Justin Cooper , 2025-04-15 19:52:00
April 15, 2025
3 min read
Key takeaways:
- Visual impairment is highly prevalent in long-term care.
- Older people may view vision deterioration as “inevitable and irreversible.”
Vision screening and eye care for residents of long-term care facilities have significant potential to enhance quality of life, but there are barriers to care in these communities, according to a review.
“The prevalence of visual impairment among individuals living in long-term care is substantial, yet eye care is often disregarded and inadequately addressed. This neglect contributes to a decline in quality of life for residents,” Divya Anantharaman, MPhil, a PhD candidate at the University of Queensland, Australia, and colleagues wrote in Optometry and Vision Science. “There is therefore significant potential to enhance the quality of vision and overall well-being of long-term care residents by addressing the impact of visual impairment through the timely identification and management of eye conditions.”
Vision screening among residents of long-term care facilities has significant potential to enhance quality of life, but there are barriers to care in these communities. Image: Adobe Stock
To learn more about the barriers and potential solutions in this area, Anantharaman and colleagues reviewed 11 studies focused on vision and eye care in long-term care facilities, analyzing the challenges to eye care in this setting from the perspectives of different stakeholders, including long-term care residents, family members, facility staff and eye care professionals.
The analysis suggested that older people may view the deterioration of their vision as simply “inevitable and irreversible,” with one study showing that many long-term care residents in South India did not avail themselves of free eye care services near their facility.
“Residents could be empowered with the knowledge that vision loss caused by conditions such as cataracts can be successfully treated,” Anantharaman and colleagues wrote. “Creating strategies to increase awareness could help to enhance residents’ knowledge and their desire to seek appropriate eye care.”
Residents also reported their glasses being physically difficult to handle or being lost, stolen or broken, particularly among those with dementia.
“When residents are often not using their glasses, eye care professionals and aged care staff could take a person-centered care approach to understand their visual requirements and offer solutions to maximize their vision through refractive correction and thereby enhance their quality of life related to vision,” the researchers wrote.
Optometrists highlighted the challenges of accurately assessing the vision of people with dementia due to impaired cognitive ability and communication. Potential strategies to overcome this include “repeated testing to ensure reliability, evaluating patients at the optimal time of day to elicit an effective response, speaking clearly, providing encouragement and tailoring the assessment to match individual needs,” Anantharaman and colleagues wrote.
“Depending on the resident’s cognitive capacity, the optometrist should choose between using a counting fingers test and different types of visual acuity charts, such as those using letters, numbers or pictures,” they added. “They could utilize objective measurements with an autorefractor, combined with questionnaires assessing subjective perceptions of vision problems and ophthalmic assessments, such as pupil reactions and ocular movements.”
Anantharaman and colleagues concluded that attempts to overcome these barriers “should not target a single stakeholder but rather involve the behavioral perspectives of all stakeholders.”
“When eye care professionals are approached by long-term care communities to serve their residents, they might seize the challenging but rewarding opportunity to enhance residents’ visual capacity,” they added. “While providing interventions, it is crucial to actively engage the residents, considering their cognitive capacity, and involve their family members in the decision-making.
“This may entail enhancing the residents’ vision-related quality of life by providing them with visual aids and surgical or medical intervention or offering customized guidance on environmental modifications designed to meet each resident’s specific needs.”
This study took a hard look at the barriers to assuring that residents in long-term care facilities could enjoy fully corrected vision in their daily lives. A surprising number of barriers were discovered that spread across all of the stakeholders, including the resident, the family, the faculty staff and the eye care community.
One would assume that the barriers would mostly be access to care. This study, however, pointed out that the most consistent barrier was lack of information and education about the options available to correct vision. The residents often believe that the gradual loss of vison is a normal part of aging. As the resident does not complain about a problem they believe is normal, the family does not prioritize vision care as a way to improve the quality of life for their loved one. Likewise, the staff does not prioritize vision and is unaware of potential resources. And lastly, the eye care community assumes that vision care is covered as part of the health care team of the facility.
The authors correctly conclude the solutions to improve eye care in this population would need to be more global and would need to involve all stakeholders rather than employing a targeted approach.
Perspective
This study took a hard look at the barriers to assuring that residents in long-term care facilities could enjoy fully corrected vision in their daily lives. A surprising number of barriers were discovered that spread across all of the stakeholders, including the resident, the family, the faculty staff and the eye care community.
One would assume that the barriers would mostly be access to care. This study, however, pointed out that the most consistent barrier was lack of information and education about the options available to correct vision. The residents often believe that the gradual loss of vison is a normal part of aging. As the resident does not complain about a problem they believe is normal, the family does not prioritize vision care as a way to improve the quality of life for their loved one. Likewise, the staff does not prioritize vision and is unaware of potential resources. And lastly, the eye care community assumes that vision care is covered as part of the health care team of the facility.
The authors correctly conclude the solutions to improve eye care in this population would need to be more global and would need to involve all stakeholders rather than employing a targeted approach.
Scott A. Edmonds, OD, FAAO
Sources/Disclosures
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Disclosures:
The authors report no relevant financial disclosures.Edmonds reports no relevant financial disclosures.