Visual Impairment and Fall

In a 2-year follow-up population-based study, impaired visual acuity was a risk factor for fall in disabled elderly (odds ratio 2.3) Koski K, Luukinen H, Laippala P, Kivela SL. Risk factors for

major injurious falls among the home-dwelling elderly by functional abilities. A prospective population-based study. Gerontology 1998; 44: 232–8.

Visual impairment is strongly associated with falls and hip fractures Abdelhafiz, A.H. and Austin, C.A Visual factors

should be assessed in older peoplepresenting with falls or hip fracture Age and Ageing, 32, 26-30, 2003

Ivers RQ, Cumming RG, Mitchell P et al. Visual impairment and falls in older adults: the Blue Mountains Eye Study. J. Amer Ger. Soc. 46(1): 58-64, 1998

This association with falls may be explained by to Poor visual acuity Reduced visual field Impaired contrast sensitivity Cataract

Ivers RQ, Cumming RG, Mitchell P et al. Visual impairment and falls in older adults: the Blue Mountains Eye Study. J. Amer Ger. Soc. 46(1): 58-64, 1998

Common eye problems in the elderly:

VisionCataract – 17-30%

AMD – 65+ 11-18% 75+ - 30%

Glaucoma – 2%65 + 17%75+ - 30%

Low vision is……

• A level of visual disability that causes difficulty in carrying out everyday tasks

A common cut off point is taken as a binocular visual acuity of 6/12 or 6/18 as used in the MRC study

Low Tech- vision assessment and Falls Service:

Visual acuity

• A measure of how clearly you can

see

• Measured with a letter chart at a

distance (usually 6m)

• Decreased by refractive error,

cataract

Contrast sensitivity

• A measure of how well one can see at different light levels and contrasts

• Important for seeing edges, colours, steps

• Affected by cataract and age-related macular degeneration

Visual field

• A measure of how well you can see in the periphery of your vision

• Measured with a computerised visual field test

• Affects seeing steps and objects to the side

• Glaucoma decreases visual field

Multifocal lens and Falls:

Multifocal glasses impair obstacle avoidance and increases the risk of falls in older people.

Provision of single lens glasses significantly reduces falls in older wearers in active older adults participating in outdoor activities. Effect on falls of providing single lens distance

vision glasses to multifocal glass wearers: VISIBLE randomized controlled trial.

M.J.Haran et al BMJ 2010:340:c2265