Visual Impairment and Fall

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Visual Impairment and Fall
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• 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 2328.

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• Visual impairment is strongly associated with
  falls and hip fractures
• Abdelhafiz, A.H. and Austin, C.A Visual factors
  should be assessed in older people presenting
  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

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• 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

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Common eye problems in the elderly
Cataract 17-30
Vision
AMD 65 11-18 75 - 30
65 17 75 - 30
Glaucoma 2
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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

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Low Tech- vision assessment and Falls Service
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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

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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

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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

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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 2010340c2265