Q. A friend told me that vision loss is a risk factor for dementia, but that treating it can help lessen the risk. My mom never wears her glasses and may need cataract surgery but refuses to get her eyes checked. Her family has a high rate of dementia, and this is something that certainly concerns her. She would do whatever she could to reduce her own risk. Can you tell me if what my friend says about better eye care is true? If so, I will try to convince my mom to wear her glasses, get her eyes checked more regularly, and take care of her cataracts. Thanks so much for your help!
A. A recent study published in the British Journal of Ophthalmology examines ophthalmic and systemic conditions (conditions that affect the entire body) and their relationship to dementia. A similar US study published in JAMA Neurology also looked at ophthalmic conditions and dementia, taking it one step further to show that better eye care can help lessen the risk of dementia. The US study found that 1.8% of dementia (representing more than 100,000 cases) potentially would be prevented if the risk factor of vision impairment was eliminated.
Are Ophthalmic Conditions an Indicator of a Higher Incidence of Dementia?
Ophthalmic and systemic conditions often occur as we get older. The authors of the study in the UK analyzed data from the UK Biobank to determine whether ophthalmic conditions alone — in the absence of other high-risk systemic conditions — are indicators of a higher incidence of dementia.
For the UK study, researchers assessed 12,364 adults aged 55–73 years between 2005 and 2010 and then followed them up for 11 years until 2021. During this time, they recorded 2,304 cases of dementia from all causes, including 945 cases of Alzheimer’s disease and 513 cases of vascular dementia.
The scientists asked participants whether a doctor had told them during the study period that they had certain common medical conditions. These conditions included heart disease, stroke, high blood pressure, depression, and diabetes, to see whether dementia was more prevalent in those with simultaneous conditions.
In the American study, Joshua Ehrlich, MD, MPH, of the University of Michigan in Ann Arbor, and his team also explore vision loss as a contributing factor to dementia. He believes that “a very large fraction of vision impairment — possibly in excess of 80% — is avoidable or has simply yet to be addressed.” According to Dr. Ehrlich,”(w)e sought to illustrate that vision impairment is just as influential as a number of other long accepted modifiable dementia risk factors. When we include vision alongside these factors, we’re able to account for an even greater proportion of dementia cases that, in theory, could be prevented.”
Analysis of Data from Both Studies
Both studies examine how sensory loss, such as vision loss, is emerging as an important dementia risk factor. Analysis of the data showed that:
- Researchers in the US study found that vision impairment may be one of the first manifestations of dementia, noting that “(r)educed stimulation of visual sensory pathways may lead to an acceleration of its progression.”
- Ophthalmic conditions are often present in older individuals, those who smoke and are less physically active, and those with low levels of education.
- Stroke only, heart disease only, diabetes only, hypertension only, and depression only were independently linked to an increased risk of dementia. In combination with any of these conditions, age-related macular degeneration was also associated with an increased risk of dementia.
- Compared with participants who did not have an ophthalmic condition at the start of the UK study, the risk of dementia was 26% greater in those who developed age-related macular degeneration during the study period.
- Participants with cataracts in the UK study showed an 11% increase in risk of dementia, and those with diabetes-related eye disease were 61% more likely to experience dementia.
- The authors of the UK study conclude that age-related macular degeneration, cataracts, and diabetes-related eye disease, but not glaucoma, are associated with an increased risk of dementia.
- The US study found that older adults who had cataract removal to restore their vision had a lower risk of Alzheimer’s disease and other forms of dementia. Surgery to remove cataracts, which cause the eye’s normally clear lens to become cloudy, can restore vision almost instantaneously.
- The US study found that many of the pathways by which hearing loss (about which I’ve written many times) may lead to dementia may hold for vision as well, including increased cognitive load, changes to brain structure and function, and increased social isolation and loneliness.
What Researchers Had to Say
The link between vision loss and dementia has not been as well studied as the link between hearing loss and dementia, but vision is “a target for high-yield nonpharmacologic interventions, such as cataract surgery or prescription of eyeglasses” and could have a considerable effect on dementia prevalence, US researchers pointed out.
One of the US researchers, Dr. Nathaniel Chin of the University of Wisconsin, said that “(d)octors in primary care clinics or those who treat memory need to screen more for visual decline,” adding that primary care physicians should “talk to people about potential brain health improvements with cataract surgery as well as the need to address vision throughout one’s life as a means of protecting cognition.”
If you or a loved one are experiencing vision loss, it’s important to consult an eye doctor to explore possibilities of sight correction. Optometrists are eye doctors who evaluate sight and prescribe vision correcting devices such as eyeglasses and contact lenses. Many also do screenings to look at the health of the inside of the eye, including the retina, and test routinely for glaucoma and other eye diseases, and they can prescribe medications such as eye drops that help treat certain eye diseases. Ophthalmologist are medical doctors who specialize in the surgical treatment of eye disease, such as cataract surgery and surgery to correct retinal disease and glaucoma.
Does Medicare Cover Eye Exams?
For those on Medicare, it’s important to be aware that original Medicare doesn’t cover eye exams for eyeglasses or contact lenses. Medicare Part B does cover eye exams for diabetic retinopathy once each year if you have diabetes. Medicare Part B also covers glaucoma tests once every 12 months if you’re at high risk for developing glaucoma. Medicare Part B may also cover certain diagnostic tests and treatment (including treatment with certain injected drugs) of eye diseases and conditions if you have age-related macular degeneration. Visit Medicare.gov for more details.
Planning for the Future
Clearly, it’s important for everyone to take care of vision issues, as it improves quality of life and may also lessen the risk for dementia. It is also important that you and your loved ones plan for the future if someone in your family has dementia or is at a high risk of developing dementia.
At the Farr Law Firm, we can help protect your assets so that you will be able to maintain your comfort, dignity, and quality of life and obtain critical government benefits such as Medicaid and Veterans Aid and Attendance to help pay for the care that you may need in the future. Please call us any time to make an appointment for an initial consultation.
Fairfax Elder Law: 703-691-1888
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About Evan H Farr, CELA, CAP
