Visual determinants of instability and falls in older people

Poor vision (in particular, reduced contrast sensitivity, depth perception and visual field size) reduces postural stability and increases the risk of falls and fractures in older people. Multifocal glasses may add to this risk by impairing distance contrast sensitivity and depth perception. Maximizing vision through cataract surgery and occupational therapy interventions involving home hazards reduction in visually impaired older people are effective strategies for fall prevention. Although interventions involving vision assessment and provision of new spectacles improve visual acuity in older people, this strategy may not reduce, and may even increase, the risk of falls. Further randomized, controlled trials are required to determine whether restriction of use of multifocal glasses and multifaceted visual interventions can significantly reduce falls in older people.