Dementia and Eye Care: Why Regular Eye Tests Matter

Dementia affects over 900,000 people in the UK, and that number is expected to rise above 1 million by 2030. What many families and carers don't realise is that vision problems and dementia are deeply interconnected — and ensuring regular eye care can make a profound difference to quality of life.

As a domiciliary optometrist working across Essex care homes, I see first-hand how undetected vision problems in dementia patients lead to increased confusion, falls, withdrawal, and distress. This guide explains the connection and what can be done about it.

How Dementia Affects Vision

Dementia doesn't just affect memory. Many forms of the condition — particularly Alzheimer's disease, posterior cortical atrophy (PCA), and Lewy body dementia — directly impact how the brain processes visual information. This means a person may have perfectly healthy eyes but still experience significant visual difficulties.

Common visual problems associated with dementia include:

• Reduced contrast sensitivity — difficulty distinguishing objects from their background, such as a white plate on a white tablecloth
• Depth perception changes — misinterpreting shadows as steps, or struggling with stairs and uneven surfaces
• Narrowed visual field — reduced peripheral vision, increasing collision risk and spatial disorientation
• Difficulty recognising faces and objects — even familiar people and everyday items can become unrecognisable
• Problems with colour perception — particularly difficulty distinguishing blues and purples
• Visual hallucinations — especially common in Lewy body dementia, where the brain misinterprets visual signals

Why Vision Problems Are Often Missed

There's a significant problem with how vision and dementia interact in clinical settings. Many behaviours commonly associated with dementia — bumping into furniture, difficulty eating, reluctance to move around, increased agitation — may actually be caused or worsened by poor vision.

This happens for several interconnected reasons. People with dementia often can't articulate that they're struggling to see. Standard eye test charts require cognitive abilities that dementia may have impaired. Care staff, while doing their best, may attribute visual difficulties to the progression of dementia rather than a treatable eye condition. And perhaps most importantly, many people with dementia simply can't get to a high-street optician for a test.

The Impact of Poor Vision on Dementia

When vision problems go undetected in someone with dementia, the consequences ripple through every aspect of their daily life.

Falls and Injuries

Falls are the most common cause of injury-related death in people over 75. Poor vision is one of the most significant modifiable risk factors. Research shows that simply ensuring someone has the correct glasses can reduce falls risk by up to 30%. For care homes, this means fewer hospital admissions, less distress, and better CQC outcomes.

Increased Confusion and Agitation

Imagine trying to navigate a world you can't see clearly, where faces blur and shadows look like obstacles. For someone already experiencing cognitive difficulties, uncorrected vision problems compound confusion dramatically. Correcting vision won't cure dementia, but it can significantly reduce the disorientation and distress that poor sight causes.

Social Withdrawal

When someone can't recognise the people around them or see the television, read, or engage in activities, they naturally withdraw. This social isolation accelerates cognitive decline, creating a downward spiral. Ensuring good vision helps maintain engagement and connection with others for as long as possible.

Difficulty Eating and Drinking

Poor contrast sensitivity can make mealtimes challenging — not seeing food on a plate, missing a glass of water, or struggling with cutlery. Simple interventions like high-contrast tableware combined with correct vision correction can transform mealtimes.

How We Adapt Eye Tests for Dementia Patients

Traditional eye tests rely on the patient reading letters on a chart, communicating preferences ("better with lens one or lens two?"), and sitting still in an examination chair. None of these assumptions hold for many dementia patients.

As a domiciliary optometrist, I've developed an approach specifically adapted for people with dementia:

• Objective testing methods — using retinoscopy and auto-refraction to determine the prescription without needing verbal responses
• Preferential looking tests — such as Cardiff Cards or Teller Acuity Cards, which assess vision through the patient's natural gaze behaviour rather than verbal responses
• Patient, unhurried examinations — allowing extra time, following the patient's rhythm, and returning for a second visit if needed
• Familiar environment — examining patients in their own room or a quiet space they know, reducing anxiety and confusion
• Working with carers — speaking with care staff who know the patient's routines, preferences, and communication style
• Eye health assessment — checking for cataracts, glaucoma, and macular degeneration using portable equipment that doesn't require the patient to position themselves at a slit lamp

Simple Changes That Make a Big Difference

Beyond ensuring correct glasses, there are practical environmental adjustments that can dramatically help dementia patients with visual difficulties:

• Improve lighting — dementia patients typically need 2-3 times more light than younger adults. Ensure even, glare-free lighting throughout living spaces
• Increase contrast — use contrasting colours for door frames, handrails, toilet seats, and tableware. A dark toilet seat on a white toilet, a coloured plate on a white tablecloth
• Reduce visual clutter — busy patterns on carpets and furnishings can cause confusion and visual disturbance
• Mark hazards clearly — use high-contrast tape on step edges, glass doors, and changes in floor level
• Ensure glasses are clean and worn — this sounds obvious, but it's one of the most common issues. Establish a routine for cleaning glasses daily

NHS-Funded Home Eye Tests for Care Home Residents

All care home residents are entitled to NHS-funded home eye tests, regardless of their age or health status. This means there is absolutely no cost for the eye examination. Many residents are also eligible for NHS optical vouchers that contribute towards the cost of glasses.

Despite this, many care homes don't have regular optometry visits in place. If you manage a care home and don't currently have an arrangement for regular eye care, I'd encourage you to get in touch. We can set up a visiting schedule that works around your home's routine, ensuring every resident receives the eye care they need.

When to Arrange an Eye Test

For people living with dementia, I recommend an eye test at least every 12 months — more frequently if there are noticeable changes. Watch for these signs that might indicate a vision problem:

• Bumping into furniture or door frames more than usual
• Difficulty recognising familiar faces or objects
• Reluctance to move around or leave their chair
• Reaching past objects when trying to pick them up
• Increased falls or near-misses
• Changes in eating habits — missing food on the plate, spilling drinks
• Increased agitation, particularly in unfamiliar environments
• Squinting, tilting the head, or holding things very close

If you notice any of these signs in a family member or resident, please don't hesitate to contact us. A home eye test is straightforward, stress-free, and could make a real difference to their quality of life.

Nicholas Templeman is a GOC-registered optometrist and NHS contractor specialising in domiciliary eye care across Essex. He provides home eye tests and care home visits in Colchester, Chelmsford, Braintree, Witham, Maldon, Clacton, Southend, Basildon, and surrounding areas.