Dr. Bonnielin Swenor's research aims to improve the health of people with visual impairments and is fueled by her personal experience living with a visual disability. To achieve this, her research concentrates on three interrelated areas:
- Vision and Aging: examining the impact of visual impairments on health and well-being across the lifespan, with a focus on older adults
- Access to Care: documenting health care disparities and improving healthcare utilization, quality, and access in patients with vision loss
- Disability Inclusion: enhancing the inclusion of persons with visual impairments and other disabilities in the biomedical workforce
Dr. Swenor and her team are now expanding on this research framework to more broadly examine disability health. This area of research examines disability – including visual impairment - as a health disparity population, and uses an interdisciplinary, collaborative approach to establish the evidence needed to design effective policies and programs that will reduce disability health disparities. The overarching goals of this research are to maximize health, equity, and participation for persons with all types of disabilities.
The Swenor Research Group focuses on examining the interrelationship between vision loss and aging. This includes determining the effects of visual impairment and eye disease on physical and cognitive functioning in older adults, and identifying interventions that could enhance the health of older adults with visual impairment and eye disease.
This work is guided by an overarching research framework (Figure) that integrates concepts and terminology from both ophthalmology and geriatrics. Under this framework, visual impairment leads to downstream changes in functioning – physical, cognitive, and social/psychological functioning – that in turn lead to negative health outcomes associated with accelerated aging – including frailty, comorbidity, and increased risk of mortality. This framework also acknowledges the complexity of these relationships, as there are common causes or risk factors that may contribute to functioning decrements and negative health consequences among older adults with visual impairments. To achieve these goals, Dr. Swenor’s research team relies on a highly collaborative approach working with investigators across multiple departments, The Dana Center for Preventive Ophthalmology and the Johns Hopkins Center on Aging and Health.
Cognitive Impairment and Neuroimaging
Prior research has indicated that visually impaired older adults are more likely to have cognitive impairment than those with normal vision. However, the mechanisms underlying this relationship are not fully understood, limiting our ability to mitigate the cognitive consequences of vision loss. Dr. Swenor’s research is advancing understanding of the vision-cognitive relationship by leveraging longitudinal studies, as well as neuroimaging data to investigate how brain structure and function may change in older adults with age-related eye disease.
- Lee MJ, Varadaraj V, Ramulu PY, Whitson HE, Deal JA, Swenor BK. Memory and Confusion Complaints in Visually Impaired Older Adults: An Understudied Aspect of Well-Being. Gerontol Geriatr Med. 2019 Jan 8;5:2333721418818944.
- Swenor BK, Wang J, Varadaraj V, Rosano C, Yaffe K, Albert M, Simonsick EM. Vision Impairment and Cognitive Outcomes in Older Adults: The Health ABC Study. J Gerontol A Biol Sci Med Sci. 2018 Oct 25
- Zheng DD, Swenor BK, Christ SL, West SK, Lam BL, Lee DJ. Longitudinal Relationships Between Visual Impairment and Cognitive Functioning : The Salisbury Eye Evaluation Study. JAMA Ophthalmol. 2018 Sep 1;136(9):989-995.
Mobility and physical functioning are important aspects of good health in late life. However, maintaining mobility and keeping physically active usually requires good vision. Results from Dr. Swenor’s work has identified vision loss as an important factor contributing to walking difficulties and mobility disability in late life, and highlight the need to address the physical consequences of vision loss in older adults.
- Varadaraj V, Mihailovic A, Ehrenkranz R, Lesche S, Ramul PY, Swenor BK. Gait characteristics of age-related macular degeneration patients. Transl Vis Sci Technol. 2017 Aug 1;6(4):14. PMCID: PMC5539799
- Swenor BK, Simonsick EM, Ferrucci L, Newman AB, Rubin S, Wilson V; Health, Aging and Body Composition Study. Visual impairment and incident mobility limitations: the health, aging and body composition study. J Am Geriatr Soc. 2015 Jan;63(1):46-54. PMCID: PMC4300238.
- Swenor BK, Muñoz B, West SK. A longitudinal study of the association between visual impairment and mobility performance in older adults: The Salisbury Eye Evaluation Study. Am J Epidemiol. 2014 Feb 1;179(3):313-22. PMCID: PMC3954103.
Reading difficulty is a common complaint among individuals with visual impairments, including older adults, resulting from age-related macular degeneration and glaucoma. Working with Dr. Pradeep Ramulu, Dr. Swenor has studied sustained reading speed, a measure of reading difficulty, as well as examined the role of comprehension and cognitive function on sustained reading speeds in visually impaired older adults.
- Varadaraj V, Lesche S, Ramulu PY, Swenor BK. Reading Speed and Reading Comprehension in Age-related Macular Degeneration. Am J Ophthalmol. 2018 Feb;186:138-143.
- Swenor BK, Varadaraj V, Dave P, West SK, Rubin G, Ramulu PY. Impact of the ability to divide attention on reading performance in glaucoma. Invest Ophthalmol Vis Sci. 2017 May 1;58(5):2456-2462.
- Ramulu PY, Swenor BK, Jefferys JL, Friedman DS, Rubin GS. Difficulty with out-loud and silent reading in glaucoma. Invest Ophthalmol Vis Sc. 2013 Jan 23;54(1):666-72.
Frailty is a geriatric syndrome defined as a vulnerability to negative health outcomes, and is thought to result from dysregulation across multiple physiological systems. Assessing frailty in older adults can help identify individuals at risk of falls, hospitalization, worsening disability, and mortality. Dr. Swenor and her are examining the relationship between visual impairment and frailty, and aims to determine if visually impaired older adults are at increased risk of developing frailty, as well as determine if being both visually impaired and frail puts older adults at greater risk of negative health outcomes.
- Varadaraj V, Lee MJ, Tian J, Ramulu PY, Bandeen-Roche K, Swenor BK. Near vision impairment and Frailty: Evidence of an association. Am J Ophthalmol. 2019 Aug 26. pii: S0002-9394(19)30401-5.
- Swenor BK, Lee MJ, Tian J, Varadaraj V, Bandeen-Roche K. Visual Impairment and Frailty: Examining an understudied relationship. J Gerontol A Biol Sci Med Sci. 2019 Aug 16. pii: glz182.
Dual Sensory Impairment
Dr. Swenor and her research group are examining how dual sensory impairment – defined as concurrent vision and hearing impairments – affects health and aging. This research is a joint collaboration with investigators at the Johns Hopkins Cochlear Center for Hearing and Public Health.
Swenor B, Ramulu RY, Willis J, Friedman D, Lin F. The prevalence of concurrent hearing and vision impairment in the United States. JAMA Intern. Med. 2013 Jan 21:1-2.
Huddle MG, Deal JA, Swenor B, Genther DJ, Lin FR. Association Between Dual Sensory Impairment, Hospitalization, and Burden of Disease. J Am Geriatr Soc. 2016 Aug;64(8):1735-7.
Fuller SD, Mudie LI, Siordia C, Swenor BK, Friedman DS. Nationwide prevalence of severe vision, hearing, and dual sensory impairments and their associations with cognitive, independent living, self-care, and ambulatory difficulties - in the 2011-2015 American Community Survey PUMS. Ophthalmology. 2018 Jan 4. pii: S0161-6420(17)31673-1.
Access to health care is an important component of aging well. Dr. Swenor and team aims to characterize and ultimately reduce disparities in eye care and healthcare for individuals with visual impairments. This includes collaborating with researchers from WIlmer Eye Institute's Vision Rehabilitation department to examine utilization of low vision rehabilitation services, which are critical to maintaining or enhancing the functioning of individuals with chronic visual impairment.
Varadaraj V, Frick KD, Saaddine JB, Friedman DS, Swenor BK. Trends in Eye Care Use and Eyeglasses Affordability: The US National Health Interview Survey, 2008-2016. JAMA Ophthalmol. 2019 Jan 24.
Benoit SR, Swenor B, Geiss LS, Gregg EW, Saaddine JB. Eye Care Utilization Among Insured People With Diabetes, U.S. 2010-2014. Diabetes Care. 2019 Jan 24. pii: dc180828.
Swenor BK, Guo X, Boland MV, Goldstein JE. Leveraging electronic health records to identify and characterize patients with low vision. Ophthalmic Epidemiol. 2018 Oct 16:1-8.
Driven by her own experience with a disability, Dr. Swenor’s research and advocacy include efforts to enhance disability inclusion. Persons with disabilities offer a unique and valuable perspective that can drive scientific innovation and advance patient care, yet this group is often absent from research and medical settings. To change this, Dr. Swenor is providing evidence of this underrepresentation and identifying barriers to inclusion for persons with disabilities across the academic pipeline, from students to faculty.
- Swenor BK. Losing Vision and Gaining Perspective. JAMA. 2019 Feb 5; 321(5):455-456.
- Swenor BK, Meeks L. Disability Inclusion: Moving Beyond Mission Statements. N Engl J Med. 2019 May 30;380(22):2089-2091.
- Focus On Eye Health National Summit: Losing Vision and Gaining Perspective (Video) - Prevent Blindness (July 2019)
- What Medicine Can Learn From Doctors and Researchers with Disabilities - NPR (June 2019)
- High Sights for Low Vision - Hopkins Medicine (Winter 2019)
- Exploring links between senses and cognitive health - Science Daily (Sept 2018)
Postdoctoral Research Fellows
- Lamma Assi
- Fahd Naufal
- Niranjani Nagarajan
- Ahmed Shakarchi
- Varshini Varadaraj
- Sophie Gu
- Moon Jeong Lee
- Priyanka Kumar
Master of Public Health Students
- Mina Motaghi
- Niranjani Nagarajan
- Yi Sun
- Yunmeng Wang
- Annie Zhang