Visual loss is a common age-related condition. For people living with dementia, visual impairment can compound cognitive challenges, affecting independence, communication, and quality of life.
This article features how visual loss can impact persons living with dementia (PLWDs) and practical tips from care partners Lybea Lau and Rosalind Chan, on managing visual loss in PLWDs.
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Introduction
Visual loss is often characterised by specific patterns of sight degradation, mainly due to conditions like age-related visual loss (ARVL), cataracts, glaucoma, and diabetic retinopathy. A study by Singapore Eye Research Institute (SERI) found that about 43% of older adults in Singapore have visual impairment, often from treatable causes, while up to 90% of those with conditions such as age-related macular degeneration and diabetic retinopathy remain undiagnosed. 1.
Understanding Visual Loss in Late Life
Most visual loss in older adults commonly arise from three categories:
Caused by a condition or disease of the eye. The most common eye diseases are age-related macular degeneration (AMD), glaucoma, and cataracts.2
This is where another disease leads to someone developing vision loss e.g. diabetic retinopathy. Diabetes is also a risk factor for dementia.
This is when loss of vision occurs due to neurological causes, such as problems with the nerve cells in the eye or the brain.
Dementia-Related Visual Difficulties
Persons living with dementia may develop visual difficulties during their diagnosis, particularly Alzheimer’s disease, which can directly affect vision.
For instance:
- Visual Processing Impairment: A lesser-known symptom of Alzheimer’s disease is its effect on visual processing and depth perception. 3During one’s diagnosis, the brain regions responsible for interpreting and recognising visual stimuli may slowly start to deteriorate, leading to difficulties with visual perception (e.g., difficulty recognising faces, interpreting spatial information, or judging distances).
- Cortical Blindness or Visual Agnosia: Certain types of dementia (like posterior cortical atrophy) can cause visual agnosia. This form of agnosia is an atypical non-memory form of Alzheimer’s disease. 4 This can cause individuals lose the ability to recognise objects, even though their eyes are functioning well.
How Visual Loss Impacts Persons Living with Dementia
Persons living with dementia who also experience visual loss face significant challenges in performing everyday tasks. Caregivers Lybea Lau and Rosalind Chan share how visual impairment can complicate everything from eating to walking.
Rosalind Chan, care partner to her husband Darren, who was diagnosed with Alzheimer’s disease and has experienced deteriorating vision.
Lybea Lau, care partner to her husband Andy, who is currently living with dementia and glaucoma.
Early studies suggest persons living with dementia experiencing visual loss may experience a loss of safety and independence.5 The inability to compensate for poor memory with visual cues impaired their loved one’s ability to manage everyday tasks.
For Lybea, her husband Andy’s glaucoma has increased his need for assistance with basic activities, such as dressing, grooming, and even eating. This loss of autonomy led to frustration and a decrease in confidence, making it harder to carry out day-to-day tasks without help.
Similarly, Rosalind shared that visual loss has intensified her husband Darren’s fear of moving around alone safely.
Disorientation is another key impact of visual loss in persons living with dementia. Research suggests, when vision declines, it becomes harder to recognise familiar places and people, which can lead to anxiety and distress. 5 Lybea’s husband Andy tends to become increasingly anxious in public spaces, especially when surrounded by crowds.
Likewise, Rosalind notes that Darren’s difficulty with spatial awareness makes it harder for him to process instructions which increases his anxiety. This also makes Rosalind more cautious when guiding Darren.
Visual loss has also found to lead to isolation.5 Persons living with dementia may have reduced ability to engage in activities such as social outings, games or previous hobbies, resulting in withdrawing themselves from these social interactions. Both Lybea and Rosalind observe that their loved one’s struggle with confidence in social settings due to difficulty engaging in activities they once enjoyed.
Care Partner Perspectives: Real-Life Tips
Caregivers supporting a loved one through gradual visual loss can feel overwhelmed and deeply personal. Care partners, Lybea and Rosalind, share their experiences and tips in navigating this path.
Environmental Adjustments
Creating a safe, navigable environment helps maintain independence and reduce accidents:
- Install grab bars in bathrooms and at main entrances.
- Keep floors dry and walkways free of furniture, wires, and other obstacles.
- If your loved one has glaucoma keeping lights on in key areas, such as hallways and bathrooms, especially at night.
- Keep the bathroom floors dry to prevent falls and slips.
- Use adaptive devices such as nightlights or motion sensor lights, strategically located for night-time safety.
Caregiver Insights
- Keep the house brightly lit and minimise clutter, especially in areas your loved one frequents. It helps them feel more confident moving around. –Rosalind Chan, Care Partner
- Carry a torch when going out at night and provide guidance in advance for steps or uneven terrain. – Lybea Lau, Care Partner
Daily Life and Routine Adjustments
Routine tasks may need additional support or modification:
- Assist with tasks such as dressing, grooming, eating, and mobility, particularly when vision is limited.
- Walk closely beside the person or hold their hand for reassurance and stability.
- Provide clear, step-by-step directions and encourage trust in guidance to reduce anxiety and prevent disorientation.
- Encourage your loved ones to engage in activities they enjoy while they still have usable vision.
For example, Rosalind shared that Darren enjoys singing, so she encouraged him to read song lyrics and follow lip movements while singing. Practising these activities early can help build familiarity and muscle memory as vision declines.
Tips from Rosalind, Care Partner
- Encourage your loved one to touch and feel objects, which helps compensate for limited vision.
- Instructions will not always be verbal. Sometimes caregivers must guide and steady them by holding their hand when using stairs or escalators.
Preventive and Supportive Measures
- Encourage regular eye check-ups for early detection of eye diseases like glaucoma early.
- You can self-check your vision with the EySEE application which simulates how a healthcare professional would check the Visual Acuity of a person. Click here for more information.
- Individuals with diabetes are at higher risk of vision loss and eye diseases. Attend scheduled eye examinations diligently.
Tips from Lybea, Care Partner
- Check for any known family history of eye diseases to anticipate potential challenges.
Key Takeaways for Caregivers
- Reassure your loved ones and encourage them to trust your guidance.
- Emotional reassurance reduces anxiety in unfamiliar or busy environments.
- Environmental modifications significantly improve safety and independence.
- Regular medical follow-ups can prevent or decelerate further vision loss.
Conclusion
For people living with dementia, visual impairment can compound cognitive challenges, affecting independence, communication, and quality of life. Lybea Lau and Rosalind Chan’s experiences show how combining practical strategies with emotional reassurance can preserve dignity, confidence, and connection for persons living with dementia experiencing visual loss.
- Teo, J. (2026, February 24). Most older Singaporeans unaware of eye disease, study finds. The Straits Times. https://www.straitstimes.com/singapore/health/over-1-in-3-seniors-have-undiagnosed-eye-disease-1-in-5-have-serious-hearing-loss-study
- Singapore Association of the Visually Handicapped. (n.d). Common Eye Diseases. SAVH. https://savh.org.sg/common-eye-diseases/
- Rauch, K. (2022, July 26). Alzheimer’s Disease, Dementia and the Eye. American Academy of Ophthalmology. https://www.aao.org/eye-health/diseases/alzheimers-disease-dementia-eye
- Murray, E., M. (2024, April 15). When Alzheimer’s Disease Begins with Vision Problems. Alzheimer’s Disease Research. https://www.brightfocus.org/resource/when-alzheimers-disease-begins-with-vision-problems/
- Lawrence, V., Murray, J., Ffytche, D., & Banerjee, S. (2009). “Out of sight, out of mind”: A qualitative study of visual impairment and dementia from three perspectives. International Psychogeriatrics, 21(3), 511–518. https://doi.org/10.1017/S1041610209008424
- Singapore National Eye Centre (n.d). EySEE- Self Check Eye Test. SNEC. https://www.snec.com.sg/patient-services/e-services/eysee