Vision loss has a significant impact on the lives of those who experience it, as well as on their families, and friends. Deterioration or loss of eyesight can feel frightening and overwhelming, leaving those affected to wonder about their ability to maintain their independence, pay for needed medical care and continue employment. The health consequences associated with vision loss extend well beyond the eye and visual system. Vision loss can affect one’s quality of life (QOL), independence, and mobility and has been associated with an increased risk of falls and injury. Sight loss also impacts on an individual’s mental health, cognition, social roles and employment / educational status.
From speaking with individuals with limited visual ability, it is easy to understand the significant role that vision plays in health and social well-being. In this blog, we look specifically at the impact visual impairments, such as cataracts, can have on an individual’s quality of life and mobility.
Reduced QOL, and various negative health outcomes, have been related to the severity of disease in glaucoma, cataract, age-related macular degeneration, and strabismus. It is easy to see why patients with vision loss report a reduction in QOL as it affects their ability to work, and their ability to perform basic self-care activities, such as eating and dressing, as well as instrumental activities of daily living such as shopping, financial management, medication management, and driving.
Most studies have found that vision loss has a greater impact on dependency in instrumental activities such as reading (e.g., reading medication labels, balancing bank statements, or following recipes), recognising faces and images (e.g., socialising, playing cards, using a smartphone), or manipulating small objects (e.g., sewing, replacing batteries). Visual field deficits can also affect one’s ability to perform tasks that require ambulation in challenging settings (e.g., navigating crowded city streets, negotiating stairwells) or the use of peripheral vision (e.g., driving).
Due to the challenges that vision loss poses for independent living, older adults with vision impairment may be more likely to require long-term care, or they may need to rely more heavily on a caregiver or family member.
It is widely recognised that mobility is greatly affected by vision loss, whether resulting from changes in visual acuity, visual fields, depth perception, or contrast sensitivity. In a person with intact eyesight, the primary sense used to navigate their environment is vision, therefore an individual with some form of visual impairment may have difficulty with walking or going up or down steps. Due to these difficulties, people with vision loss are at higher risk of several types of injury, and are therefore more likely to be admitted to hospital. Of these, the link between vision loss and fall-related injuries has been most clearly documented.
A UK study found that 46 percent of frail elderly individuals admitted for hip fracture in two hospital regions had visual impairment, most frequently untreated cataract (49 percent) and macular degeneration (21 percent), but also uncorrected refractive error (17 percent). (Cox et al., 2005).
Additional factors such as weakness, other chronic conditions, and the use of medications are also linked with falls, suggesting that positive interventions to decrease falls and increase mobility in visually impaired populations will require a holistic approach.
Not surprisingly, vision impairment has also been shown to be associated with an increased risk of fractures in multiple studies, and risk increases for those with worse visual acuity, depth perception and binocular visual field loss.
Studies have suggested that reversing vision impairment from cataract may be protective against fractures. A randomised controlled trial found that women with expedited cataract surgery had a 67 percent lower risk of fractures within 1 year after surgery than women with routinely scheduled surgery (Harwood et al., 2005).
The association between cataract and injury may extend beyond a reduction in fracture risk. Vision loss can also complicate chronic disease management, including self-care, and the proper administration of medicine – creating a “vicious cycle” of worsening health.
Two studies in the Blue Mountains region, Australia, both demonstrated that patients with vision improvement after cataract surgery had decreased mortality risk compared with patients with vision impairment due to cataract who had not undergone surgery or those with persistent vision impairment after cataract surgery (Fong et al., 2013, 2014). The reduction in the risk of fractures and accidents was proposed as a contributing factor in the reduced risk of death.
Similarly, researchers at the University of California found older women who received cataract surgery had a lower-risk for overall and cause-specific death. In the study published in JAMA Ophthalmology, the researchers found a 60% reduced risk of death from all causes among the women who received surgery compared to those who did not (Tseng et al., 2017).
These findings illustrate the importance of our visual abilities in preserving our wider health. It is important to monitor your eye health. The NHS recommends we visit our optician every 2 years but you don’t have to wait for your biennial appointment, if you suspect your eyesight is deteriorating please seek the advice of your optician.
References
Cox A, Blaikie A, MacEwen CJ, Jones D, Thompson K, Holding D, Sharma T, Miller S, Dobson S, Sanders R. Visual impairment in elderly patients with hip fracture: Causes and associations. Eye (London). 2005;19(6):652–656.
Fong CSU, Mitchell P, Rochtchina E, Teber ET, Hong T, Wang JJ. Correction of visual impairment by cataract surgery and improved survival in older persons: The Blue Mountains Eye Study cohort. Ophthalmology. 2013;120(9):1720–1727.
Fong CSU, Mitchell P, Rochtchina E, De Loryn T, Tan AG, Wang JJ. Visual impairment corrected via cataract surgery and 5-year survival in a prospective cohort. American Journal of Ophthalmology. 2014;157(1):163–170. e161.
Harwood RH, Foss A, Osborn F, Gregson R, Zaman A, Masud T. Falls and health status in elderly women following first eye cataract surgery: A randomised controlled trial. British Journal of Ophthalmology. 2005;89(1):53–59.
Tseng VL, Chlebowski RT, Yu F, et al. Association of Cataract Surgery With Mortality in Older WomenFindings from the Women’s Health Initiative. JAMA Ophthalmol. 2018;136(1):3–10. doi:10.1001/jamaophthalmol.2017.4512
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