jlink
Sunday, September 27, 2020
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I found your September 3, 2020 Health Link article, “Take Care of Your Vision & Reduce Falls,” interesting and informative, but would like to offer some important insight on some missing information. While the literature supports the assertion that the incidence of falling down among older adults is higher among those wearing bifocal/progressive lenses when navigating steps (because they can misjudge their height), it is not true under all conditions, and is more likely due to faulty proprioception of their foot placement (common in older adults). Multifocal lenses are a safe and efficient mode of correction for tens of millions of people worldwide.

In a 2010 study in the British Journal of Medicine, the authors reported that “Replacing multifocals (or bifocals) with distance-only lenses for walking and outdoor activity reduced the risk of falling by 38 to 40% among (older) people who regularly take part in outdoor activity. But among those who didn’t get outside much, switching to distance (only) lenses didn’t affect falls overall—and actually increased those occurring outside the home.”

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This means that falls could be reduced by switching to single vision lenses, but only among those who regularly spend time engaged in outdoor activities. Among those who are not active outdoors it may actually increase their fall risk (by switching to separate pairs of glasses for distance and reading). Having multiple pairs of glasses for older adults can also be confusing. So what should be done?

Older adults who are believed to be less than physically stable, and also those who have had cataract surgery and wear only a small or no actual distance vision correction in their bifocals/multifocals, need not wear their glasses while ambulating; their uncorrected vision will be sufficient to get around indoors or outside. Once stable (or seated) they can resume wearing the glasses. This is a decision that should not be imposed on an older adult, so for everybody else who needs their multifocal glasses to see and has worn them for a time, I would recommend wearing them as you always have. If you feel it would help you, then order a single vision lens for some activities such as walking on irregular outdoor surfaces, but the goal should be to spend more time on outdoor activity so that the need for an extra pair of glasses is minimized.

Lastly, as you correctly cited, the most important consideration is to have regular annual eye exams with your eye doctor. Only then can you get answers to your specific concerns.

Steven D. Starkman, O.D.
Teaneck
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