Falls are a burgeoning societal problem, and much effort is being made to reduce falls. The risk for falling increases with advanced age, with nearly 1 in 4 individuals in the US over the age of 65 reporting a fall every year. Falls can lead to injury, activity limitation, economic burden and even death. Falls are the leading cause of injury related death in elderly individuals and an estimated 80 billion is spent annually on non-fatal falls in the U.S..
A fall can occur for a multitude of reasons, and it is often more than one factor that contributes. As humans, our balance system relies on vision, our sense of touch, and inner ear vestibular information, all integrated at the level of the brain. Impairment of one or more of these sensory systems has the potential to result in loss of balance and/or falls.
Why Multifocal Lenses Increase Fall Risk
A common but often overlooked risk factor for falls is multifocal lens use. Multifocal lenses refer to glasses that have more than one magnification in them to correct for visual deficits, such as bifocals, trifocals or progressive lenses.
As people age, vision naturally declines, making corrective glasses necessary for both near and distance vision. Multifocal lenses offer a convenient solution by incorporating multiple magnifications into a single pair of glasses.
Typically, the upper portion is designed for distance vision, while the lower part is for close-up tasks. However, while these lenses improve visual clarity, they can negatively impact balance.
It has been shown that older individuals using multifocal lenses are twice as likely to fall as their peers wearing a single distance corrected lens. Multifocal glasses may distort visual input from the ground and increase the risk for tripping and falling. This distorted visual input from the lower visual field has been shown to impair edge contrast and depth perception, with resultant foot placement errors.
Older adults who wear multifocal lenses are twice as likely to fall compared to those using single-distance lenses. The distorted visual input can impair depth perception and foot placement, especially in unfamiliar environments or on uneven surfaces.
The impact of this is most notable in unfamiliar environments, as well as on uneven ground or stairs. It appears that the increased risk for falling is not equal across all multifocal lens types either, with progressive lens users being twice as likely to suffer from multiple falls compared to bifocal lens users. It was initially thought that some of these impairments were a phenomenon only observed as a new user multifocal lens until the brain adapted, however, there is some evidence to support more long-term impaired contrast sensitivity and depth perception.
Multifocal lenses are likely to be more problematic for your balance if you have other risk factors for falls as well. Your optometrist should be aware if you have other falls risk factors such as: advanced age (>75), prior falls, deconditioning, diabetes, inner ear/vestibular conditions, dementia, and polypharmacy.
What to do? Reducing Your Fall Risk
There is some evidence to support that discontinuing multifocal lenses and opting for single distance corrected lenses only may reduce the risk of falling, particularly for active elderly individuals. This is not necessarily convenient, because then you may require distance corrected lenses when walking, with another set of glasses for reading or other up-close activities to be used while seated. There is less evidence to support that changing from multifocal lenses to a single distance corrected lens is an effective falls reduction strategy for elderly users who are inactive and rarely leave the home.
If you are a candidate for surgical correction/improvement of your vision, by removing cataracts for example, this may be worth considering rather than utilizing multifocal lenses. Surgery is not without risk either, please consult with your ophthalmologist. Lastly, ensuring that your glasses are the correct prescription and not outdated is important, so consider an update eye exam if any changes in vision are noted.
