Optometric management of patients with Alzheimer's disease

The earliest symptoms of Alzheimer's disease (AD) may be visual. AD is an age-related, progressive dementia. At least 7% of Americans over 65 years of age are afflicted, and it ranks as the fourth leading cause of death in the United States. A review of the literature was performed to delineate the visual manifestations of Alzheimer's disease.

Abnormal visual perception and visuospatial processing are common among patients with AD Visual acuity, pupillary light reflexes, and the ocular fundus do not appear to be specifically affected by AD. Whether AD impairs color vision is controversial. Stereopsis may also be affected. True visual-field defects are rarely found. Although not universally reported, some studies of contrast sensitivity functions show abnormal sensitivity possibly at low spatial frequencies. The electroretinogram is normal, while the visual evoked response is frequently abnormal.

As primary eye care providers, optometrists must properly identify and refer individuals with suspected Alzheimer's disease to the appropriate specialist, as well as manage their visual welfare.