Why Link Between Cognition and Vision May Emerge as a Focus of Innovation

WASHINGTON – With the graying of America and a push to create age-friendly communities and health systems, ophthalmologists and innovators in the field need to better understand the interplay between low vision and cognition for the best outcomes, a panel of experts said at Prevent Blindness’ 2019 Focus on Eye Health summit.

The number of people with visual impairment is expected to double between 2015 and 2050,¹ said Bonnielin Swenor, PhD, MPH, an associate professor at the Johns Hopkins Wilmer Eye Institute. Physicians often look at individual systems like cognitive, physical, or mental/social functioning in seniors, but there is a need to look at vision and its connection to the brain, she said. Over the past decade, researchers have been studying the link between visual impairment and cognitive impairment, she said, finding a bidirectional relationship: Worse vision and worse cognition are associated, but older adults with vision impairment also are more likely to report memory complaints.

Interventions at Cellular, Biological Level

Vision researchers came together a couple of years ago to outline a road map for vision and cognitive impairments.² There could be a common etiology, such as inflammation, that may simultaneously drive vision and cognitive changes, Dr. Swenor said. Interventions would then have to be at the cellular or biological level. Another idea is a vision loss consequence pathway, suggesting that changes occur downstream from vision loss that put the person at a steeper trajectory for decline. Interventions could then target behavioral changes seen after vision loss in how people move and socialize.

Visual and cognitive impairments impact a number of daily functioning areas, such as self-care activities and mobility, said Joshua Ehrlich, MD, MPH, an assistant professor of ophthalmology and visual sciences at the University of Michigan. Information from the Salisbury Eye Evaluation and National Health and Aging Trends Study shed light on how vision impairments gradually affect life skills. But not all activity limitations are equivalent, he said: Mobility and household activity limitations account for more than half of the effect of vision loss on well-being. “If we can move older adults to a better position on the activity hierarchy, we may be able to effect change in their ultimate outcome,” he said.

Getting Health Systems on Board

Meanwhile, several efforts to promote age-friendly (and vision-friendly) communities are ongoing, said Marcus Escobedo, MPA, vice president of communications and senior program officer at The John A. Hartford Foundation. The foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and Catholic Health Association of the United States, launched an initiative to develop age-friendly health systems in which every adult’s care is guided by evidence-based practice, causes no harm, and is consistent with what matters to the adult and their family. They aim to get 20% of health systems participating by the end of 2020, Escobedo said. About 357 sites from 126 health systems have signed on.

The plan focuses on areas such as medication, mentation, and mobility, all of which encompass vision care, he said. Vision-friendly steps through these programs could include efforts such as increasing access to vision screening and eyeglasses and assisting people with low vision through technology.

References

Varma R. et al. Visual impairment and blindness in adults in the United States: Demographic and geographic variations from 2015 to 2050. JAMA Opthalmol. 2016;134:802-9.
Whitson H.E. et al. American Geriatrics Society and National Institute on Aging Bench-to-Bedside Conference: Sensory impairment and cognitive decline in older adults. J. Am. Geriatr. Soc. 2018;66:2052-8.