Vision and Fall Risk

Normal Aging

When we look at vision and fall risk, there are a couple of things to consider. First of all, we have normal aging of the eyes. Normal aging of the eyes is going to affect everybody. No matter if you have an eye problem or not, as you get older your eyes are going to age. With normal aging of the eyes, a lot of people need more light to see what they used to be able to see with less light. A lot of people need glasses for reading just because of the normal aging of the eye.

Also, in older adults, the contrast sensitivity is reduced from normal aging. For example, say you are walking down a flight of stairs and they are all made out of concrete. It’s all gray, so you may not be able to see the edge of the step. This can cause you to miss the step because everything blends in – it’s all sort of a grayscale.

So, if we are looking at this through the lens of vision and fall risk, the reduced ability to see contrast can cause falls. Even somewhat the ability to see colors in general is reduced, so all things tend to fade into a grayscale.

That is just normal aging of the eye that will affect everybody, increasing their risk of falling.

Eye Diseases

Then we have actual diseases that affect the eyes. Examples of these are cataracts, macular degeneration, glaucoma, and diabetic retinopathy, which are more common in people over 65 years old.

The recommendation is to get your eyes checked annually (or possibly more often if you have diabetes). At your eye exam, you will get screened for the eye diseases that I mentioned. Often times these eye diseases go hand in hand with vision and fall risk

This is good to do because you may be able to treat the disease and decrease your risk of falling. For example, there is some evidence that the first eye cataract surgery reduces the risk of falling.

Your doctor may prescribe eye drops, medications, or vitamins to keep your eyes healthy.

If you have diabetes or high blood pressure, you must keep them well-managed to reduce the effect on your eyes.

Multi-focal Lenses

If you are prescribed glasses, beware of multifocal lenses like bifocals, trifocals, and progressive lenses! They may cause dizziness.

If you start having a problem with dizziness once you start wearing bifocals, trifocals, or progressive lenses, that may not be the best choice for you. You may have to go back to one pair of glasses for distance and one pair of glasses for reading. This will help with your vision and fall risk.

If you have bifocals, trifocals, and progressive lenses and you find that you are tripping on curbs, steps and inclines, then you have to be careful not to look down through the reading lens while you are stepping up on things. If you look through the reading lens, the magnification will be “off.” This will affect your depth perception, and cause a stumble on a curb, step, incline, or ramp.

This has caused a lot of falls in people I have met including my very own grandmother who fell at the curb walking up to a shopping center when she got a new pair of bifocals. She couldn’t tell how far the curb was and missed her step and slid out onto the sidewalk, which was painful and very embarrassing for her. So, when we talk about vision and fall risk, with the bifocals, trifocals, and progressive lenses, even if they don’t make you dizzy, you still have to be careful on curbs, steps, and inclines that you don’t trip or miss the step.

Be mindful of your changing vision as your get older and get the proper care that you need to reduce your risk of falling.


This blog is provided for informational and educational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

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