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Falls prevention and the importance of eye tests

During National Eye Health Week, ExtraCare is highlighting the importance of regular sight tests. Here Mr Akbar Karim, Lead Optician for Specs at Home, explores the role opticians play in preventing falls. Akbar currently provides a home eye test service at several of ExtraCare’s Birmingham retirement villages.

It’s simple. Falls can have a massively detrimental impact on quality of life. The College of Optometrists’ “Focus on Falls” report says:

“Falls are the most common cause of hospitalisation for people aged over 65. Across the UK, one in three people aged over 65 will fall every year and fractures from falls cost the NHS approximately £2.2 billion per annum.

“The chances of having reduced vision greatly increase with age and older people with reduced vision are more likely to fall. Vision is fundamental to co-ordinating our movement – balance and postural stability are directly affected by vision. In addition, vision is fundamental to adapting gait to enable safe travel though the environment, avoiding obstacles and negotiating steps and stairs. As optometrists, we can play a vital role in helping to prevent falls by detecting and appropriately correcting sight loss, providing the right advice and ensuring that spectacles are correctly centred and of a suitable design for the patient.”

How eye tests help reduce falls

I’ll focus on just two areas in which regular eye tests can help…

1. By checking eye health

Eye exams can detect ocular problems before any long lasting visual deterioration may take place so regular eye tests help to pick up these conditions before they affect the vision to the extent shown in the pictures below.

Age Related Maculat Degeneration
Diabetic Retinopathy

Once eye diseases are noted, a prompt referral to an ophthalmologist at the eye department will save vision in treatable conditions.

For untreatable conditions it’s still worthwhile understanding the type of sight loss to best appreciate someone’s particular visual needs and falls risk. For example someone with ARMD (picture 1) will struggle more with tasks in their central vision, such as reading, whereas someone with Glaucoma (picture 2) may have no problems reading but may have poor peripheral vision which would make things like crossing the road more dangerous.

Preventing or raising awareness of these eye conditions can help to inform lifestyle changes that in turn can reduce the risk of falls.

Other ways eye tests can reduce falls include referring to other healthcare professionals such as low vision specialists, orthoptists and rehabilitation workers.


2. By prescribing spectacles

Having up to date spectacles is a simple enough thing to do – even for those who can’t leave their home, thanks to Home Visiting Opticians; but there are several other factors beyond just issuing spectacles that a good optician will consider when considering falls reduction:

All in one versus separate pairs: If a client is an existing Bifocal or Varifocal (‘all in one’ spectacles) wearer, would it be safer to prescribe separate pairs of spectacles to reduce the potential trip hazard of the lower reading half of the bifocal or varifocal?

When it’s felt this is the case (for example, in a client with worsening dementia who is mobile but a little wobbly on their feet), I replace the Bifocal or Varifocal with separate Distance and Near spectacles instead.

Identical Distance and Near spectacles: A pet peeve of mine is where a client has chosen or been recommended separate distant and near pairs of spectacles (GOOD!) that look very similar (BAD!) which causes unnecessary confusion especially if a client has dementia.

When I’m dispensing new distance and near spectacles I always recommend the client chooses frames that look different to each other. This avoids clients mistakenly walking about in their reading specs, which tends to blur distance vision hence increasing risk of falls!

Large changes in prescription: When changing to new spectacles, most people tolerate small to moderate changes in their prescription just fine – for these people, the worst thing they may experience is the new spectacles feeling a bit strange at first. However, when the prescription change is large, for some people the strange feeling doesn’t go away. They can even get headaches or feel the new prescription is ‘distorting’ their view of the world.

It’s counter intuitive to think that an improvement in prescription could adversely affect a person’s vision but unfortunately (only in a small number of cases) it can happen. But the optician can ‘modify’ the prescription by not prescribing the full amount all at once.

The main thing to remember is to always return to your optician if you’re experiencing issues with your new specs.

I’m really pleased to be raising awareness on the issue of falls. When you consider the huge impact falls can have on a person’s life, it makes sense that we all do what we can to reduce our own personal falls risk.

Regular eye tests are an often over-looked vital part of reducing your risk of falls.

Eye tests are free to people over 60 in England and if you can’t get to the optician on your own then home eye tests are also free.