Study underscores optometry’s role in improving aging patients’ quality of life

With 1 in 28 Americans over the age of 40 affected by blindness and low vision, a new study looks at the link between vision and cognitive function.

In the study, researchers from Stanford University and Veterans Affairs Palo Alto Health Care System drew from a cross-sectional sample of two national data sets: the National Health and Nutrition Examination Survey (1999-2002) and the National Health and Aging Trends Study (2011-2015). Together, the data sets contained about 33,000 respondents. The analysis was published online on Aug. 17 in JAMA Ophthalmology.

Through their analysis, researchers sought to better define the relationship among older adults between visual impairment and cognitive function, such as memory and reasoning. Their analysis found that "visual impairment measured at distance, near and by self-report was associated with 1.9- to 2.8-fold higher odds of cognitive dysfunction or dementia after adjustment for confounders."

Opportunity for doctors of optometry

The study's findings hardly surprise Paul Freeman, O.D.

For more than 40 years, Dr. Freeman has provided low-vision care to the communities of western Pennsylvania. He also is past chair of the AOA's former Vision Rehabilitation Section—now Vision Rehabilitation Committee—and co-author of "The Art and Practice of Low Vision."

"Because of the numbers of aging patients, we will all be sharing in the health and well-being of these individuals, attempting to maximize their vision either with 'conventional' lenses or low-vision management options," says Dr. Freeman, who has seen some of his patients for decades. "Hopefully, doctors of optometry also will help them maintain good cognitive functioning.

"However, a caveat is that even with relatively good health, beginning around the seventh or eighth decade, there is a progressive and gradual loss of some intellectual functions, so any support we can give our senior patients will be welcomed," he adds.

A doctor who provides low-vision rehabilitative services can deliver the help and resources needed for visually impaired patients to regain that independence and freedom they thought was once lost. People with low vision can be taught a variety of techniques—along with low-vision devices—to perform daily activities with what vision remains.

Before clinical tests, a meaningful doctor-patient conversation needs to be had, Dr. Freeman says.

"We must first listen to their life's frustrations related to their visual challenges based on visual impairments, and what tasks they have given up because of hearing that 'nothing more can be done,'" he says. "Then, a compassionate ear and a positive direction for realistic help can go a long way in underscoring the concept of 'learned optimism.'

"This is an opportunity to engage a patient as a partner in problem solving those situations that have been impacted by impaired vision," he adds. "By doing this, it will hopefully build the patient's confidence for ongoing creative problem solving using all the tools that are available to them, in a logical and systematic way. With the numbers and complexity of optical, non-optical, and electro-optical choices, practitioners must help develop strategies for success based on the patient's motivation to achieve his or her goals."

Golden rule

Previous studies have looked at the impact low vision has on older Americans' quality of life.

A 2016 study in JAMA Ophthalmology evaluated about 112,300 volunteers, ranging in age from 40 to 73 years, on the basis of visual acuity and their social, economic, education and employment status. Researchers say participants in the most severe category—vision impairment, severe vision impairment and blindness—had three times the risk of being unable to work and twice the risk for being unemployed.

"Someday each one of us will be someone else's patient, and with any luck we will be those patients who are aged as well," Dr. Freeman says. "If we stop for a moment to think how we might like to be cared for in what may appear to be an overwhelmingly negative situation, the approach to the care of these patients with vision loss and functional challenges becomes very evident."