Fixing Seniors' Vision May Improve Brain Health By dlee135 on March 15, 2019

From the American Academy of Ophthalmology

A recent study from England has found that people who have had cataract surgery have better mental function in later life. The report joins a growing body of research that suggests that taking care of vision has benefits for older adults beyond just improving sight.

Researchers compared the rates of cognitive (thinking) decline before and after patients had cataract surgery. The researchers found the rate of cognitive decline was slowed by 50 percent following cataract surgery over 13 years of follow-up. The rate of decline among people who had cataract surgery was slower after the surgery compared with beforehand and became similar to the decline among those with no cataracts. 

Other studies have associated visual impairment with lower cognitive ability in older adults. But until now, about it wasn't known whether improving vision through cataract surgery would help slow changes in mental function. The new study included 2,068 adults who underwent cataract surgery and 3,636 adults with no cataracts. Researchers tested participants' memory by asking them to recall 10 words, both immediately after the words were read aloud and then again after participants had been distracted by other tasks.

The researchers note that scientists still don't know why vision problems affect cognitive decline. But they think that the isolation, embarrassment and lack of physical activity from vision problems may contribute to the problem.

"There is little doubt that cataract surgery is very likely to improve a person's vision, which can allow people to stay active and independent," said Thomas Steinemann, MD, professor of ophthalmology at Case Western University and an ophthalmologist at MetroHealth Medical Center in Cleveland. Dr. Steinemann wasn't involved in the English study. "If you can’t do things for yourself because you can't see well, it's easy to fall into a depression and withdraw from activities. This could affect a person's cognitive abilities."

Another recent study found that people who are diagnosed or identified as having reduced mental function are less likely to receive cataract surgery than those with normal mental function.

Dr. Steinemann is part of another study being conducted at Case Western on cataract surgery and cognitive decline. The study includes patients who have had cataract surgery, those who agreed to wait to have the surgery and the caregivers of both groups. Preliminary data from the study suggests that improving vision isn't the only benefit of cataract surgery, it also improves quality of life and delays or lessens cognitive decline in adults. The results also suggest that patients who had cataract surgery — and their caregivers — have less emotional distress compared with patients who did not have the surgery and their caregivers.

Other Benefits of Cataract Surgery

One study found that when older people have cataract surgery to improve their vision, they also lower their risk of falling and breaking a hip. Another study of 55- to 85-year-olds with and without cataracts found that those with cataracts were four times more likely to report difficulty with challenging driving situations. Drivers with cataracts were also 2.5 times more likely to have a history of at-fault crash involvement in the prior five years.

Correcting Vision Improves Quality of Life

Dr. Steinemann has seen that correcting vision problems, including cataracts, can make a big difference in a person's quality of life.

"Sometimes family members say, 'My mother doesn't do much anymore – she doesn't read, or drive, and she's a little confused, so why bother doing surgery?'" he said. "I take issue with that. I've seen some pretty amazing changes in older patients who have their eye conditions treated. Cataract surgery is a safe outpatient procedure. It can enhance people's lives and make them more engaged with the world."

Sometimes something as simple as getting new eyeglasses can make a difference in an older person's vision, Dr. Steinemann said. A new study published in JAMA Ophthalmology found that almost 40 percent of the adults age 78 and older in the study needed eyeglasses or an updated prescription. Many of those in the study had a hard time getting to the eye doctor.

"A majority of those in the study had worse than 20/40 vision, which is considered 'driving vision,'" Dr. Steinemann said. "Even something as simple as getting your eyeglasses checked can really help a lot. It helps maintain your driving vision, allows you to see your pills and the food on your plate."

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