difficulties or need more time to make decisions.

It is possible for eye care professionals to adapt their testing approach and communication to accommodate dementia. There are many parts of the routine eye test that can still be done even for people with more advanced dementia, such as where the person is no longer able to communicate. Keeping up annual eye tests, even as dementia progresses, can help to detect problems early and address them promptly. If you have any worries or concerns about eye medications, or want to explore options for cataract surgery before dementia progresses, your eyecare team are here to help. To help eye care professionals learn more about dementia, we have created online training and regularly deliver professional development talks for all kinds of eyecare professionals.

Having poor eyesight can make living with dementia harder, such as reading clocks and calendars or using smartphones, so having a low vision assessment done in the early stages of any sight loss can be important, to embed low vision aids such as day lights and magnifiers into daily routines (Lawrence et al., 2009). Lastly, if you are a carer for someone with dementia, it is important for you to look after your eyesight too! If you can’t see well, it can make it more difficult for you to provide the right support. SeeWay is easy to navigate for people with low vision, so if you are a carer with sight loss, you can use SeeWay to find the support you need.

Where to get help and support

You can explore SeeWay to get tailored information, find out about available sight loss services, and obtain mental health support. All of the Australian sight loss support charities welcome people with dementia and their families to use their services. You can also make use of telephone services and information programs wherever you live, such as Macular Disease Foundation of Australia’s EyeConnect service, and Glaucoma Australia’s Sightwise.

To find an optometrist who knows about dementia, why not give Good Vision for Life’s ‘Find an Optometrist’ search a try? Over 300 optometry practices across Australia have marked themselves as dementia-friendly using this platform. You can also find optometrists who do home visits, visit aged care facilities, specialise in low vision, or have wheelchair accessible practices. Access Good Vision for Life's website to 'Find an Optometrist'.

It's very helpful to let the optometrist, ophthalmologist or orthoptist know about a dementia diagnosis, any aspects of dementia that might impact the appointment, such as communication difficulties, and potential support needs during the eye test or low vision assessment. To do this, you can use this handy print-at-home pocket card, available free on Dementia Australia’s National Library Guide about eye health and dementia. Print it out, fill in both sides, and bring it with you to your appointment. Low vision assessments are often longer appointments, so you can use this card to indicate if some breaks throughout the assessment might be helpful. Everyone is different, so you can just tick whatever applies to you.

For more information

• Visit Dementia Australia's website for resources and information about living with dementia.
• Visit Dementia Eyecare Pathway's website to learn more about Dr Coleman's important work.
• Access Dementa Australia's National Library Service for resources and support for eye health and dementia.