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Peripheral Vision & Dementia

During #VisionHealthMonth we are focusing on vision changes that occur as we age, as well as how to assist our aging loved ones navigate this new normal.

In today's blog, we are discussing an area of vision change we often do not hear about - peripheral vision loss - and in particular how it affects those individuals with dementia.

Peripheral vision refers to part of sight outside of a person’s central field of vision and allows you to see objects to the side without having to move your eyes or head.

If you have ever noticed something out of the corner of your eye, it is likely that you were using your peripheral vision to do so! One simple way to see how your peripheral vision works, put your arms out to your side and wiggle your fingertips, you should be able to see them move while you are looking straight ahead.

Reduced Peripheral Range

In your youth, you probably enjoyed 180 degrees of clarity in front of you. As we age, our vision naturally narrows. During a person living with dementia, this process is on overdrive, so they might not notice a caregiver coming from behind, or even a plate of food in front of them if they're not looking at it directly.

Being unable to see things around you can make it easier to bump into furniture. It may also make someone with dementia startle more easily since they may not see someone coming towards them from the side. This is why you will hear people say, "Always approach a dementia patient from the front or side, not the rear.” You have probably heard this advice, but did you ever wonder why it works? Well, it's a result of the patient’s visual field. They can no longer sense you approaching them from the rear, and eventually, they will not be able to see you coming towards them from the side either.

Why does this happen? Vision is controlled by your brain, of course. When you have a disease such as Alzheimer's or dementia, this is affected, just like all other senses. But a shrinking visual field presents many more issues than just approaching a patient from the rear. Many times this has to do with peripheral vision loss. In the later stages of this disease, one’s peripheral vision weakens so significantly that it gets to where their sight is binocular or telescopic.

The following is an example from of how peripheral vision loss affects those with dementia during meal times.

Put your hands up to your eyes, form them as if you were looking through binoculars and consider what you see: Nothing but what is directly in front of you. Now again, with that in mind, think about when you or a staff member at a facility is feeding your loved one.

What do they see? They won't likely see that you are indeed feeding them. They most likely won't understand, even if you tell them you are feeding them. All they can see is this fork coming at them at the very last second. They can't see the food on the plate, they can't see that you are feeding them. What they do see is something, possibly a fork, or whatever they think it is, heading right for their face.

Not only does the brain have difficulty registering movement and objects surrounding the person, but it also experiences increasing challenges when it comes to processing the information it receives and turning it into a meaningful message or perception. Sometimes the conclusions the brain arrives at are incorrect and result in illusions, misperceptions or misidentifications of faces.

Caregivers commonly observe vision decline in dementia patients. People living with dementia commonly experience changes to their vision beyond what’s expected as part of the normal aging process. As dementia-related illnesses cause progressive brain deterioration, a person will experience certain sight deficits because the brain is no longer processing what the eyes see in the same way. Other common problem areas include:

Depth perception

The patient may exhibit difficulty in navigating steps, grabbing objects, and distinguishing between two- and three-dimensional scenes. With the latter, for instance, the person may try to pick up flowers from a floral-printed tablecloth. Depth perception can be seriously affected by visuoperceptual mistakes. When a patient is walking, they may not be able to tell when, for example, the floor changes from carpet to tile. If the tile or carpet is patterned, this can disorient them even further, which can certainly attribute to falls. A shadow or dark throw rug on the floor can also appear to them as a hole in the ground, which can be very frightening.

Facial recognition

Dementia symptoms include confusion and memory loss. But that may not be all that’s in play when a patient seems to not recognize a loved one or frequent visitor. Damage to certain parts of the brain may cause misidentification of people, like thinking a man is one’s brother instead of a husband. The problem similarly manifests itself in instances like seeing a red ball and calling it an apple.

Colour and contrast decline

Problems detecting contrast are commonly found in the bathroom, where the white toilet and seat disappear against a white tile floor. Mealtimes, already a challenge for some who struggle with swallowing, are problematic when, for example, white mashed potatoes aren’t noticed when served on a white dinner plate. Additionally, a reduced ability to distinguish colours may result in a person picking out mismatched clothing.

Ideal Caregivers 4u is here to help your senior loved one navigate their surroundings and assist with daily tasks such as meals, physical activities and personal care that may be affected by vision loss. Contact us today for more details!


"Improving the quality of life for our clients since 1998 while providing peace of mind to their families."

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