The Association between Vision Impairment and Incidence of Dementia and Cognitive Impairment: A Systematic Review and Meta-analysis

Ophthalmology. 2021 Aug;128(8):1135-1149. doi: 10.1016/j.ophtha.2020.12.029. Epub 2021 Jan 8.


Topic: The magnitude and direction of the association between vision impairment and incident dementia and cognitive impairment in prospective cohort studies was estimated by systematic review and meta-analysis. The global burden of dementia associated with vision impairment then was estimated.

Clinical relevance: Because a predominant proportion of vision impairment is preventable or treatable, investigating its association with dementia may help to identify an important modifiable factor for the prevention of dementia.

Methods: A literature search was conducted using PubMed, Embase, Web of Science, and Google Scholar on September 15, 2020. Relative risks (RRs) were pooled using random-effects models and stratified analyses for subgroups representing different study characteristics. Publication bias was evaluated with funnel plots and the Egger test. The global burden of dementia associated with vision impairment was estimated based on the Global Burden of Disease Study data on the prevalence of dementia and vision impairment.

Results: In the meta-analysis of 14 prospective cohort studies with 6 204 827 participants and 171 888 dementia patients, the pooled RR associated with vision impairment was 1.47 (95% confidence interval [CI], 1.36-1.60). In the meta-analysis of 12 prospective cohort studies with 45 313 participants and 13 350 patients with cognitive impairment, the pooled RR was 1.35 (95% CI, 1.28-1.41). Stratified analyses showed that the associations of vision impairment with incident dementia and cognitive impairment were similar across methods of vision assessment, length of follow-up, and study quality. The global number of people with dementia associated with moderate or severe vision impairment in 2016 was 2.1 million (80% uncertainty interval, 1.0-3.3 million), which accounted for 4.7% (95% CI, 2.3%-7.5%) of the global burden of dementia. Economic inequality was significant for the burden of dementia associated with vision impairment.

Discussion: The overall quality of the body evidence was low because of the observational design of the studies included in the analysis. Vision impairment is associated with an increased risk of both dementia and cognitive impairment in older adults. Screening and treating vision impairment, especially in low- and middle-income countries, may help to alleviate the global burden of dementia.

Keywords: Cognitive impairment; Dementia; Meta-analysis; Population-attributable risk; Vision impairment.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Cognitive Dysfunction / epidemiology*
  • Dementia / epidemiology*
  • Humans
  • Incidence
  • Prospective Studies
  • Risk Factors
  • Vision Disorders / epidemiology*
  • Visually Impaired Persons / statistics & numerical data*