In an earlier SeniorHomes.com blog post on vision loss, we discussed how this normal condition of aging can affect the health and well-being of older adults. Vision loss can increase the likelihood of seniors requiring assistance with activities of daily living and the risk of falls. Last week the Centers for Disease Control and Prevention (CDC) released Preventing Falls: A Guide to Implementing Effective Community-Based Fall Prevention Programs and the CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults, 3rd Edition. The reason why these reports were solely dedicated to preventing falls is because “falls are the leading cause of fatal and nonfatal injuries among adults 65 and older and 10,000 people in the United States turn 65 every day”(Preventing Falls page 1) and the economic impact that result from medical costs is reported at being $34 billion annually(Compendium 1).
The Preventing Falls report provides guidance for community programs when developing and implementing a fall prevention program, while the compendium highlights research studies on fall-prevention measures among community-dwelling seniors. Though the intended audience of the compendium is clinicians, public health practitioners senior service providers, there is one study included in the report that is of value to caregivers and seniors.
How Glasses can Affect the Likelihood of FallsThe use of eyeglasses as one ages is often due to presbyopia, a common form of vision loss. Wearing either single lens or multifocal glasses is the usual prescription to compensate for the loss of vision. A recent study conducted by researchers in Sydney, Australia, Effect on falls on providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial, sought to determine whether the use of single lens distance glasses reduced the number of falls in seniors who wore multifocal glasses. Each lens type has its advantages: a single lens is useful for distant and near vision, while multifocal lens (bifocal, trifocal or progressive lens) are useful in activities, such as driving or cooking, that require the eye to switch between focusing at different distances. However, studies have found that bifocals or progressive lens affect a senior’s distant depth perception and the ability to see contrasts; “in particular, wearers of multifocal glasses have high risk of falls when outside their homes and when walking up or down stairs.”
Study Design and ResultsIn this randomised study, 606 participants were separated into the intervention or control group. At the first visit, subjects in the intervention group were examined by an optometrist who prescribed single lens distance glasses that matched the prescription of their multifocal lenses. On the second visit, these subjects received their new single lens glasses and were shown how multifocal glasses can affect depth perception and noticing obstacles. The optometrist recommended use of the single lens glasses for most walking and standing activities, such as walking in the street, walking up and down stairs, or walking in unfamiliar surroundings. Control group subjects also received the same exam by the optometrist and received updated multifocal lenses if needed; however, they did not receive any advice on using their glasses.
Determining the effectiveness of single lens glasses upon falls, researchers measured the number of falls in the 13-month follow-up period; falls were defined as “unintentionally coming to the ground or some lower level and other than as a consequence of sustaining a violent blow, loss of consciousness, sudden onset of paralysis as in stroke or an epileptic seizure.” They also measured other outcomes such as physical activity levels and fear of falling.
The intervention group reported 461 total falls compared to 496 in the control group. Of the falls occurring outside, the control group reported 197 while intervention only had 192. Of the injurious falls, the intervention group reported only 11 less than the control group’s 235.
Of the participants who were less likely to leave their house, their number of outside falls increased significantly, though researchers “found no indication that falls occurred at the time of switching between multifocal and single lens distance glasses. The intervention did not influence the secondary outcome measures, indicating that the intervention did not increase physical activity or improve quality of life through fewer falls.”
However, for older adults who participated in regular outdoor activities, using single lens glasses was an effective method to prevent falls.
Study RecommendationsFrom these results the authors had several recommendations which caregivers or seniors can make note of:
- older people who have minimal correctable distance refractive error should avoid multifocal glasses
- older people with considerable correctable distance refractive error who take part in frequent outdoor activities should use single lens distance glasses when outdoors and in other unfamiliar settings
- older regular wearers of multifocal glasses with considerable correctable distance refractive error who take part in little outdoor activity should use multifocal glasses for most activities (rather than using multiple pairs of glasses)
- insufficient evidence exists to recommend one type of multifocal glasses over another