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Review: ODs can help prevent falls in older patients
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A review recently published by Optometry & Vision Science discussed techniques to better manage older patients who are at risk for falling, one of which is to avoid dramatic changes in spectacle lens prescriptions.
David B. Elliott, PhD, MCOptom, FAAO, discussed the role of blurred vision in the risk of falls and how inappropriate vision correction may increase that risk. He said the first step is to identify patients at risk.
"Risk factors include older age (>75 years), female sex, a history of falls, living alone, decreased muscle strength, Parkinson’s disease, stroke, arthritis, diabetes, Meniere disease, dementia, taking sedatives and antidepressants, and polypharmacy," he wrote. "The more risk factors patients have, the more likely they are to fall."
Elliott also advised not to dramatically change prescriptions, as "older frail people may have greater difficulty adapting to such changes and be at increased risk of falling during this adaptation period.
"To help prevent falls, changes to refractive corrections in older people should be conservative, with maximum changes of approximately 0.75 D and minimal changes in cylinder axes, particularly if oblique," he added. "Indeed, if a patient reports no problems with his or her vision, but simply requests a new frame, ‘if it ain’t broke don’t fix it’ is an appropriate clinical maxim, and the refractive correction is best not changed."
Elliott recommended against prescribing progressive-addition lenses or bifocals to patients who are accustomed to wearing single-vision lenses and who may be at high risk for falls.
He also called for more education and training for optometrists who treat older patients.
"Falls are common and represent a very serious health risk for older people," he wrote. "They are not random events, as studies have shown that falls are linked to a range of intrinsic and extrinsic risk factors. Vision provides a significant input to postural control in addition to providing information about the size and position of hazards and obstacles in the travel pathway and allows us to safely negotiate steps and stairs."
Elliott received the 2013 Glenn A. Fry Award for this review, according to a press release from Wolters Kluwer Health.
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Optom Vis Sci. 2014; doi: 10.1097/OPX.0000000000000268.
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