Optometrists can help prevent falls among the elderly by making conservative changes to refractive corrections, steering away from prescribing progressive-addition lenses or bifocals to patients who are accustomed to wearing single-vision lenses and providing elderly patients with comprehensive vision advice.
Presenting the prestigious Glenn A. Fry Award Lecture 2013 on Blurred Vision, Spectacle Correction, and Falls in Older Adults, Professor David B. Elliott said even noninjurious falls can significantly impact the elderly by leading to the fear of a fall which can curtail normal activities. He said “this can have an avalanche effect as the activity restrictions can lead to decreased mobility and independence, social isolation, deteriorating health, and depression, which all mean that the person is more likely to fall again”.
Professor Elliott, who is from the Bradford School of Optometry and Vision Science at the University of Bradford, has reviewed the literature on how blurred vision contributes to falls, gait, and postural control and how these are influenced by spectacle correction. He said, “to help prevent falls, clinicians first need to be able to identify patients who are at high risk of falling. Risk factors include older age (>75 years), female sex, a history of falls, living alone, decreased muscle strength, Parkinson’s disease, stroke, arthritis, diabetes, Meniere disease, dementia, taking sedatives and antidepressants, and polypharmacy” and noted that “the more risk factors patients have, the more likely they are to fall”.
“Changes to refractive corrections in older people should be conservative with maximum changes of approximately 0.75 diopters and minimal changes in cylinder axes, particularly if oblique. Indeed, if a patient reports no problems with his or her vision, but simply requests a new frame, ‘if it ain’t broke don’t fix it’ is an appropriate clinical maxim and the refractive correction is best not changed. Similarly, it may be better to keep lens form, PAL design, bifocal type, and so on, the same in any new glasses unless there are significant reasons for change.”
it may be better to keep lens form, PAL design, bifocal type, and so on, the same in any new glasses…
Professor Elliott wrote that patients should be advised about magnification changes experienced with new spectacles and recommended progressive addition lenses or bifocals never be prescribed to high risk patients who are used to wearing single-vision glasses. Additionally, he wrote that appropriate advice should be provided to long-term wearers of progressive addition lenses, bifocals, and monovision correction who come to be at high risk of falls.
“Be wary of using a monovision approach because of the loss of stereoacuity; long-term wearers of bifocals/PALs with minimal ametropia may be advised that they would be less likely to fall if they removed their glasses when walking outside their home; long-term wearers of bifocals/PALs with significant ametropia who take part in frequent outdoor activities should use distance single-vision glasses when outside their home (other than when driving or shopping) and prescription single-vision sunglasses may be particularly useful for sunny days and holidays; long-term wearers of bifocals/PALs with significant ametropia who take part in few outdoor activities should continue to wear bifocals/PALs for most activities. Suggesting that patients “tuck their chins in” to look through the distance vision part of their PALs or bifocals when negotiating steps and stairs seems useful.”
He wrote that while reduced vision is a significant risk factor for falls, “randomised controlled trials of optometric interventions and cataract surgery have not shown the expected reduction in falls rate, which may be due to magnification changes (and thus vestibulo-ocular reflex gain) in those participants who have large changes in refractive correction. Epidemiological studies have also shown that progressive addition lens and bifocal wearers are twice as likely to fall as non–multifocal wearers, laboratory-based studies have shown safer adaptive gait with single-vision glasses than progressive addition lenses or bifocals, and
a randomized controlled trial has shown that an additional pair of distance vision single-vision glasses for outdoor use can reduce falls rate.”
He said reducing the risk of falls among the elderly may require “an adaptation to the case history, including routinely asking elderly patients whether they have a prior history of falls, determining when glasses are actually worn (do elderly patients always wear their distance glasses when walking outside the home?), and asking bifocal/PAL wearers whether they have any problems with steps and stairs and whether they take off their bifocals/PALs when negotiating stairs?”