Course: The Ageing Eye: Vision and falls, Section: Unit 3 - Multifocals, monovision CLs (~4 mins)

General

No CPD Points

In this programme, Professor Dave Elliot of the University of Bradford explains the link between vision and falls and the important role optometrists can play in helping to prevent falls in older patients.

Falls are a common and serious health risk for older people. They are not random events and there are typically multiple factors involved. Studies indicate that visual impairment is a significant risk factor. Professor Elliot outlines the latest research into falls and provides expert guidance on questions to ask patients, dealing with changes in prescription, and referring patients with low vision.

First published: November 2014
Last reviewed: August 2024

Unit 3 - Multifocals, monovision CLs (~4 mins)

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