Increasing the visibility of visual impairment in later life
Sight loss is often easily treated and managed, but the level of under-diagnosis is astonishing.
Aideen Young writes that while sight loss is not an inevitable part of ageing, there are things we can do to help retain our vision in later life.
National Eye Health Week – happening this week (23rd to 29th September 2019) – exists “to communicate the importance of good eye health” and encourage “people from every walk of life to take better care of their eyes and have regular sight tests.”
Although it can affect the whole population, we know that visual impairment is a particular issue as we get older. In the 50-69-year age group, blindness and vision impairment are one of the top contributors to disability. One in nine people aged 60 and over; one in five aged 75 and over; and one in two aged 90 and over are living with sight loss. And there is a pronounced ethnic disparity, with Black African and Caribbean people four to eight times more likely to develop certain forms of glaucoma and South Asian people three times more likely to develop diabetic eye disease.
Age-related vision impairment (which includes such things as age-related macular degeneration, cataracts, glaucoma, diabetic eye disease and myopic degeneration) is among the top contributors to disability in later life and may even impact life expectancy. People with vision impairment can experience mobility problems and social isolation, may have problems taking medicines correctly and are at a significantly higher risk of falls and subsequent hospitalisation. Indeed, vision impairment in older adults is associated with depression, poor quality of life, cognitive decline, limitations in ability to perform normal daily functions and even increased mortality.
Reducing the risk of sight loss
There are many things that can increase our risk of losing our sight as we age. Smoking, hypertension, obesity, a lack of exercise and/or a diet low in omega 3 and 6, vitamins, carotenoid and minerals and high in fat are all risk factors for several age-related visual conditions.
This means that, just as for other age-related conditions, preventing visual impairment in later life means living a healthy lifestyle.
And when visual impairment does occur, further sight loss can be prevented if the condition is detected and treated early enough. Glaucoma, for example, is treated with eye drops in the first instance, or laser treatment or surgery if eye drops have not been successful. One year post-surgery the success rate for glaucoma surgery is about 70-90%. Simple injections for wet age-related macular degeneration stop further deterioration of vision in nine out of 10 people treated and actually improve vision in three of 10.
From our 40s and 50s, regular eye tests are hugely important
In spite of the ease and effectiveness of the treatment and management of these conditions, the level of under-diagnosis is astonishing.
In one study, three-quarters of people with definite glaucoma were not known to the eye services. Another study found severe visual problems in one-third of patients attending a geriatric day hospital, more than half of whom had treatable cataracts. It is estimated that more than half a million people in England have substantial vision-related impairment of their quality of life and that friends and family provide around 180 million hours of unpaid and informal care to support people living with sight loss every year in the UK. The annual cost of treating falls directly attributable to vision impairment is £128 million. Of older people who fall because of poor vision, three-quarters had visual impairment that was easily correctable.
Doing more to prevent and reduce visual impairment
It doesn’t have to be this way. At least half of all cases of sight loss in the UK would be avoidable if diagnosed and treated early enough.
Regular eye tests are the first step. But approximately half of all people aged 60 and over do not have an annual eye test. One study suggests that some people see no need to visit their optometrist because they can buy cheap, reading glasses off-the shelf in large retailers across the country. There is a clear need to ensure that the public understands the function and importance of eye tests and the need to act promptly.
We also need to change attitudes so that sight loss is not thought of as a normal part of getting old. And it’s important to understand the links between sensory conditions, including sight loss and other negative outcomes, and appreciate the importance of diagnosing these in older patients and ensuring they’re referred to specialists as appropriate.
In partnership with Public Health England, our goal at the Centre for Ageing Better is to give everyone five more years of life free of disability by 2030. With visual impairment one of the big causes of disability in later life, primary prevention of visual deterioration through healthy behaviours, and secondary prevention of unnecessary sight loss through prompt diagnosis, treatment and management, could go some way to increasing our years spent disability-free.
National Eye Health Week helps increase the visibility of this important but neglected area of our later life health. And it’s important to start in mid-life – from our 40s and 50s, regular eye tests are hugely important. If people start taking care of their eye health in their mid-years, they can prevent serious consequences later.