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Low Vision Linked to Cognitive Impairment


My health changed within the first year of moving Mom into our home. I PANICKED when I suddenly could not see out of my right eye. I had migraines before that crept into the day after a night of restless sleep and not drinking enough water, but nothing like this one. The first response was to call the optometrist and beg to be seen immediately. Thankfully, they squeezed me between appointments and quickly put me at ease.

I described how I suddenly started seeing shadowy blurred vision yet also a speckled aura and tv fuzz or static the longer it lasted. This strange effect lasted about an hour and dissipated by the time I sat in the patient chair. As I went through the eye exam and waited for the drops to dilate my eyes, I felt a sense of calm wash over me as my sight became clear again. This temporary loss of vision had never happened to me before. Then again, I had never lived through such extreme stress before our lives were turned upside down.

The optometrist explained that I had experienced an ocular migraine, an episode of vision loss in one eye, usually lasting less than an hour. These migraines are believed to happen when the blood vessels in your eye suddenly narrow, restricting blood flow. Dehydration is one of the most common causes of migraines, but when stress is involved, dehydration is often overlooked. She asked what kind of stress I had been under and how much caffeine or alcohol I had consumed because of the pressure. Once I explained becoming Mom’s full-time caregiver, she sighed deeply and explained how to avoid more migraines.

I found it ironic when the primary mode of prevention, without medication, was resting my eyes and reducing time spent in front of harsh lights. Rest was challenging to achieve after Mom moved in with us. I was far more stressed, filled with fear and anxiety, and doubted my ability to fulfill her needs while living connected with Frontotemporal Dementia. Then there were moments when I was confident because of the balanced routine I built for her, but I did not always want to follow through with it as our communication strained.

I knew I needed to create a balanced routine to be proactive in self-care to avoid experiencing more ocular migraines. Luckily, I was not driving when the first one came on suddenly. Even though the experience came and went, the feeling of losing my sight incentivized me to do whatever I could to rest my eyes, mind, and body throughout the day so I could have a restorative sleep overnight too.

This experience was scary, but it showed me what to be aware of when Mom spoke about similar symptoms later. Bargaining with her to drink more water became part of our daily routine. I used to think I was the only one stressing over her care, and she was along for the ride. As the years passed, I heard the comments about seeing tv fuzz and watched her movements while walking diminish. I did not have to ask her if she felt stressed. I knew how to respond to her needs to relieve the stress of losing her independence and quality of life.

Over a decade of caring for Mom showed me the difference between Mom being silly versus Mom trying to cover up. We laughed about so many silly behaviors because Mom loved making others laugh. The laughter also became the perfect cover-up. On good days we could all enjoy a chuckle or few and then dismiss the behaviors to another moment that Mom wasn’t paying attention. Upon reflection, I can say now that Mom was paying attention to the best of her abilities at the time.

Later, when Mom started to bump into things or people, it was not as funny and became more embarrassing for us from her crass excuses. She paid close attention to her Kindle tablet while she relaxed in a recliner, playing games, focused on less than a foot in front of her face. No peripheral vision was used until it came time to walk or climb stairs, then the challenge became noticeable. There were plenty of readers and expensive invisible bifocal glasses throughout the house and car consoles, but Mom only used them when she had to. Otherwise, I startled her when she could not see me approaching.

Most of us know to expect our eyesight to change as we reach our early 40s and 50s because it’s part of normal aging. It’s also due to the screen time and stress in our lives and how we cope. Mom’s concept of aging was based on her limitations instead of her daily habits. Being stuck in denial or reluctant to wear glasses because she looked old in the mirror or felt older than she imagined was a challenge for us all. Trying to help someone who does not want to be helped or understand why they need help (anosognosia) is frustrating.

I wondered if Mom was at risk, and we did not know either. I have this repetitive thought now that sounds like the reverse of a country song, “I wish I knew then what I know now.”

Mom used to pinch the air above her face and say, “Do you see it? There’s a fly.”

The optometrist examined her and told me that Mom had a floater, a small dark shape that looked like a thread, squiggly line, or little cobweb. It resembled a fly to Mom because it bounced around with her vision as she looked left to right. Although various reasons cause floaters, I believe one reason is diabetic retinopathy was possible for Mom as a diagnosed pre-diabetic that danced over the line regularly.

Diabetic retinopathy is an eye condition that can cause blindness in people with diabetes. High blood sugar affects the retina’s blood vessels, making you light-sensitive. In my early years of caregiving, Mom used to leave the television on 24/7 and live by dim light. High blood sugar blocks the tiny blood vessels that go to your retina, causing them to leak fluid or bleed. Even if your body attempts to compensate by growing new blood vessels, they typically don’t work, leak, or bleed.

I opened the blinds during every visit and turned on lamps in the evening, yet she was back in a dimly lit living room each day I returned. Mom always preferred the dark. I used to think this way of living was so depressing, but now I know this was another limitation she blamed on aging and learned to exist alone without asking for help. The problem with dismissing problems related to low vision as aging is losing valuable time to make a difference in daily habits to preserve your sight. It could be as simple as limiting screen time and maintaining a healthier lifestyle.

Our eyes are how we see the world and process information. When our lifestyle hinders our senses, we lower our ability to experience a better quality of life. We are exposed to disabilities such as low vision, which is not correctable through glasses, contacts, or surgery. There are some tools and practices to help improve your vision, though.

If you suspect your loved one has withdrawn from activities they love or engaging with others, it may be time to encourage routine eye exams. They may not admit to feelings of depression or stress. However, isolation and depression are also deemed early signs of Dementia. If your loved one has diabetes or heart disease, their risk of having low vision and Dementia increases.

Sometimes the signs are present, yet we are not ready to accept them. Reacting to life is human nature because we cannot predict our future or cope with our loved one’s decline in the present moment. Recognizing the symptoms of diminishing abilities to be proactive with your self-care is life-changing for caregivers and their loved ones.

Consider the information below from the NIH National Eye Institute.

Who is at risk for low vision?

Age-related disorders like macular degeneration and glaucoma will affect adults over age 45 but are more common for those over 75. Having diabetes doubles your risk of developing a type of glaucoma.

What causes low vision?

Age-related macular degeneration

Glaucoma

Cataract

Diabetic retinopathy

Brain injury

Inherited disorders

What are the signs of low vision?

Blurry vision, not seeing well enough to do everyday tasks like reading and driving.

Being unable to recognize people’s faces or tell colors apart.

Unable to see your television or computer screen clearly (aka. tv fuzz, static, hazy, or granular).

Night blindness, peripheral or central vision loss.

How is low vision treated?

Telescopic glasses

Lenses that Filter Light

Magnifying glasses

Hand magnifiers

Closed-circuit television

Reading prisms

I am grateful I had the chance to care for Mom in our home because she taught me more than she could imagine. Learning about ocular migraines and low vision early became part of my Proactive Caregiver routine. Protecting my vision is as important as protecting my heart and gut. Can you see why?

Your eye doctor can check for low vision during a dilated eye exam.




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