Visual Impairment in Elderly Patients Receiving Long-term Hemodialysis

Background

Visual impairments are associated with low quality of life, impairment of daily activities, and accidental falls. As dialysis patients are increasingly older and more disabled, we sought to assess visual impairments within an elderly dialysis population. Based on data from the general population, we hypothesized that more than 30% of dialysis patients 65 years or older would have visual impairment manifested by loss of visual acuity, depth perception, or contrast sensitivity.

Study Design

Single-center cross-sectional study.

Setting & Participants

Patients established on hemodialysis therapy, age older than 65 years.

Outcomes

The proportion of elderly hemodialysis patients with impairments in visual acuity, contrast sensitivity, and depth perception.

Measurements

Lighthouse Near Visual Acuity Test, Lea Screener contrast sensitivity test (Goodlite, MA, USA), Titmus Stereotest, Folstein Mini-Mental Status Examination.

Results

152 of 159 patients (95.6%) had visual acuity levels less than age-expected values. Under North American (American Medical Association, edition 4) guidelines for disability compensation, 62 patients (39.0%) fulfilled criteria for legal blindness. Sixty patients (37.0%) had poor contrast sensitivity and 48 (30.6%) failed the Housefly component of the Titmus Stereotest. Failing the Housefly component was associated with a lower Folstein Mini-Mental Status Examination score (23.4 ± 4.2 v 25.1 ± 3.5; P = 0.01).

Limitations

This study is limited by the cross-sectional study design and abbreviated test protocol used for vision assessment.

Conclusions

Results of this study suggest that elderly hemodialysis patients have a high frequency of visual impairment. Formal low vision assessment and low vision rehabilitation may be useful in elderly dialysis patients. Additional study is required to determine whether the absence of depth perception in this patient group is associated with deteriorating cognitive function.

Index Words: Hemodialysis, elderly, visual impairment, low vision, low vision rehabilitation, falls, cognition