bifocals increase fall risk

Could Your Bifocals Increase Your Risk of Falling?

Falls are an extremely common problem that can result in significant injury, decreased quality of life, and even death. The U.S Centers For Disease Control report that around 1 in 4 individuals over the age of 65 fall each year. Falls are the most common reason for both fatal and non-fatal trauma related admissions to hospitals in older individuals in the United States. Falls also have a large economic burden with estimates of treating fall related injuries thought to be 67 billion by the year 2020.

As one can see, the physical, mental, and emotional costs for a fall are high for everyone involved. The best way to try to reduce the burden of falls is by trying to prevent a fall in the first place. Often times individuals over the age of 65, whom are the most prone to injurious falls, will have several health comorbidities that may cause them to be imbalanced or dizzy. 

These include but are not limited to orthopedic abnormalities, medication side effects, deconditioning, vestibular disorders, and visual abnormalities. Many of these comorbid health conditions can be difficult or impossible to treat. One may also have lingering symptoms that result in dizziness or imbalance even if the health comorbidity is treated correctly.


Falls related to the use of multifocal lenses


Recent literature in the British Medical Journal showed that the use of multifocal lenses in older individuals increases risk of falling. This study included 606 individuals who utilized multifocal lenses, were 65 years of age or older and were at an increased fall risk. Half of the participants were prescribed single, monofocal lenses while the other half continued to utilize their bifocal lenses.

The researchers switched half of the individuals to single lens glasses while walking, navigating rough or uneven ground, going up and down stairs, and while entering/ exiting public transportation. The results showed an 8% overall reduction in falls for the individuals utilizing the single lenses, which was found to be statistically insignificant.

The largest difference was an observed 38% to 40% reduction in falls for individuals that regularly engaged in outdoor activities. Those who only occasionally participated in activities outside the home and were switched to single lenses actually had a slightly higher risk of falling.

It is unclear exactly why this would happen, but one can speculate that those individuals who are less physically active outside the home may already be at a greater risk for falls due to frailty or a number of other causes. Also, those who are less active may be less able to adapt to new lenses, resulting in a slight increase in falls risk.

Based on the results of this study, older individuals who are regularly active outside of the home would likely benefit from having glasses with single lenses only rather than multifocal lenses. Those that are only mildly active or rarely leave their home should continue with the lenses they have as long as they are correctly fit for their visual needs.


Why would glasses effect ones balance?


As humans, we utilize three main senses for maintenance of equilibrium: vision, somatosensation (sense of touch), and vestibular (inner ear) inputs. These are integrated at the level of the brain for reflexive postural control in order to maintain an upright posture. Anything that impacts these senses or reduces the brains ability to integrate this information can adversely impact ones balance.


What can be done?


There are many things that can be done to reduce one’s risk of falling but correctly fit glasses are an often overlooked and incredibly simple change that can help. General recommendations from recent literature would suggest that the use of single lenses in ones glasses rather than multifocal lenses for older adults who are active outside of the home may be beneficial in reducing fall risk.

Older individuals who are only minimally active outside of their homes and utilize multifocal lenses are less likely to benefit from a change to mono-focal lenses. 

Also, large changes in one’s magnification and/or switching styles of lenses (going from single lenses to bifocal lenses) for individuals who have multiple fall risk factors should be avoided if possible. Appropriate counseling on potential hazards for tripping should be discussed with any change in one’s lens prescription in attempt to further reduce fall risk.

The biggest drawback to mono-focal lenses is that an individual may require more than one pair of glasses- one pair to be utilized while ambulating and another for reading. This seems a simple price to pay to reduce one’s risk of a potentially injurious fall.

About Brady Workman

Brady Workman, AuD, is an audiologist in the Balance Disorders program at Wake Forest Baptist Health Center. Brady resides in Winston-Salem, North Carolina and is licensed by the North Carolina Board of Examiners for Speech Language Pathologists and Audiologists and is a fellow of the American Academy of Audiology. His primary clinical interests include comprehensive vestibular assessment and adult hearing diagnostics.

1 Comment

  1. My own cases of falling turned out to be due to the blood pressure medication I was on (Lisinopril). My wife and I live in Central California, but over the 4th of July we visited our son and his wife for one week in Kentucky. Just before we returned to California my daughter-in-law mentioned to me that her mother’s falls were due to her blood pressure medication. Therefore back in California, I did a web search for “Lisinopril and falling” and a very significant number of hits resulted. So I stopped taking it immediately and told my doctor about it. He approved of my stopping the medication and I have suffered only one incident since then.

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