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Aging and the Eyes

Authored by Matthew Levine, Director of Communications, Research to Prevent Blindness

Overview

The eye, like the rest of the body, breaks down as we get older. Not only is sight crucial for many essential tasks of daily living, but by some estimates, 80% of the information we take in is through our eyes. Yet we seldom think about maintaining healthy vision until something diminishes our ability to see. Unfortunately, while 80% of blindness is preventable if detected and treated early enough, most vision loss cannot be reversed once it has occurred. 

Aging-related vision changes affect everyday activities we take for granted: reading the mail, shopping, cooking, walking safely, driving, and discerning the faces of loved ones. Job performance can be impacted. Limited vision can also cause a fear of falling, and the resulting, self-imposed reduction in mobility or activity has been associated with an overall decline in health, further exacerbating the challenges of aging. The cumulative impact of these changes can affect us on psychological and social levels, creating a sense of isolation and loss of freedom. Vision loss is among the most common chronic conditions associated with depression.

On an economic level, an individual’s loss of independence and an increasing reliance on others can affect their productivity as well, creating a drain on the economy. In 2014, eye disorders were responsible for $68.8 billion in direct medical costs (eye disorders are the fifth most expensive chronic condition to treat), but the total economic burden of vision loss and blindness in the U.S. – including loss of productivity by patients and their caregivers – was $145 billion.

The incidence of the major aging-related eye disorders – glaucoma, cataract, age-related macular degeneration, and diabetic eye disease – is rising dramatically in the U.S. population, driven largely by two factors: the aging of the population and the diabetes epidemic. By 2050, the population of people with vision loss and blindness is estimated to increase by approximately 150%. At that time, the total economic burden is expected to reach $717 billion, after adjusting for inflation. Scientists at the Centers for Disease Control and Prevention are already anticipating that the U.S. medical system will be overwhelmed by the growing caseload of patients with diabetic eye disease unless something is done to address the epidemic driving its rise. In fact, something must be done.

Americans are concerned about vision loss. According to a recent national public opinion poll, Americans fear losing their eyesight more than any other sense and are as scared of going blind as they are of getting Alzheimer’s disease, cancer, or HIV/AIDS. A large majority of those polled strongly believes that research to improve the prevention and treatment of vision disorders should be a priority for the federal government (which currently spends, on average, $2.10 per person each year on such research). And half of those polled also want industry, patient groups, and philanthropies to increase funding for eye and vision research.

The Impact of Major Aging-Related Eye Diseases

As we age, we all experience vision changes such as the loss of the ability to focus on close objects (presbyopia) or the ability to rapidly adjust to dark conditions (dark adaptation). In addition to the normal aging of the eye, there are major, aging-associated eye disorders that cause significant vision loss and blindness: cataract, glaucoma, age-related macular degeneration, and diabetic eye disease. Each is progressive and, in addition to stealing sight, contributes to a loss of quality of life. 

Funders Who Have Focused on Vision Loss and Aging Issues

Low vision rehabilitation programs offer a way to help patients deal with the daily tasks of living by helping them maximize the vision they have left, and by helping them set up their lives in a way that's more manageable. These programs are difficult to sustain through patient revenue due to the time required per patient. They do not generate reimbursement revenue sufficient to sustain operations and many of them are dependent on grants and support from foundations and other entities. Resources in rural areas may be limited, complicating matters for the homebound elderly, and requiring providers and nonprofit organizations to collaborate in trying to reach the public and get services to them.  

The Eyesight Foundation of Alabama is creating the Alabama Vision Coalition, which will fund a combination of support from ophthalmology, optometry, occupational therapy, and psychology to work together to help a patient who perhaps has been told that there's nothing much left to do to save their vision. The participation of area agencies on aging, senior centers, faith-based organizations, and community leaders will also be vital to the coalition, which will seek to connect people to all eye care services, including education about preventive and routine eye care/screenings/eye exams/surgeries.

Program partnerships with local Lions Clubs offer a number of opportunities for local funders to help increase access to eye care for the elderly. The Lions Clubs International Foundation SightFirst program funds the support of eye health care delivery systems, training and infrastructure development. Through this initiative, which operates domestically as well as internationally to create programs to address the vision needs of underserved populations, funders can work with a regional SightFirst technical advisor to assess local eye care needs and develop projects.

Funders seeking additional financial support in order to create a vision health resource for the elderly may want to consider joining with a local nonprofit in partnering with the Reader’s Digest Partners for Sight Foundation, an organization that is dedicated to increasing the self-reliance and dignity of blind and visually impaired persons by providing the tools and resources necessary to lead independent, productive lives. 

Research to Prevent Blindness (RPB) is a national nonprofit that supports research to develop treatments, preventives, and cures for all conditions that damage and destroy sight. RPB has granted hundreds of millions of dollars to cutting edge eye research, and fostered leadership in the vision research field. Recently, in an effort to accelerate vision research progress and efficiency, and driven by the urgency of the eye concerns of aging baby boomers, RPB organized and hosted the first-ever convening of leading vision research funders (a list of those organizations can be found at the end of this document) to explore the potential for collaborative initiatives and partnership projects. 

Trending Topics

Grantmakers interested in funding on issues of vision and aging should be aware of the following issues. Funders may also want to seek opportunities in the area of blindness prevention through education.

Loss of independence

There is an area of the science of blindness prevention that examines the consequences of vision loss beyond loss of sight. The goal of these studies is preserving quality of life and independence for those with vision loss, particularly the elderly. Investigators are revealing that loss of independence is connected to (and may even begin with) vision loss, and that loss of health may have roots there as well. They are also exploring modifications people can make to manage their lives in the unfamiliar territory of reduced sight. These findings are particularly important to the growing elderly population and retiring baby boomers, who may be starting to experience symptoms of age-related eye diseases. 

Modifiable risk factors

In a recent study of the association between vision loss and falling, participants’ homes were evaluated for “riskiness” in an attempt to quantify the scope of the disabilities created by vision loss. Measureable risk factors that are fixable included the amount of light in the house, the slipperiness of surfaces and the placement of furniture. Research into modifiable risk factors and measures to alleviate risk can help older adults maintain their independence.

Cessation of driving

Some of the earliest signs of diminishing independence caused by age-related low vision may surface as changes in mobility or driving behavior (well before a driver is asked to give up his or her license). Driving is a primary mode of transportation in the U.S., and especially important to those living alone and trying to maintain contact with others. Older drivers face increased risk due to slowdowns in visual processing speed (how quickly the brain processes information that comes in through the eyes); decreased contrast sensitivity, particularly at night; and problems with dark adaptation (the ability to see under low light conditions or adapting to sudden changes in lighting).

Falling and loss of mobility

Another frequent adverse event of aging that is related to vision impairment in older adults is falling. Falls are the leading cause of injurious death in persons over the age of 65, and decreased vision (particularly visual field and peripheral vision loss) is a major reason for these falls. In addition to changes inside the home, accommodations might also include training in how to change one’s gait, how to scan a scene with available vision, or tai chi to improve balance.

Vision loss and loss of health

Older adults with low vision often reduce their physical activity, sometimes by as much as 50% if their visual acuity is less than 20/40. That’s a drop-off in physical activity greater than that brought about by stroke, arthritis, or COPD. Efforts are needed to develop strategies and programs designed to help older adults with vision loss increase their physical activity in safe environments, and to adapt activities to accommodate their vision status. 

Vision loss and depression

More than one out of every ten U.S. adults who report vision loss has clinically meaningful symptoms of major depression. Studies have drawn a connection between depression and patients’ reduced adherence to treatments for chronic diseases, including diabetes and glaucoma, both of which can lead to permanent loss of sight if untreated.  While diminished sight can, indeed, limit one’s ability to perform specific tasks, it is a person’s self-reported sense of limitations that are connected to depression rather than actual measures of visual acuity. The presence of an eye disorder should alert eye care providers to the possible presence of depression, even if vision testing finds no medical cause for concern. 

Project Ideas for Grantmakers

  • Enhancing access to vision care and low vision services for the elderly in nursing homes.
  • Partnering with local vision care and low vision providers to educate communities on risk factors for/how to prevent aging-related vision loss.
  • Orientation and mobility (O&M) training services, which are not readily available in all areas and are important activities in conjunction with low vision rehabilitation.
  • Research on AMD, glaucoma, and diabetic retinopathy, including collaborations with institutions engaged in research/demonstration projects, using telemedicine and other advanced approaches.
  • Transportation services for the elderly with vision loss.
  • Support for reduced cost or free drug programs for those needing medications, such as glaucoma drops.

Summary

Aging-related vision problems impact aspects of everyday life required for independent living such as driving, reading, seeing at night, and walking. When vision loss is extreme, preparing meals, grocery shopping, managing one’s own money, using a telephone, housework, or taking medications can no longer be performed without the help of someone else. The need to fund basic, clinical, and translational research to understand, prevent, treat, and reverse vision loss remains ongoing, particularly in the area of aging-related eye diseases that affect large swaths of the population. Further studies are also required to understand and create solutions for the limitations placed on the elderly as the result of vision loss. 

Source: Research to Prevent Blindness May 2015

Resources

The National Eye Institute
The National Eye Health Education Program
The National Institute on Aging
National Institute on Disability Research and Rehabilitation (NIDRR)
National Alliance for Eye and Vision Research (NAEVR)
The Centers for Disease Control
The Lighthouse Guild
Restoring Vision to the Blind: The Lasker/IRRF Initiative for Innovation in Vision Science
The Silver Book: Vision Loss
More Vision Resources from Research to Prevent Blindness

Readings

Colleen O’Donnell, “The Greatest Generation Meets Its Greatest Challenge: Vision Loss and Depression in Older Adults,” Journal of Visual Impairment & Blindness, April 2005.

John E. Crews, D.P.A. and Frank J. Whittington, Ph.D., eds., Vision Loss in an Aging Society: A Multidisciplinary Perspective, American Foundation for the Blind, 2000.

Additional Funders in Vision Research

International Retinal Research Foundation: A private foundation that provides financial support of vision research directly, as well as through training fellowships, public awareness programs, and the promotion of the exchange of research findings.

Glaucoma Research Foundation: Stimulates innovative research and education in the search for a cure for glaucoma, the leading cause of preventable blindness. GRF is America’s oldest institution dedicated solely to fighting the disease.
 
E. Matilda Ziegler Foundation for the Blind: Partners with a council of leading scientists to guide individual grant-making, inviting promising young researchers to apply for funding for basic research.        
Macula Vision Research Foundation: Funds groundbreaking research with the hope of improving the lives of millions of people affected by visual impairment. The Karen and Herbert Lotman Foundation underwrites administrative and fundraising expenses, allowing MVRF to allocate 100% of donations to finding a cure.
  
BrightFocus Foundation: Founded in 1973 as the American Health Assistance Foundation, supports research on three diseases, macular degeneration, glaucoma, and Alzheimer’s disease. BrightFocus also provides public information and support services for those with conditions impairing the mind or sight.

American Federation for Aging Research: Supports healthy aging through biomedical research grants to researchers across the spectrum of disciplines that study age-related diseases and the ways we change as we grow older.

Fight for Sight: Grants funding to promising scientists early in their careers, providing a critical bridge for young researchers not yet in line for funding from major governmental or institutional funders.

Foundation Fighting Blindness: Has mission of driving research into cures and new treatments for the entire spectrum of retinal degenerative diseases. A leader in collaboration, the foundation currently funds 129 grants and 71 institutions. 

Lighthouse Guild: Created through the merger of Lighthouse International and Jewish Guild Healthcare, the Lighthouse Guild promotes research excellence through awards given to leading investigators. Lighthouse’s own Arlene R. Gordon Research Institute conducts research with a focus on assistive devices for people who have visual impairment.

Juvenile Diabetes Research Foundation (JDRF): Leading global organization funding Type 1 Diabetes (T1D) research. JDRF collaborates with a wide spectrum of partners and uses its scientific resources to better treat, prevent, and eventually cure T1D.

Prevent Blindness: Leading volunteer eye health and safety organization. Prevent Blindness provides screenings, trains service providers, runs public education programs, and supports research into cures for the diseases that threaten vision loss and blindness.