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Welcome to question of the day #236

Eyeools question of the day #236 

I know that the refractive error in children can change over short periods of time so an eye examination every 6 to 12 months can help detect these changes and I know that for most adults with healthy eyes an examination every two years is sufficient. What I’m less sure about is how often older people with healthy eyes should be examined. What should I advise my patients who are 70 and older?

Very good question. I’ve turned to the research literature and my own clinical experience to answer it.

A link between cognitive decline and visual acuity has been found. Cognitive decline is when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life.

What causes a cognitive decline through reduced visual acuity is unclear. However, it is clear that it is the reduced visual acuity that causes the cognitive decline and not the cognitive decline which causes the reduced visual acuity.

This link between cognitive decline and under-corrected visual acuity suggests the need for earlier and more regular refraction testing in older patients to ensure adequate glasses are provided and vision-associated cognitive decline is reduced.

Of course, making sure older people have the best visual acuity possible also means less likelihood of falling and generally a better quality of life. Older people who fall sometimes develop other serious medical conditions such as a broken hip from which it is difficult to recover even with surgery.

More frequent eye examinations will also more quickly detect eye conditions that are common in older people such as cataracts and glaucoma.

My suggestion is that it is in the best interests of people over the age of 70 to be examined every 6 months. A clear explanation to each patient and their carers, where they have them, will help older patients understand why a 6 month recall period will be beneficial to them in terms of quality of life, eye disease detection, fall prevention, and cognitive resilience.