Optometry’s role in preventing falls in elderly patients

Denver- During the American Academy of Optometry's Academy 2014, Susan J. Leat, BSc, PhD, FCOptom, outlined the optometrist's role in preventing falls. She is a professor at the School of Optometry and Vision Science, University of Waterloo, British Columbia.

In an often-cited study published in the Journal of American Geriatrics Society, researchers randomized 616 subjects to undergo comprehensive eye exams, including any necessary spectacle correction and appropriate referrals to ophthalmology or occupational therapy, versus care as usual.

"What they found-or at least what is quoted-is that falls and fractures were more frequent in the intervention group than in the control group in the first six months, although there was no difference in the second six months. I don't think this is what the investigators set out to find,” says Dr. Leat.

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However, only 44 percent of the intervention group actually underwent some form of therapy.

“And only 30 percent received new glasses. On the other hand, 72 percent of the control group visited the optometrist or ophthalmologist in that time period. This illustrates a confounding factor-crossover or contamination between the two groups. And it illustrates the difficulty of planning these studies. What is likely to happen is that the control group might be more likely to get an eye exam themselves-it triggers their memories."

Furthermore, subjects with major changes (0.75 D or more in sphere or cylinder) had more falls. Accordingly, she says that when it comes to prescribing, “The one thing I believe is useful from that study is to try to avoid larger changes in power, and larger axis changes as well. That means we could be giving a partial prescription to these patients if they have a change in fraction. That probably means that we need to see them more frequently. For example, if they are having an increase in their hyperopia or moving towards myopia, we ultimately need to keep up with that refractive change."

Optometrists also could counsel more precisely, she said. When giving a prescription change, "We tend to say, 'You could have some difficulty adapting to these glasses. It might take a week or two.' Perhaps we could be more specific. If it's a change in the hyperopic direction, we might say, 'This is going to make things look bigger and closer to you. You might find that you miss an object on a table, or a step, so be extra careful.' And that adaptation period might be longer than two weeks for some of our older patients."

She also suggested not giving new progressive-addition lenses (PALs) or bifocals to elderly patients, especially those at risk of falls. “And we don't want to change that lens design unless we have a very good reason. If you really are going to give new PALs to a patient in this age category, then a soft design, and a shorter corridor, are recommended.”

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