A survey has found that a remarkably high proportion of Baltimore nursing home residents are blind, prompting researchers to suggest that eye conditions are often neglected or passed off as inevitable problems of aging.
In a study of 499 residents, investigators at the Johns Hopkins School of Hygiene and Public Health found that 17 percent were blind -- a rate that is many times higher than that found among elderly people in the surrounding community.
Even more striking was the estimate that 40 percent of the blind residents suffered from ophthalmological problems that were either treatable or preventable. Among these people, the largest number had cataracts, a condition that can be reversed with surgery.
"In general, nursing home patients haven't gotten the kind of care that a typical community-dwelling patient would," said Dr. James Tielsch, a professor of international health who directed the study. "They are clearly an under-served population."
The study appears in today's New England Journal of Medicine.
Some medical directors, he said, are probably preoccupied with the more serious and obvious problems of incontinence and dementia -- afflictions that are among the central reasons that people enter nursing homes. But many doctors, he said, do not think to examine patients' eyes or refer them to specialists.
Dr. Tielsch conceded that some patients who are severely demented wouldn't benefit from surgery or other treatments because they would not notice the difference between one visual state and another. Others might be scared or confused by the treatments.
But many people in the early or middle stages of dementia are able to tolerate treatment and could maintain a much higher quality of life if they were able to see.
For the survey, researchers examined patients in 30 nursing homes, selecting only those who had previously lived in East Baltimore. The geographical focus was chosen so results could be compared with an earlier survey of adults living in neighborhoods near the Johns Hopkins Medical Institutions.
In the earlier study, researchers were surprised to find that one in 100 residents was functionally blind -- often from conditions that are preventable or treatable.
Both studies found that African-Americans fare worse when it comes to eye care.
The latest study showed that the prevalence of blindness was 50 percent greater among black residents of nursing homes than among whites.
Among residents 80 and older, for instance, 17.6 percent of the white residents were blind compared to 29.7 percent of the blacks. A similar disparity had been found between black and white residents in the general community.
In the entire sample, another 4 percent of the residents could see adequately if given the proper corrective lenses -- but were functionally blind because they did not have glasses or had gone so long without having their prescriptions updated.
Cataracts were, by far, the leading cause of blindness, followed by corneal disease, macular degeneration, glaucoma and diabetes.
Dr. Tielsch said glaucoma can often be effectively treated -- and blindness prevented -- with proper medical and surgical treatments, especially if it is caught early. Among diabetics, proper diet and insulin treatments can stave off blindness.
Dr. Rebecca Elon, medical director of the Johns Hopkins Geriatric Center, said the nursing home is unusual because it is located next to an eye clinic on Hopkins' Bayview campus in East Baltimore. That gives the residents unusual access to eye care, including doctors who are able to visit them at their bedside.
"But this study . . . makes all of us who do nursing home care stop and think, 'Have we given this adequate attention?' "
