Are Routine Retinal Examinations useful for Patients with Dementia?

Abstract

Purpose: Persons with dementia may be less likely to complain of symptoms of impaired vision and thus major eye diseases may be under-diagnosed and under-treated. In this study, we aim to describe the prevalence and awareness of vision-threatening eye diseases in a cohort of patients with dementia.

Methods: We recruited clinically diagnosed demented patients from 3 study sites (dementia/memory clinics from the National University of Hospital, Khoo Teck Puat Hospital and Singapore General Hospital, Singapore). All patients underwent clinical neurologic and neuropsychiatric assessment for dementia. We used a standardized questionnaire to ascertain patients’ history of eye diseases from their main caregiver. Retinal photographs were taken from all patients and assessed by an ophthalmologist for presence of any retinal pathologies. Patients were advised and referred if they required an ophthalmology evaluation. The eye pathologies were then classified into four categories of vision threatening eye diseases: age-related macular degeneration (AMD), diabetic retinopathy, cataract (defined based on media opacity from photographs), and glaucoma (defined based on cup/disc ratio of >0.7).

Results: A total of 265 dementia patients were recruited of which there were 255 with gradable retinal photographs. More than three quarters (n=205, 76%) had at least one eye pathology based on signs detected from the retinal photographs, with the majority (n=158, 63%) requiring a clinical ophthalmology assessment. Of the 205 patients with at least one eye pathology, nearly half (n=121, 47%) had pathology which were previously undiagnosed. In terms of specific vision-threatening eye disease, 173 (68%) patients had cataracts, 53 (21%) had AMD, 41 (16%) had glaucoma, and 37 (15%) had diabetic retinopathy. Of these, 15% (29/173) of cataracts, 86% (46/53) of AMD, 78% (31/41) of glaucoma and 73% (27/37) of diabetic retinopathy cases were previously been undiagnosed.

Conclusions: Three quarters of patients with dementia have vision-threatening eye pathology, of which half were undiagnosed. A routine retinal examination identifying eye diseases and appropriate referral would be beneficial to patients with dementia to preserve vision.

Keywords: 464 clinical (human) or epidemiologic studies: risk factor assessment • 412 age-related macular degeneration • 759 visual impairment: neuro-ophthalmological disease