Dementia can change far more than memory. It can change how a person sees the world, even when their eye exam looks “normal,” says Natali Edmonds, PsyD, ABPP. “When it comes to dementia, the vision changes are greatly impacted by the brain’s ability to process and understand what’s being seen.” Edmonds identified the common vision changes in dementia as tunnel vision, depth perception problems, color and contrast loss and visual misrecognition.
Tunnel vision: Tunnel vision is a condition “when the person with dementia can only see what is directly in front of them.” Side (peripheral) vision is lost. It’s like looking through a narrow tube for them.
Depth perception: A person with dementia may begin to have difficulty accurately judging how close or far an object is. You might notice they are more hesitant around stairs or they might reach for a cup and miss it. “This is happening because the brain’s spatial processing areas are impacted. Depth perception may decrease slightly for all of us, but in dementia it’s more significant.”
Color and contrast sensitivity: A white plate on a white tablecloth might seem to disappear or dark rugs might look like holes in the floor. “In normal aging, some color loss can be normal, especially with blues and greens. That’s OK, but in dementia, the brain’s visual pathways are disrupted, so even with perfect eye health or perfect prescriptions, the color contrasts seem to blend.” Making the contrasts greater can help. For instance, swapping out a white toilet seat cover with a sunny yellow or royal blue one will be easier for someone with dementia to see.
Visual agnosia: This is a condition in which a person can see an object or face, but has trouble recognizing it.
“It’s not about their eyesight; it’s about their brain not being able to understand what they are seeing. They might use their pen as a toothbrush, for instance. Sometimes what could help here is to literally call out the item as you hand it over. ‘Here’s your pen.’”
If you suspect your loved one with dementia has vision changes, you may want to consider making the following adjustments:
- Use high contrast colors when you can: a brightly colored plate on a white tablecloth and different color plates for different purposes. Put colored tape on doorframes to make them easier to identify.
- Simplify the environment. Remove clutter. Your person may not be able to see items that are outside their own (tunnel) vision.
- Place easy-to-read labels on frequently used drawers.
- Improve lighting. Bright, even lighting can reduce shadows, which can be misinterpreted as people, animals and holes. Use nightlights in the hallways. But eliminate glare. Floors that are shiny may be uncomfortable to look at and be perceived as wet. Consider covering or removing mirrors, which may be perceived as a real person and startle your care partner.
Natali Edmonds is a board-certified geropsychologist and the creator of Dementia Careblazers (www.careblazers.com).