Image of senior receiving eye exam
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Vision impairment and blindness were highly prevalent and linked to morbidity in a study across 74 North Carolina nursing facilities. But corrective lenses may play a big role in improving resident outcomes, the researchers say.

Investigators from the University of South Florida and the University of Colorado examined records for comprehensive eye exams in 7,753 residents. Participants were aged 65 years and older at the time of their initial eye exam.

Vision impairment and blindness affected 66% of residents overall, with particularly high rates among participants who were older, women, or had diagnosed eye diseases, the researchers found. 

A cross-sectional analysis showed that 34% of residents had normal vision, 43% were visually impaired and 23% were blind. Vision impairment and/or blindness was highly prevalent among participants with age-related eye diseases, ranging from 63% to 76%. The prevalence of blindness alone ranged from 23% to 53%.

In addition, diabetes and diabetic retinopathy were identified as risk factors for vision loss. These two diseases may serve as biomarkers for the cerebrovascular changes seen in stroke and the progression of dementia, the investigators concluded.

Benefits of corrected vision

The study also found that correcting refractive errors alone helped to reduce vision impairment or blindness. Refractive errors include nearsightedness, farsightedness, astigmatism (which prevents the eye from focusing correctly) and age-related farsightedness (presbyopia).

Fully 80% of vision loss can be managed and treated, noted first author William Monaco OD, PhD. 

“The cost-benefit solely derived from dispensing spectacle lenses to correct refractive error are evident in daily clinical practice,” he and his colleagues wrote. Disengaged residents with dementia, for example, often will return to social engagement and interaction after receiving a pair of glasses, they reported.

“This study substantiates the positive impact of comprehensive eye examinations to promote visual, systemic, and cognitive health and well-being,” the authors added. Eye care services should be used to inform clinical practice and policy with the goal of improving patient functioning and independence, they said.

Data equal change

The study builds on an earlier one conducted across Delaware nursing homes that found a rate of 47% moderate-to-severe vision impairment and 16% blindness among residents.

Data sets such as those can help stakeholders address the role that vision loss plays in resident health, including the role of vision in falls prevention and patient safety, the researchers noted. The authors foresee special considerations for vision loss being incorporated into clinical and staff education and into human-factor considerations, such as facility design, to promote safe mobility and navigation.

Improved ADL

Other research has linked vision correction with functional improvements in older adults, as well. One study from France, for example, has estimated that approximately one-sixth of instrumental activity of daily living limitations and one-fifth of social participation restrictions in community-dwelling older adults could be prevented with optical correction. 

In the current study, vision impairment was defined as best-corrected visual acuity between 20/40 and 20/200, and blindness was defined as best-corrected visual acuity of 20/200 or worse.  

Full findings were published in JAMDA.

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