Visual impairment in nursing home residents: The Blue Mountains Eye Study

Objectives: To assess the prevalence and causes of visual impairment, and the proportion of treatable eye conditions, among nursing home residents. Design and setting: The Blue Mountains Eye Study is a population-based survey of vision and common eye diseases in people aged 50 or older in two postcode areas west of Sydney. Nursing home examinations were conducted during 1993. Participants: Three representative nursing homes were selected from the nine in the study area. There were 128 residents aged 50 or older (64% females), representing 21% of all eligible nursing home residents in the two postcode areas. Main outcome measure: Blindness or visual impairment in one or both eyes. Results: Eye examinations were refused by five nursing home residents, and dementia precluded eye examination in 34 (28%) of the remainder. We found significantly higher prevalences (fivefold increase) of bilateral (11%) and unilateral (21%) blindness in nursing home residents compared with local community residents (bilateral, 0.5%; unilateral, 2%). In seven of the 10 blind nursing home residents, the blindness was potentially reversible (advanced cataract); late age-related macular degeneration (AMD) was the second most frequent cause of blindness, affecting one or both eyes of 12% of residents. Open-angle glaucoma affected 10% and advanced cataract 11%, a history of past cataract surgery was obtained in 14%. Conclusions: These data confirm earlier reports of a substantial number of treatable eye diseases, particularly advanced cataract, in nursing home residents, and indicate a need for increased surveillance of these communities. The high rate of visual impairment and blindness, compared with similar age groups in the local community, suggests that visual disability may contribute to nursing home placement.