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How vision loss and impairment could signal dementia

A UW Medicine ophthalmology professor is researching how certain age-related eye conditions could point to Alzheimer's disease. Better home testing can help.

SEATTLE — A Seattle-based ophthalmologist and researcher is hoping new and improved ways of gathering patient data from vision tests will help unlock the mysteries of Alzheimer's disease and other forms of dementia.

But what does eyesight have anything to do with memory loss?

Dr. Cecilia Lee, a professor of ophthalmology at UW Medicine, has been researching this question for years.

"The fact that the eye actually came out of the brain as a brain tissue during our embryology, it's quite a catch in terms of you being able to just literally use the eyeball as a window to the brain," Lee said.

For years, doctors have studied how certain eye conditions could signal dementia. Lee, who specializes in medical conditions of the retina, is exploring this more deeply.

"Other than skin, the eye is the only organ where you can see directly -- the tissue -- without cutting or without any kind of invasive method," Lee said.

Lee and her team are part of the Eye ACT study, a branch of its parent ACT study led by the Kaiser Permanente Washington Health Research Institute. The "Adult Changes in Thought" study launched in 1994 to better understand cognitive decline due to aging.

Age-related macular degeneration, or AMD's link to dementia, is among the conditions Lee is researching.

"It's not causative, but if we compare people who have AMD to people who never develop AMD, then their risk of developing Alzheimer's goes up by 50 to 60 percent," Lee said.

Alzheimer's disease afflicted up to 6.7 million Americans last year and that figure only keeps growing. The Centers for Disease Control and Prevention estimate that the number will triple by the year 2060.

A cure remains elusive, but scientists are working to understand the devastating disease.

Moreover, Lee's research was published in the latest update about dementia prevention in The Lancet Commission journal in July.

"We know that vision loss is highly associated with risk of developing dementia and Alzheimer's," Lee said.

Her findings showed impaired vision later in life, can be a factor in cognitive decline.

"So then the brain is really thinking overtime, trying to figure out, 'What am I seeing?' So then it's not able to spend time in forming new memories," Lee said.

Lee's team also found improved vision after cataract surgery decreased the risk of dementia by 30 percent.

Her work at UW Medicine's Karalis Johnson Retina Center uses advanced imaging technology to further her research.

"So now what we are saying is that let's go ahead and characterize the retina even better. Much better than just saying, this person had a diagnosis," Lee said. "We are able to really get a microscopic view of the retina in ten seconds," Lee said.

But more research is needed, as such correlations have been deemed in medical circles as "controversial," and conflicting with other neurological conditions, according to Lee.

Lee wants to gather as much data as possible to provide more clarity. Her ongoing study requires older patients' retinas to be examined every two years until they develop dementia, or not.

However, not everyone -- particularly older or disabled patients -- can make it to a clinic for the tests.

So Lee says, "We will come to you."

"The ACT study has had this capacity of doing home visits for many decades. Our study staff will take our machine, because they are pretty portable," Lee said.

For more information on Lee's other study opportunities, visit https://comp.ophthalmology.uw.edu.

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