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

Having dementia does not increase likelihood of developing age-related eye diseases. However, people with dementia are less likely to see eye care professionals regularly, or receive regular eye tests, cataract surgery, intravitreal injections, or topical ocular medications. Because people living with dementia are less likely to access eyecare, they are more likely to experience preventable sight loss from age-related eye problems or un/under-corrected refractive error. 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living with dementia in residential aged care, with close to half of vision impairment being attributed to broken, outdated or missing glasses. Because of this, it’s really important for all eyecare professionals 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 dementia progresses and support needs change.

Promoting early help-seeking to maintain social engagement

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 many 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 have older patients who are starting to experience vision changes, encouraging them to find help and support early can also help to reduce their risk of developing dementia too. SeeWay is available to everyone with sight loss, so you can signpost clients to the platform any time, so they can explore it at their own pace. SeeWay can help people learn about ways to make the most of their vision, look after their mental health, and stay independent, active and social.

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.

In my research, I found there were many ways optometrists adapted 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 regular eye examinations, even as dementia progresses, can help to detect problems early and address them promptly, such as cataract surgery, or difficulties with medication adherence. 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 offering a low vision assessment in the early stages of any sight loss can be important, to help people master smartphone accessibility features and to embed low vision aids such as day lights and magnifiers into daily routines (Lawrence et al., 2009). Lastly, it is important that carers look after their eyesight too, as poor vision can make care tasks more difficult. Two thirds of people with dementia are living in the community, supported by over 100,000 carers who may be family or friends, who may be attending your practice. SeeWay is easy to navigate for people with low vision, so carers with sight loss can also use SeeWay to find the support they need.

Signposting to help and support

You can encourage your patients to explore SeeWay to get tailored information, find out about available low vision 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. There are telephone services and information programmes that are Australia-wide, such as Macular Disease Foundation of Australia’s EyeConnect service, and Glaucoma Australia’s Sightwise.

If you are comfortable and confident in examining people living with dementia, make it easy for them and their families to find you. If you are an Optometry Australia member, you can update your profile to show you are dementia-friendly, like over 300 other optometry practices across Australia, and then your practice will show up on Good Vision for Life’s ‘Find an Optometrist’ search. My research found that people living with dementia and their families would prefer to see an optometrist who knows about dementia, but are sometimes unsure how to find someone with this expertise.

If you are not an Optometry Australia member, there are other ways you can show your support, such as signing up as a Dementia Friend with Dementia Australia, or participating in Dementia Action Week.

Visit the Dementia Australia website to become a Dementia Friend, and find more ways to get involved in supporting the community.

My research also found that optometrists are often not aware of a person’s dementia diagnosis before they start testing, and this information can sometimes emerge over the course of the consultation. We have developed resources to help people with dementia and their families alert their optometry practice to 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. This is a handy print-at-home pocket card, available free by accessing Dementia Australia’s National Library Guide about eye health and dementia.

Dementia-friendly eyecare training for optometrists and practice staff

To help eye care professionals upskill in dementia care, we have developed comprehensive evidence-based training about dementia, available online any time and accredited with Optometry Australia.

You can access this training on the University of Melbourne's short courses page.

We are also developing training for optical dispensers.

This Dementia Action Week, why not get started with our handy tip sheet about adapting communication and testing to accommodate dementia?

For more information

• Learn more about Dr Coleman's important research by visiting the Dementia Eyecare Pathway's website or the Dementia Australia National Library Service.
• Visit Dementia Australia's website for resources and information about living with dementia.