Walter Kuntz: Everything is just so, so much brighter. Colors are just unbelievable, beautiful. I guess that's the way they were 50 years ago when I was a kid and didn't realize it. Allison Sekuler: That's Walter Kuntz. When he noticed his vision was going downhill, he didn't just turn a blind eye. He got cataract surgery, it cleared up his eyesight and it probably gave his brain a boost too. Jay Ingram: Welcome to Defy Dementia, the podcast for anyone who has a brain. Allison Sekuler: Defy Dementia is all about living in ways that keep our brains healthy and reduce our risk of dementia, because dementia is not preordained by our genes. Genetics can play a part, but lifestyle risk factors like poor sleep and smoking can also have a major impact. Jay Ingram: And according to the very best evidence that research has to offer, scientists are saying that if we make healthy changes to those lifestyle risk factors, we could reduce dementia cases worldwide by at least 45%. Allison Sekuler: Today on the show, we're looking at the surprising connections between untreated vision loss and dementia risk. Jay Ingram: I'm Jay Ingram, I'm a science author and broadcaster. I've been exploring dementia in books and articles for decades. Allison Sekuler: And I'm Allison Sekuler, President and Chief Scientist at the Baycrest Academy for Research and Education, and at the Center for Aging and Brain Health Innovation. Jay Ingram: Join us as we defy dementia, because you're never too young or too old to take care of your brain. Allison Sekuler: On the subject of vision loss, here are some eye-popping numbers. Canada is a country of over 40 million people, and according to a report from the Canadian Council for the Blind, an estimated 1.2 million Canadians were living with vision loss and blindness. That's over 3% of the population. Jay Ingram: That same report also says that more than eight million Canadians were living with eye disease from one of four conditions, age-related macular degeneration, cataracts, diabetic retinopathy, and glaucoma. Furthermore, almost everyone over the age of 50 will have some problems with their sight, which might benefit from correction or treatment. Allison Sekuler: And getting treatment is key, not only because it may help us see better, but it also can help us lower our dementia risk. And that's because untreated vision loss is one of the newest additions to the list of risk factors for dementia. Jay Ingram: We're going to explore why treating vision loss is so important for our brain health, by focusing on cataracts. Cataracts are the most commonly reported eye disease in Canada, and also one that's usually readily treated by surgery. Cataracts happen when the lens of the eye becomes cloudy over time, eventually obscuring vision. During cataract surgery, the lens of the eye is removed and in most cases, replaced with an artificial lens. Allison Sekuler: Our first guest is going to share his experience before and after cataract surgery. Walter Kuntz is a 78-year-old from Ontario. He's a retired postal worker and he worked for Canada Post for 28 years, and 20 of those years were spent delivering the mail. And what you need to know about Walter is, he loves to work outdoors. Walter enjoyed walking his mail route, but after two hip replacements, Canada Post gave him an indoor job at a mail sorting plant. He hated it. So in 2004, he retired. Then he set up a landscaping business with his wife, and he did that for 10 years, until a lung condition slowed him down. Walter is still physically active, but now he carries around an oxygen tank to help him breathe. But there was one other thing that was slowing Walter down, his vision, it got worse and worse. Walter Kuntz joins us from Heidelberg, Ontario. Walter, thank you for helping us defy dementia. Walter Kuntz: Well, thank you for inviting me. Allison Sekuler: It's great to have you here, and we want to hear all about your eye surgery, but first we'd like to know a little bit more about you. So people have now heard that you love working outdoors and you ran a landscaping company, but that's a lot of physical work. How do you do that with two artificial hips? Walter Kuntz: The jobs that I did, took on with the landscaping company, I could pick and choose. I didn't do any that was too strenuous. I didn't plant trees or anything of that nature. I only planted flowers in the spring and did some mulching, pushing wheelbarrows and things like that, but I kind of picked and choose the easy way out. I was happy doing that and my customers were happy for my wife and I to be doing it for them. Allison Sekuler: So keeping Heidelberg beautiful and keeping yourself fit and active. Walter Kuntz: Yes, it was a combination of both. Allison Sekuler: Yeah, and how busy are you now? What are you doing now to keep fit and socially active? Walter Kuntz: Well, right now because of my lung condition, I walk as much as possible and carry my little buddy with me, as I call him. Allison Sekuler: The oxygen tank? Walter Kuntz: The oxygen tank, yes. And the other thing is that I live on a half acre property. So it's quite large, and requires quite a bit of maintenance. I do enjoy socializing in several card groups, but now that spring is here, I probably will cut back on those and just enjoy the outdoors. Jay Ingram: So Walter, tell us about your vision. How did it change and how bad did it get? Walter Kuntz: I didn't have a problem at all when I was delivering mail, but after I was assigned a position in the plant, I did quite a bit of looking at a computer screen and I got very severe headaches. And then I had to go and have my eyes examined and I needed glasses. So from there on down, it just slowly progressed over the years, that I would have to have the prescription upgraded in my lenses all the time. Jay Ingram: How did you discover that you needed to have cataract surgery? Walter Kuntz: Well, it was during my eye examinations that it was recommended that surgery would be a good idea, just because I complained a lot about wearing glasses, and working outside, perspiration on the lenses and things like that. So I went ahead and had the eye surgery done. Jay Ingram: So what was your vision like Walter, before you decided to have cataract surgery? When you were reading or doing other activities, like playing cards, what was it like for you? Walter Kuntz: Playing cards, I made mistakes, get the two black suits confused with each other. And one of the other things too that I used to do a fair amount of time was I used to do woodworking. The situation became uncomfortable because either the tape measure was too close or too far away and I couldn't really read it properly. Allison Sekuler: Yeah, and woodworking is so precise. If you don't get it exactly right, it's not going to work right. Walter Kuntz: Well, one of my favorite projects [is that] I built mailboxes that were quite unique Allison Sekuler: That's fitting. Walter Kuntz: Oh yeah, I never thought of it that way. I had built them, so they had a little panel in the front and the panel you could change according to the times of the year. Allison Sekuler: Oh, cool. Walter Kuntz: So right now I have one of a person kneeling on the ground planting flowers. It was quite interesting and quite fiddly kind of work. but then it [wasn't] fun anymore when I couldn't see properly. I never read much before I retired. and after I retired, [I] tried to read books, novels and it wasn't comfortable at all and [I] lose interest and things like that. So my wife got me reading large print books, so that was quite nice for a while. And now I don't need [to], after the surgery, now I can read normal books and that makes life fun again. Allison Sekuler: Now people who haven't had cataract surgery maybe don't know what it's like. Can you walk us through that? Walter Kuntz: Well, I was quite surprised because I was just under the impression of more of a surgery-type operation. That [it] wasn't going to be a laser light show. I was just totally blown away. Lasers were blasting all over the place. I didn't realize it was going to be like that at all. So that was really, really, really exciting. Jay Ingram: And I've heard the operation goes fast, is that right? Walter Kuntz: Yes. Oh, definitely. And no pain, absolutely none. No pain whatsoever, which was quite nice. Allison Sekuler: So you've gone through the surgery, cataracts are removed, presumably they put new lenses in place. What does the world look like for you after cataract surgery? Walter Kuntz: Well, that's another amazing point. Everything is just so, so much brighter. Colors are just unbelievable, beautiful. I guess that's the way they were 50 years ago when I was a kid and didn't realize it. And everything slowly got cloudy and yellow-looking, just covered the eye with a film. And like I said, I didn't realize it, but when I came out of that surgery, everything is just unbelievable bright. That's what I really enjoy about it most, it's one of the best things I ever had done because now I can see and the colors are just amazing. They gradually left, I guess, almost became colorblind I would think, because now it's just... As an example, I have two cars that are made by the same manufacturer and they're the same color according to the color chart, but one's whiter than the other one, and that I can notice now. I never used to be able to see that. Jay Ingram: Walter, you described what the world looked like before your surgery. You said reading books was hard, it was difficult to read the tape measure and tell the difference between playing cards. Did those things improve as well? Walter Kuntz: Oh, very much so. I still read large print books because I got used to them, but if none are available that I'd like to read, I'll go to small print and read those. Allison Sekuler: So Defy Dementia is all about spreading awareness of brain health and the idea that your dementia risk can be dramatically reduced by healthy lifestyle choices. Is dementia risk on your radar at all? Walter Kuntz: Oh, yes, I'm afraid so, yes. It's just something you worry about when other people in your family have it. So you need to take care of yourself and stay positive. And by having the corrective surgery, it improves your outlook on life. Just, excuse me, I can't say enough how happy I am that I had it done and the procedure finished. Allison Sekuler: And it sounds like you're already pursuing a lot of healthy lifestyle choices that are thought to reduce dementia risk. So you're physically active, you're socially active, and now you've treated your vision loss. What do you think of the idea that your surgery might be great for your brain health? Walter Kuntz: I think what happens is, in my case, is it keeps you more active. The world is a better place again. You see everything, you can go outside. There's a lot of robins in our neighborhood, and just to see the robins in the spring, you can hear them first, but then the colors, you notice that the orange breast is an orange breast, things like that. It opened up the world again so you can see what's going on and it just boosts your confidence so much. It cheers you up to be able to see properly, and I shouldn't say [you] don't have to be concerned when you're driving a car, but you're more confident you don't have that blocked vision on one side, you see things as they're happening more so. So I think what that does is, it kind of keeps the Alzheimer's away from the door. I hate to get back to a different subject, but, what kind of slows me down health-wise is my lung condition. But if you can fix one thing, it improves your overall health, physically and mentally. Allison Sekuler: Yeah, and in fact, we had an episode previously on wellness and well-being, and there is a suggestion that your overall outlook on life, having that positive outlook, that in and of itself can help you reduce your dementia risk. So that's terrific to hear that the vision surgery actually had that follow on effect for you. That's wonderful. Walter Kuntz: Yes. Jay Ingram: So Walter, is there one thing that you would like people to know about dealing with vision loss? Walter Kuntz: Yes, if you have a problem, get it looked into. Go to your optometrist and have your vision checked. And if you need glasses, wear glasses, and as it progresses, if you need the laser surgery, don't hesitate, get it done. It's a great way to look at life again and it just boosts your morale. You don't have to struggle anymore to see, and you don't trip over things near as much. Well, I shouldn't say near as much. You just don't trip over things anymore because everything's there, you can see it. Allison Sekuler: Walter, thank you so much for joining us today and helping us defy dementia. It's been a pleasure chatting with you. Jay Ingram: Yes, thank you. Walter Kuntz: Well, it's a pleasure chatting with you also. Thank you. Allison Sekuler: Walter Kuntz is a 78-year-old retired postal worker and landscaper. He joined us from Heidelberg, Ontario. Jay Ingram: Our next guest has been listening to Walter Kuntz and his first name is also Walter. Dr. Walter Wittich is an Associate Professor at the School of Optometry at the University of Montreal. Walter studies the rehabilitation of older adults who have combined vision and hearing loss. And he has a personal stake in this story, and in fact, in any story about dementia. He and his husband are caregivers for Walter's mother-in-law, she has vascular dementia and Alzheimer's, and Walter has the distinction of being our guest on the very first episode of Defy Dementia. On that show, we focused on untreated hearing loss as a dementia risk factor. Walter, thank you again for helping us defy dementia. Dr. Walter Wittich: Thank you very much. We're very excited to be back. Jay Ingram: Walter, first, how is your mother-in-law? The last time we talked, you and your husband were caring for her at home. Dr. Walter Wittich: Yes, things have developed a little bit, so we're still providing care, however, she does not actually live with us anymore. She moved into long-term care last year. It's an interesting situation because we're now observing things that you only know from science. I'm now observing what's called retrogenesis. She is slowly becoming this happy girl that is just happily living in the moment. It's a very good life, she enjoys every day, but at the same time she's fading and she is sort of fading backwards into time. Allison Sekuler: It's good to hear she's living a good life, but I'm sorry that you're going through that. So turning back to what struck you when you listened to his story? Dr. Walter Wittich: I was really excited about how he could really explicitly talk about the things that he's rediscovering in life. How he can go back out and be physically active without having to worry, for example, to trip and fall. And I often am reminded by the fact that cataract surgery is something that if we all live long enough, we will all benefit from it. But for many people, it's the very first time that they actually have any kind of surgery. And so there is a little bit of this anxiety and anticipation. The idea that somebody is going to poke around in your eye, it's not really that much fun as an idea, but it turns out, as he said, it goes rather quickly and it is pain-free. We often call it almost drive-through surgery because it is so uncomplicated now, and it has immediate benefits that you can observe immediately afterwards. Allison Sekuler: He was so excited, it seemed, about the changes in his vision. So obviously it was easier to read, but even things like the color, for him that was so important. Is that common? Dr. Walter Wittich: Yeah, so it turns out there are two things about color that are quite fascinating. There is of course the cataract itself, which is this clouding of the lens and it will block a little bit of light. That's also why people always report right away that things are so much brighter afterwards. But it's also that there is a natural process called lens brunescence. And what happens here, is that as we get older, our lens gets a little bit yellow with time, and that will block out certain wavelengths of color specifically in the blue range. And so people report that colors have become this intensive experience again, because now all of the color actually comes through. I also find this quite fun in the context of blue light blocking because you may have seen some elderly ladies that have slightly bluish or purple tints in their hair, and that means that they simply haven't had cataract surgery yet because they're probably coloring their hair, but they don't necessarily notice that there's a bit of a blue tint in there. Allison Sekuler: So it's not necessarily a style choice, it might be a vision. Dr. Walter Wittich: Very well possible. Yes. Jay Ingram: So that's fascinating stuff, Walter, but what's really interesting to us, and I'm sure to you is, how does untreated vision loss, so let's say in the absence of cataract surgery, actually increase the risk for dementia? Dr. Walter Wittich: Yeah, I think that this link between vision, and vision impairment and dementia, some of it still remains a little bit elusive for us because we don't have that much data to really explain all of it, but we do have a few hypotheses. One of them that I find really interesting is the cognitive load hypothesis because it relates to the fact of how much work it is to do the things you want to do. So if you are visually impaired or if you have trouble seeing, it will simply take you a bit more effort to do certain things, and that takes away from the energy that is available for you for other cognitive things, like for example, remembering what you may have just read. And so for me, one of the big links here is of course we want to make things as easy as possible because then it is easier to engage, but it now also links to other things like for example, social engagement and mobility [which] are also linked to dementia. And if you have trouble with your vision, you might be less likely to go for a walk because you might be afraid of falling. And so, vision is important in this context. Jay Ingram: Does the sensory deprivation that vision loss creates, this is kind of opposite to the cognitive load, but does that lesser stimulation actually contribute to dementia risk? Dr. Walter Wittich: I think that this plays a definite role because of course we want the brain to remain as active as possible. If less information comes in, of course the system has less to work with. This is not necessarily unique to vision, you may observe that in hearing as well. I think that that also explains some of the other sensory data that we've observed. So having more information, more access, better access and easier access to the world around us is by definition going to make the brain more active, and that's really what we're after. Allison Sekuler: So what about someone who is blind from birth, as opposed to someone who's got vision loss as they've gotten older? Because we often talk about untreated vision loss as a risk factor for dementia. Is that true for people who are blind from birth as well? Dr. Walter Wittich: I think this is an excellent point, it's an excellent question because of course there are lots of people that are congenitally blind whose cognition is just fine as they grow up and as they grow older. The detail here that is important is the change and the adaptation and the effort to change. So if you turn 60, 70, 80 and you are now developing your visual impairment, you have to adapt to this. You have to learn new strategies, learn new ways, maybe learn to use technologies you have never used before. All of this, again, requires a lot of adaptation. If you've been visually impaired all your life, you don't got to adapt to anything, right? This is just [your] normal, so you don't have to worry about any adaptations or changes. Allison Sekuler: So we've been talking mostly about vision loss, but we talked previously with you about hearing loss as well. I wonder if you can talk about how untreated vision loss might interact with other risk factors like hearing loss. Do those go together? Is it sort of double whammy or not? Dr. Walter Wittich: Yeah, there's a definite correlation here because of course as we get older, the probability of having hearing difficulty and having vision difficulty go up. They both appear at the same time. We do get a little bit into this double whammy situation, as you call it. The key critical point here is, how bad is it? Because if you have a bit of a problem with one, or the other, it may not matter because you've got the other one to help you compensate. But at some point there comes sort of a critical cliff where suddenly the other senses may not be available anymore to help you with the things that you need to compensate for. I think speech perception is an interesting example because we use both hearing and vision to understand speech. We use cues from the face, we use cues from the voice. Allison Sekuler: Like lip reading? Dr. Walter Wittich: Exactly, we translate that into how we understand speech, but at some point that may fall apart. And at this point when we get to what we call dual sensory impairment, then also the rehabilitation approaches have to change a little bit and we need to recruit some other resources, some of which might be tactile, for example. Jay Ingram: After Walter Kuntz's surgery, he mentioned being able to move better, not trip over things. Walter, can you expand on how treated vision, better vision interacts with other dementia risk factors? Dr. Walter Wittich: Yeah, I think his report and his experience about the things he was able to do again, relates beautifully to some of the other modifiable risk factors that we know about. For example, physical activity is important in the protection against dementia. Other variables like social isolation, if you are physically more active again, you will be less likely to be socially isolated, you will be less likely to be depressed. And so here are all these other variables that are suddenly linked to vision and of course that you can also link to hearing. It's all about communication and the experience of being social. And suddenly this sort of all grows again together to make somebody's life as rich as possible and thereby protective against dementia. Jay Ingram: Walter, we've been talking so far mostly about cataracts. They come with age. It's an operation that's usually readily available in Canada. But what about other kinds of vision loss? Are there other kinds that play a role in dementia risk? Dr. Walter Wittich: What is an obvious target are the risk factors that come from systemic diseases. So for example, if you have diabetes, you may have the effects of diabetes that you're managing, but diabetes can also come with diabetic retinopathy. There are some cardiovascular diseases that may also then change how the vasculature in the retina operates, and so suddenly vision is just a part of the piece. So it's a reminder for us to take care of our health globally and it will have automatic beneficial effects on vision, on hearing, on all other senses together. So, vision is one piece of the puzzle. Allison Sekuler: For our audience, what is your take home message? How can they take action? Dr. Walter Wittich: I think the first piece that we all should sort of keep in mind is to get a regular comprehensive eye exam. I think that's a very good start. If you can, do this once a year, if you can, do this once every two years. It may depend on which province you're in, in terms of what your coverage might be or what your insurance will allow you, but that's a great starting point because prevention is always better than trying to address something. And so, early detection [is important]. If you do have a condition like diabetes or hypertension or also potentially high cholesterol, look at how you manage your health in general and include vision care in this to make sure that you don't forget about it. Sometimes I've had clients who tell me, "Well, I didn't go to my ophthalmologist because I had only one family member to take me to my cardiologist and that was more important because my vision may not kill me." And it's interesting because if you cross the street and you don't see the car that's coming, then that may also be dangerous. So that's a tricky one to balance. Something else that I think is good to keep in mind is to look at your environmental risk factors. So for example, sunglasses, always a good idea. Protect yourself from UV light, it's really, really important. Allison Sekuler: An increase in UV light can potentially increase your risk of cataracts? Dr. Walter Wittich: That is true. Now, that is more so the case if you're closer to the equator because there is more exposure. But yes, UV protection is always a good idea. Other than that, I just say use your vision as much as possible. Read, be social, engage in anything that you find visually interesting or stimulating. That can only be beneficial to you and everybody around you. Jay Ingram: We've been talking, Walter, about the situation in Canada and North America [in general] and access to medical care that would help preserve your vision, but that's not true of the entire world. And if ophthalmologists are not readily available, are there anything, any kind of at-home things one can do to preserve vision? Dr. Walter Wittich: One aspect to simply know where you're at is you can do a little bit of self-screening. The World Health Organization has created a free app that you can download onto your smartphone, it's called WHOeyes, and it gives you a couple of tests for near vision and for contrast vision, and it also gives you a few health hints on things that are good for your vision. And I think it's a great start because it also gives people a moment of control where you can sort of see where you're at, learn a bit about what's going on, and then be proactive from there. Jay Ingram: Well, thank you for this, Walter, it's great to talk to you again. And this is really interesting and crucial information about the role of vision loss in the risk for dementia. Thank you. Allison Sekuler: Thank you. Dr. Walter Wittich: Thank you very, very much. It's always a pleasure. Anytime. Jay Ingram: Dr. Walter Wittich is an Associate Professor at the School of Optometry at the University of Montreal. Wow, lots of interesting, useful information. What stood out for you, Allison? Allison Sekuler: As you know, I'm a vision scientist [as well], so I knew a lot of this, but even I was learning new things. When Walter Kuntz was talking about color and his impressions of colors, that really stood out for me. And then to have Walter Wittich link it back to people's fashion choice, in terms of their blue hair, I thought that was really fascinating. I also thought it was wonderful to hear about the WHOeyes program that Walter Wittich mentioned, because that means that people anywhere, no matter where they are, have a free way to check their vision, just like they can check their hearing with Baycrest's free hearing screening. What stood out for you? Jay Ingram: Well, actually, I'm going to throw out an idea, but I really want your comments on it because you know this area quite well. I'm struck by the kind of opposition between cognitive load, like trying to do too much work if you have vision loss, and also the deprivation of information that comes from vision loss. They're kind of acting in opposition. And I'm just wondering if rather than say getting more powerful glasses or reading larger print when vision loss becomes really serious, might there be other ways to stimulate the brain to bring in that sensory information that's been lost as the vision declines? Allison Sekuler: Well, Jay, one of the things we actually study in our lab is brain training or neuroplasticity. And in particular, how can you train people to see things in different ways? For example, with face perception, as you get older, your ability to recognize somebody's face gets worse. And it's not just because you can't remember their names, it's a vision problem. So we've done a lot of work in the lab over the years with our students and trainees showing that you can in fact train older people to recognize faces better. The question is, can you make it generalizable and can you show that this kind of training will actually have that impact that you're talking about? So if I make your vision better, will it actually improve your ability to process cognitive information? That's the holy grail, and that's what we're trying to do in the lab right now. Jay Ingram: And I guess what we need to get to that point is a much clearer idea of exactly what information loss through, let's say, decline of vision, really means across the whole frontier of how the brain works. Allison Sekuler: Absolutely. Jay Ingram: To find out more about how we can all boost our brain health and reduce the risk of dementia or slow its progression, please visit us at defydementia.org. There you can check out other episodes of the podcast, as well as our videos, infographics, and other resources. We'll also have a link to the World Health Organization website that Walter Wittich and Allison mentioned. WHO, W-H-0, eyes. Allison Sekuler: Our podcast production team is Rosanne Aleong, Sylvain Dubroqua, and John Parvijinsky. Our writer and Chase producer is Ben Schaub. Production is by PodTechs. Music is by Steve Dodd. And our cover art is by Amanda Forbis and Wendy Tilby. Jay Ingram: We'd like to thank Dr. Jennifer Lee at the Waterloo Eye Institute at the University of Waterloo. We'd also like to thank the funders of this podcast, the Slaight Family Foundation, as well as the Center for Aging and Brain Health Innovation and Baycrest. We're very grateful for your support too, so please push that subscribe button for Defy Dementia wherever you get your pods. And don't forget to leave a like, a comment, or maybe even a five-star review. Allison Sekuler: Next time on Defy Dementia, it's a show all about the 2SLGBTQI communities. We're going to explore societal and systemic barriers to brain health for trans people, and we'll also discuss the challenges of finding kind and equitable dementia care. So join us as we proudly mark the start of pride season. That's next time on Defy Dementia. I'm Allison Sekuler. Jay Ingram: And I'm Jay Ingram. Thank you for listening to Defy Dementia, and don't ever forget, you're never too young or too old to take care of your brain.