Clinical

Eye examinations for people living with dementia

Objective testing that does not depend on the person answering questions, in the room they already know.

Home/Services/Dementia
The problem

Why is vision missed in dementia?

The signs of vision loss look like the signs of cognitive decline: withdrawing at meals, not recognising faces, hesitating at a step, managing worse in dim light. A resident who cannot describe what they see is unlikely to have a vision problem identified as one.

Up to 60% of aged care residents have some vision impairment, against roughly 5% of people over 70 living in the community.3 Among residents who had an eye condition recorded, fewer than half accessed an eye health service in their first year.4

Sudden vision loss, a curtain across the vision, new flashes and floaters together, or a red painful eye need same day care.

The evidence

Vision loss and dementia risk

Untreated vision loss in later life is one of 14 modifiable dementia risk factors named in the 2024 Lancet standing Commission, and one of only two added in that report. The Commission attributes about 2% of dementia cases to it.1

Cataract, glaucoma and retinal disease are painless and treatable. A person who cannot see is more distressed, falls more, and joins in less.

Objective testing

How do you examine someone who cannot answer?

Most of a comprehensive eye examination is objective. The optometrist measures what the eye is doing, so the assessment does not depend on the resident following a question.

Retinoscopy

An objective refraction. Light is shone into the eye and the reflection read to find the prescription. The resident says nothing.

Autorefraction

An instrument measurement of the focusing error, used alongside retinoscopy to confirm the result.

Behavioural acuity

Where letter charts are not possible, vision is estimated from fixation, following a face or an object, and preferential looking cards.

Tonometry

Eye pressure, for glaucoma. Nothing is asked of the resident.

Slit lamp

The lids, cornea, anterior chamber and lens, including how far a cataract has progressed.

Retinal imaging

A photograph of the retina and macula, examined afterwards and not in front of the resident.

Together these produce a spectacle prescription, an assessment of eye health, a referral where one is needed, and a written record. The same outputs as any other comprehensive examination.

On the day

How is the visit adapted?

  • Time of day. We ask the home which part of the day suits the resident, and schedule to it where the roster allows
  • Familiar surroundings. For a resident unsettled by being moved, we work in the room they already know
  • A familiar person nearby. A care worker or family member reduces distress, and often supplies the history the resident cannot
  • Shorter blocks. The most important measurements are taken first, so a shortened visit still produces something useful
  • One instruction at a time, spoken from the front, with time to respond before it is repeated
  • Stopping. When a resident becomes distressed the examination stops. Pushing on produces unreliable results and a resident who refuses next time
  • Drops only where needed. Retinal imaging often gives an adequate view without dilation. Where drops are used, the care team is told, because vision is blurred for a few hours
Dispensing

Will new glasses help?

A new prescription only helps if the glasses end up on the face. For some residents they will, and the change is immediate. For others they will be taken off, lost or refused.

Where that is the likely outcome we say so. Brighter and more even lighting, higher contrast at the edges of steps and tables, larger print and reducing glare often do more than a lens change, and cost less.

Where glasses are dispensed, they are labelled, fitted on a return visit, and the old pair is kept as a spare. Nothing is ordered without the resident or their person responsible agreeing, with the price known first.

Signs

What to watch for

Vision problems in dementia show up as behaviour rather than complaint. Any of these is worth an examination.

Reaching and moving

Reaching for a cup or a handrail and missing it. Bumping into things consistently on one side. Hesitating at steps, thresholds and changes in floor colour.

Looking and reading

Holding a paper very close, or turning the head to look at you. Giving up television, cards or reading without another explanation.

Faces and meals

Not recognising a familiar face until the person speaks. Eating only what is on one side of the plate.

The eyes themselves

Repeatedly rubbing one eye, or keeping it closed. Managing noticeably worse in dim rooms and corridors, or as the light drops in the afternoon.

Reporting

What goes in the report?

Every resident seen generates a written report covering what was assessed, what was found, the prescription if one was issued, what could not be assessed and why, and what happens next.

Cognitive impairment is Outcome 5.6 of the strengthened Aged Care Quality Standards, and comprehensive assessment and facilitated access sit at actions 5.4.2 and 5.4.3.2

Where we work

Where does the examination happen?

The examination happens in the clinic vehicle at the home, in a room the facility provides, or at the bedside. For a resident who is unsettled by being moved, the room they already know is usually the better choice, and we bring the instruments to them.

Questions

Dementia and eye examinations

Can someone with dementia have a proper eye examination?
Yes. Most of a comprehensive examination does not depend on the person answering questions. Retinoscopy, autorefraction, tonometry, slit lamp examination and retinal imaging are all objective, so a prescription and a view of the eye health can be obtained from someone who cannot describe what they see.
What if they cannot say which lens is clearer?
That part is skipped. Retinoscopy gives an objective refraction, where the optometrist reads the reflected light rather than asking a question. It is how children and non verbal patients have been refracted for decades and it is accurate enough to prescribe from.
Will they sit still long enough?
Often not for a full hour in one go, and the examination is built around that. We work in shorter blocks, take the most important measurements first, and stop when distress starts. What was not completed is written into the report and picked up next visit.
Is it worth it if they will not wear the glasses?
Where new glasses are unlikely to be worn, better lighting, higher contrast and larger print often help more, and we say so. The eye health examination is worth doing either way, because cataract, glaucoma and retinal disease are treatable and painless until late.
Does poor vision make dementia worse?
Untreated vision loss is one of 14 modifiable risk factors named in the 2024 Lancet standing Commission on dementia, which attributes about 2% of dementia cases to it. Being unable to see also makes a person more distressed, more likely to fall and less able to join in.
Can a family member be there?
Yes, and it usually helps. A familiar face reduces distress, and a relative can often tell us what has changed, which the resident may not be able to. Tell us when you book so the time is allowed.
Do you use dilating drops?
Only where they are needed and where the resident tolerates them. Retinal imaging often gives an adequate view without drops. Where dilation is required, the care team is told, because vision is blurred for a few hours afterwards.
Where does the examination happen?
In the clinic vehicle parked at the home, in a room the facility provides, or at the bedside. For a resident who is unsettled by being moved, the room they already know is usually the better choice, and we bring the instruments to them.

Written and reviewed by

Ali Selman, Bachelor of Vision Science, Master of Optometry. AHPRA registered optometrist. Last reviewed 23 August 2026.

Sources

  1. Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 31 July 2024. doi:10.1016/S0140-6736(24)01296-0. Fourteen modifiable risk factors, of which untreated vision loss in later life is one of two added in 2024, with approximately 2% of cases attributable to it. ucl.ac.uk
  2. Aged Care Quality and Safety Commission. Guidance material for the strengthened Aged Care Quality Standards, Standard 5 Clinical care. Outcome 5.6 Cognitive impairment, Outcome 5.5 Clinical safety, and actions 5.4.2 and 5.4.3. Commenced 1 November 2025. agedcarequality.gov.au
  3. Holloway EE, Constantinou M, Xie J, et al. Improving eye care in residential aged care facilities using the Residential Ocular Care (ROC) model: study protocol. Trials 2018;19:650. Up to 60% of aged care residents have vision impairment, against 5% of adults over 70 living independently in the community. Adequate refractive correction could improve vision in up to 50% of nursing home residents. doi.org/10.1186/s13063-018-3025-5
  4. Khadka J, Ratcliffe J, Caughey GE, Wesselingh SL, Inacio MC. Prevalence of eye conditions, utilization of eye health care services, and ophthalmic medications after entering residential aged care in Australia. Translational Vision Science & Technology 2021. Of 409,186 people studied, 43.6% (N = 178,367) had an eye condition, and 46.4% (N = 82,769) of those with an eye condition accessed at least one eye health service within the first year. tvst.arvojournals.org
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