Why Early Detection and Prompt Treatment of Cataracts Is Essential, especially for Patients With Dementia

Cataracts are one of the most treatable causes of vision loss, yet they often go undiagnosed or undertreated in patients living with dementia. At the 2025 European Society of Cataract and Refractive Surgeons (ESCRS) meeting in Copenhagen, experts emphasized a powerful message: restoring sight early can significantly improve quality of life and may even help slow decline.

Vision Loss and Dementia: A Critical Connection

Dementia is increasingly common as the population ages, and mounting evidence shows that sensory impairments — including vision loss — may accelerate its progression. Much like hearing loss, untreated cataracts can reduce a patient’s ability to interact with their environment, which may worsen confusion, anxiety, and functional decline.

Research underscores the scope of the problem. In the PrOVIDe study, Bowen and colleagues found:

• 50% of individuals with dementia had uncorrected refractive error

• 32.5% had vision worse than 20/40

• 16.3% had vision worse than 20/60

• Cataracts were the leading cause of visual impairment

Despite this, cataract surgery rates drop significantly after a patient is diagnosed with dementia. A Finnish study by Hokkinen and colleagues showed that patients with dementia were far less likely to undergo cataract surgery compared with age-matched controls — even when the procedure could meaningfully improve their independence and well-being.

Why Early Cataract Surgery Matters

During the symposium, ophthalmologists Cathleen M. McCabe, MD, and Paul G. Ursell, MD, stressed the importance of identifying and treating cataracts early. As Ursell explained,“Fix the roof while the sun is shining.”

If cataracts are removed before dementia progresses, patients are more likely to tolerate examinations, participate in their care, and attend follow-up visits. Delaying treatment can make evaluation difficult, especially when patients struggle to communicate symptoms or may forget scheduled appointments.

Dr. McCabe emphasized that untreated vision loss is a modifiable risk factor — one that may influence cognitive health.

“We have a responsibility because maybe we can do something to prevent progression of dementia,” she said. “Visual restoration can help support good brain health.”

The bottom line: early cataract treatment can provide clarity, comfort, and improved daily function for patients facing cognitive challenges.

Challenges in Diagnosis and Preoperative Evaluation

Diagnosing cataracts in patients with dementia can be difficult. Visual decline is often mistakenly attributed to dementia itself, leading caregivers and even health professionals to overlook treatable eye disease.

Dr. McCabe outlined several considerations:

• Some patients struggle with fixation or following instructions

• Handheld keratometers or immersive A-scan devices may be needed

• Objective tests should be correlated with reports from family or caregivers

• Intraocular lens (IOL) selection should reflect the patient’s needs and lifestyle

Because patients with dementia often rely heavily on intermediate and near vision, lens choice should be tailored thoughtfully. Importantly, Dr. Ursell advised avoiding multifocal IOLs, as neuroadaptation may be hindered by cognitive decline.

Surgical Considerations and Anesthesia

Many patients with mild to moderate dementia can undergo cataract surgery with light sedation and careful verbal reassurance. For those with severe cognitive impairment or agitation, general anesthesia may be appropriate.

Dr. Ursell addressed concerns about postoperative cognitive dysfunction, noting that cataract surgery is brief and carries no greater cognitive risk than local anesthetics. In fact, for some patients, immediate sequential bilateral cataract surgery — performing both eyes on the same day — may be ideal. This approach:

• Reduces the need for multiple anesthetic events

• Simplifies postoperative care

• Eliminates the adjustment period between surgeries

Clear guidelines exist to ensure this option is both safe and effective.

Postoperative Care: Simplifying the Process

Standard postoperative drop regimens can be challenging for individuals with dementia. Multiple prescriptions and tapering schedules may be confusing or difficult for caregivers to manage.

Dr. McCabe strongly recommended alternatives such as:

• Combination drop therapy, or

• Dropless cataract surgery, which eliminates the need for postoperative drops altogether

Studies show these dropless approaches are just as effective in preventing inflammation, pressure spikes, and other common concerns.

Protecting the eye after surgery can also require extra support. Some patients may resist shields or be prone to rubbing their eyes, making caregiver involvement essential during recovery.

A Highly Effective, Cost-Efficient Treatment

While billions of dollars have been invested in dementia research — with limited pharmaceutical breakthroughs — cataract surgery remains one of the most reliable, impactful interventions available. As Ursell noted, only a handful of dementia medications have emerged from more than 1,100 clinical trials over 30 years, and many offer modest benefit.

In contrast, cataract surgery is predictable, low-risk, improves quality of life immediately, and costs a fraction of many medical treatments.

The Takeaway

For patients living with dementia or at risk of cognitive decline, clear vision plays a vital role in maintaining independence, safety, and overall well-being. Early detection and proactive intervention can make all the difference.

By recognizing cataracts early and prioritizing timely surgery — with thoughtful planning, compassionate communication, and simplified postoperative care — ophthalmologists can help preserve both vision and quality of life for this vulnerable population.

Sources/Disclosures

Source:

McCabe C. Surgical and diagnostic considerations. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 12-16, 2025; Copenhagen, Denmark.

References:

• Bowen M, et al. Health Soc Care Deliv Res. 2016;doi:10.3310/hsdr04210.

• Hokkinen K, et al. Acta Ophthalmol. 2022;doi:10.1111/aos.14896.

• Ursell PG. Dementia and cataract surgery: Can we use simultaneous vision IOLs? Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 12-16, 2025; Copenhagen, Denmark.

Disclosures: McCabe reports grant or research support from Alcon, Lensar, and Rayner; consulting for Alcon, Bausch + Lomb, BVI, Lensar, Rayner, and Zeiss; and being on the speaker bureau for Alcon, Bausch + Lomb, Rayner, RxSight, and Zeiss. Ursell reports no relevant financial disclosures.