docet

References:

Cumming R, Ivers R, Clemson L et al. (2007) Improving vision to prevent falls in frail older people: A randomized trial. J Am Geriatr; 55(2), pp 175-181

2018 update:

Patients at risk of falls, who are active and long-term multifocal wearers, should be advised to wear single vision distance spectacles outdoors. However, some resist this advice because of their preference for the convenience of multifocals. A lab-based study (Elliott et al., 2016) has indicated that intermediate addition (~+1.25DS) varifocals and bifocals produce safer gait (there is minimal blur of steps and stairs and other obstacles in the travel path, less image jump with bifocals and less peripheral distortion with varifocals) and yet can provide adequate spot reading (N6) for price tags, phones, menus etc. and will be preferred by some patients to wearing single vision distance spectacles. 

References:

Davies J, Kemp G, Stevens G et al.(2001) Bifocal/varifocal spectacles, lighting and missed-step accidents. Safety Science; 38(3), pp 211-226

Elliott D, Hotchkiss J, Scally A et al. (2016) Intermediate addition multifocals provide safe stair ambulation with adequate 'short-term' reading. Ophthalmic Physiol Opt; 36(1), pp 60-68

Stephen R, Dayhew J, Howland A (2002) Multifocal glasses impair edge-contrast sensitivity and depth perception and increase the risk of falls in older people. J Am Geriatr; 50(11), pp 1760-1766

Timmis M, Johnson L, Elliott D et al. (2010) Use of single-vision distance spectacles improves landing control during step descent in well-adapted multifocal lens-wearers. Invest. Ophthalmol. Vis. Sci; 51, pp 3903-3908 

Further recommended reading:

Beschorner K, Milanowski A, Tomashek D, Smith R (2013) Effect of multifocal lens glasses on the stepping patterns of novice wearers. Gait Posture; 38, pp 1015–20

Black A, Kimlin J, Wood J (2014) Stepping accuracy and visuomotor control among older adults: Effect of target contrast and refractive blur. Ophthalmic Physiol Opt; 34, pp 470–8

Elliott D, Hotchkiss J, Scally A, et al. (2016) Intermediate addition multifocals provide safe stair ambulation with adequate ‘short-term’ reading. Ophthalmic Physiol Opt; 36, pp 60–68

Ellison A (2014) Prismatic displacement effect of progressive multifocal glasses on fall risk in elderly people. Clin Ophthalmology; pp 891–902

2018 update:

Recent studies have highlighted that cataract surgery can improve falls rates, but that the beneficial aspects of cataract surgery (improvement in visual impairment) can be offset by large changes in refractive correction (Palagyi et al, 2017; Keay & Palagyi, 2018). 

This provides more evidence that a myopic patient at high risk of falls would be better having low myopia as their target refractive correction post-surgery, particularly if they were used to reading at times without spectacles before surgery. This would mean that they would be (a) spectacle independent for reading post-surgery (which many prefer) and (b) have a reduced change in refractive correction due to surgery, so reducing the risk of falls. 

Other suggestions have been to make conservative changes in refractive correction following surgery, particularly astigmatic correction. Any astigmatic correction should be kept the same as pre-surgery if possible, particularly the axis, and the overall cylinder power kept either the same or be reduced.

References:

Campbell J, Robertson C, La Grow Set al. (2005) Randomised controlled trial of prevention of falls in people aged ≥75 with severe visual impairment: the VIP trial. BMJ; pp 331:817

Foss A, Harwood R, Osborn F et al. (2006) Falls and health status in elderly women following second eye cataract surgery: a randomised controlled trial. Age Ageing; 35, pp 66-71 

Harwood R, Foss A, Osborn F et al. (2005) Falls and health status in elderly women following first eye cataract surgery: a randomised control trial. Br J Ophthamol; 89, pp 53-59 

Keay L, Palagyi A (2018) Preventing falls in older people with cataract - it is not just about surgery. Ophthalmic Physiol Opt; 38(2), pp 117-118

Palagyi A, Morlet N, McCluskey P et al. (2017) Visual and refractive associations with falls after first-eye cataract surgery. J Cataract Refract Surg; 43(10), pp 1313-1321

Resources

Docet would like to thank the following for their contribution to this programme:

• Professor Dave Elliot, University of Bradford.