Older adults see better in the doctor’s office

Poor lighting prevents them from seeing as well at home

Older adults who have 20/20 vision in their eye doctors’ offices may not see as well at home. A new study from researchers at Washington University School of Medicine in St. Louis suggests dim lighting may be the culprit.

The study is published online in the journal JAMA Ophthalmology.

“It’s very common for older patients to have concerns about their vision but then test well on the eye charts when we examine them,” said first author Anjali M. Bhorade, MD, a Washington University ophthalmologist at Barnes-Jewish Hospital. “In this study, we found that vision in patients’ homes was significantly worse than in the clinic. The major factor contributing to this difference was poor lighting in the home.”

The researchers studied 175 patients ages 55-90. These included 126 with glaucoma. All patients had their vision measured at home and at the Glaucoma and Comprehensive Eye Clinics at the School of Medicine.

The average scores on vision tests were better in the clinic than at home, Bhorade said. Nearly 30 percent of the patients with glaucoma were able to read at least two or more lines extra on an eye chart in the clinic than on the same chart at their homes, and 39 percent of those with advanced glaucoma read three or more additional lines in the clinic.

The same results were observed with up-close vision. More than 20 percent of patients were able to read two or more additional lines of text at the doctor’s office than they did at home.

“Older adults with and without glaucoma had similar differences in vision between the clinic and home,” said Bhorade, an associate professor of ophthalmology and visual sciences. “These differences occurred not only with distance and near vision, but with contrast sensitivity and glare testing, too. The biggest difference we observed was for distance vision in patients with advanced glaucoma. They had even bigger declines in vision at home.”

The investigators were surprised by the percentage of older adults who were living with poor lighting.


“The lighting levels were below the recommended range in more than 85 percent of the homes we visited,” Bhorade said. “Since most older adults spend the majority of time at home, our study suggests that better lighting may increase vision and possibly improve the quality of life for a large number of people. The houses we visited were almost three to four times less bright than an average clinic.”

Although the study didn’t look specifically at potential dangers associated with low light, such as falls, other research has determined that a difference of two or more lines on an eye chart is associated with a significant difference in how a person functions in daily life.

The findings suggest that there may be a simple solution to ensure that older adults can function at their maximum potential, Bhorade said.

“Increased lighting in the home may improve significantly vision for older adults,” she said. “Our study results also suggest that not all older adults benefit from increased lighting. Clinicians should refer their patients for a customized in-home evaluation by an occupational therapist or low-vision rehabilitation specialist who can make suggestions to optimize the lighting in people’s homes.”

Funding for this research comes from the National Eye Institute (NEI) and the National Institute on Aging (NIA) of the National Institutes of Health (NIH), Pfizer, the American Glaucoma Society, the Harvey A. Friedman Center for Aging and Dr. John Morris grant, unrestricted grants from Research to Prevent Blindness and the Washington University Institute of Clinical and Translational Sciences Multidisciplinary Clinical Research Development Program.

NIH grant numbers 1K23EY017616-01, 5K07AG2116405, P30 EY02687.

Bhorade AM, Perlmutter MS, Wilson B, Kambarian J, Chang S, Pekmezci M, Gordon M. Differences in vision between clinic and home and the effect of lighting in older adults with and without glaucoma. JAMA Ophthalmology Online First, published online Nov. 21, 2013.
doi: 10.1001/jamaophthalmol.2013.4995

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.