Explore research on how multifocal lenses affect fall risks and balance, with implications for patient care.
MEDICAL NEWS
Presbyopia, which occurs during aging, is the loss of the eye’s ability to focus on nearby objects, due to the lens getting less flexible and not focusing light correctly on the retina. When this occurs, people who have problems seeing both near and far may be prescribed multifocal lenses (bifocals, trifocals or progressive lenses).
It seems counterintuitive that multifocal lenses, which are supposed to improve vision, actually can increase the risk of falls.
Key Findings from Clinical Studies on Multifocal Lenses and Fall Risk
A trial of 156 subjects, aged 63 to 100, compared people who wore multifocal eyeglasses to those that didn’t. It was reported that multifocal eyeglass wearers were 2.29 times more likely to fall than the controls. A second study found that multifocal lens wearers made contact with more obstacles when walking than they did when they were wearing single-vision glasses. Depth perception and distant edge-contrast sensitivity (the ability to perceive outlines of distant objects and distinguish them from the background) have been found to be decreased with multifocal lenses compared to single-vision glasses.
Visual distortion may occur because the lower part of a multifocal lens is meant for reading and can actually blur more distant objects, making falls more likely. Another issue is how well people can adjust their head angle relative to the glasses to allow vision in the middle of the lens rather than the lower part when walking or climbing stairs.
One suggested remedy for individuals where falls are a problem is the use of two sets of glasses, a multifocal lens pair for general use and a single-vision pair to use when walking. A study found that multifocal lens wearing subjects had an 8% reduction in falls when they were given single-vision distance glasses to use when walking and for outdoor activities, compared to a control group.
If someone with both near and far vision difficulty requires cataract surgery, another possible remedy, to avoid the use of multifocal lens glasses post-operatively, is to insert a multifocal intraocular lens. Multifocal intraocular lens implants have not been found to increase falls when compared to monofocal intraocular lens implants.
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References
Timmis MA, Johnson L, Elliott DB, Buckley JG. Use of single-vision distance spectacles improves landing control during step descent in well-adapted multifocal lens-wearers. Invest Ophthalmol Vis Sci. 2010;51(8):3903-3908. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/20207976/
Lord SR, Dayhew J, Howland A. Multifocal glasses impair edge-contrast sensitivity and depth perception and increase the risk of falls in older people. J Am Geriatr Soc. 2002;50(11):1760-1766. Retrieved from: https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1046/j.1532-5415.2002.50502.x
Chang D. Multifocal Spectacle and Monovision Treatment of Presbyopia and Falls in the Elderly. Journal of Refractive Surgery. 06/01/2021. Retrieved from: https://journals.healio.com/doi/epdf/10.3928/1081597X-20210408-02
Supuk E, Alderson A, Davey CJ, et al. Dizziness, but not falls rate, improves after routine cataract surgery: the role of refractive and spectacle changes. Ophthalmic Physiol Opt. 2016;36(2):183-190. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4949987/
Haran MJ, Cameron ID, Ivers RQ, et al. Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial [published correction appears in BMJ. 2016 May 27;353:i3041. doi: 10.1136/bmj.i3041]. BMJ. 2010;340:c2265. Published 2010 May 25. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876235/
Renz E, Hackney M, Hall C. Foot clearance and variability in mono- and multifocal intraocular lens users during stair navigation. J Rehabil Res Dev. 2016;53(6):933-944. Retrieved from: https://www.rehab.research.va.gov/jour/2016/536/pdf/JRRD-2015-02-0030.pdf
Gadzhanova S, Gillam M, Roughead E. Risk of falls and injuries requiring hospitalisation after first-eye cataract surgery in elderly Australians. Acta Ophthalmol. 2020;98(4):e495-e498. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/31654472/
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