2018 APPG on Dementia Call for Evidence

Read the evidence we submitted to the All Party Parliamentary Group for their inquiry into Dementia and Disability (July 2018)

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The College of Optometrists is the professional body for optometrists. It qualifies the profession and delivers the guidance, development and training to ensure optometrists provide the best possible care. We recognise excellence through the College’s affixes, by building the evidence base for optometry, and by raising awareness of the profession with the public, commissioners, and health care professionals.

We are concentrating our response on question three, as we believe the evidence we have fits best into this question. 

In 2016, we undertook our Prevalence of Visual Impairment in Dementia research project (or PrOVIDe), which investigated if older people with dementia were receiving the eye care they needed. Specifically, it examined the prevalence of vision problems in people with dementia, aged 60–89 years, and if these conditions are detected and appropriately managed. The project was funded by the National Institute for Health Research (NIHR), which provides government funding for research in the NHS. It involved over 700 people undertaking sight tests, half of whom lived in care homes, and extensive interviews and focus groups with people with dementia, family carers, professional carers and optometrists. The project took two years to complete, and we produced a Final Report that was launched at an event hosted by the co-chair of the APPG on Dementia, Debbie Abrahams MP, in 2017. 

3) How have people with dementia been supported to live well and what else do people need in order to continue to live well?

It is essential that once someone is diagnosed with dementia they continue to regularly see their optometrist for eye examinations, and that the optometrist is informed of their diagnosis.  This allows the optometrist to adjust the eye examination to suit their needs, and allows the optometrist to manage any visual impairment, something that our research has shown is more common in people with dementia.1  It is important that the patient and their general health, including vision, is not forgotten. This is especially important in dementias that impact vision, such as Posterior Cortical Atrophy. The successful management of visual impairment can also improve the quality of life of people with dementia. 

Our research found that people with prevalence of visual impairment was higher on average among those living with dementia than the general population, and yet many are not getting the eye care that they need.1 Other research has indicated that the effects of having both sight loss and dementia are much more severe than those resulting from either dementia or sight loss alone, and that there are genetic links between the risk of developing dementia and the risk of developing cataract. 2, 3, 4

PrOVIDe also found that visual impairment was 2.5 times more common in people with dementia living in care homes.1 The Alzheimer’s Society have estimated that of the 850,000 people living with dementia in the UK, two-thirds live in private households and one-third live in some form of institutional care setting.

PrOVIDe found that almost 50% of people with dementia and a visual impairment were no longer classified as visually impaired when wearing their up-to-date spectacle prescription.1 Something as simple as a full eye examination carried out by an optometrist, who can provide this up-to-date prescription, can help immensely. Eye examinations can also identify eye conditions that can have a large impact on vision but are correctable via surgery, such as cataracts. Evidence suggests that cataract surgery can improve quality of life, and may even slow cognitive decline in people with dementia.  

During the study, carers and care workers were pleased to learn that people with dementia who found it difficult to communicate could have a full eye examination, and that optometrists were able and willing to make adjustments; these adjustments were much easier to make if the optometrist was informed ahead of time. However, almost all participants of the project (over 700 people with dementia) were unaware of the availability of NHS funded free eye examinations at home or in care homes.1 The availability of NHS funded free domiciliary eye care needs to be more publicised to both people with dementia, carers, and care homes themselves. 

Following our response to the NICE consultation on its dementia guidelines, NICE has made several changes to its guidance, including a recommendation that people with dementia should see an optometrist every 2 years, and should be referred if necessary. 

We have been working to ensure that our members have everything they need to support patients living with dementia:

  • A chapter on ‘Examining patients with dementia or other acquired cognitive impairment’ in our Guidance for professional practice, as well as supplementary guidance. 
  • Learning materials for our members regarding examining patients with dementia, including peer discussion case studies, a presentation on PrOVIDe, and an online course ‘See more: dementia and optometry’.
  • A briefing paper for our members, which summarised the findings of our PrOVIDe study.
  • We are currently working with the RCGP to signpost GPs to our PrOVIDe study to promote awareness about the link between vision and dementia.
  • We have encouraged our Members to sign up to the Dementia Friends program, run by the Alzheimer’s Society, in a blog written by one of our Clinical Advisers. 

References

1 The Prevalence of Visual Impairment in People with Dementia (PrOVIDe) study (2016) Bowen, M., Edgar, D. F.et al, Health Services and Delivery Research, 4(21), pp. 1–200. doi: 10.3310/hsdr04210

2 Concurrence of Danish Dementia and Cataract: Insights from the Interactions of Dementia Associated Peptides with Eye Lens α-Crystallin (2008) Surolia I, Sinha S, Sarkar DP, Reddy PY, Reddy GB, et al. PLOS ONE 3(8): e2927 

3 Cytosolic β-amyloid deposition and supranuclear cataracts in lenses from people with Alzheimer's disease (2003), L. E. Goldstein, J. A. Muffat, R. A. Cherny et al., The Lancet, vol. 361, no. 9365, pp. 1258–1265 

4 Is there any relation between pseudoexfoliation syndrome and Alzheimer's type dementia? (2013) T. Cumurcu, F. Dorak, B. E. Cumurcu et al, Seminars in Ophthalmology, vol. 28, no. 4, pp. 224–229, 2013. 

5 Interim trial results: cataract surgery slows cognitive decline in dementia, Alzheimer's Research UK [Accessed 21st June 2018]

6  About the Guidance, Guidance for Professional Practice [Accessed 21 June 2018]

7 Make a new friend this Dementia Awareness Week, College of Optometrists [Accessed 21 June 2018] 

 

 

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