The effects of monocular refractive blur on gait parameters when negotiating a raised surface

Falls in the elderly are a major cause of mortality and morbidity. Elderly people with visual impairment have been found to be at increased risk of falling, with poor visual acuity in one eye causing greater risk than poor binocular visual acuity. The present study investigated whether monocular refractive blur, at a level typically used for monovision correction, would significantly reduce stereoacuity and consequently affect gait parameters when negotiating a raised surface. Fourteen healthy subjects (25.8 +/- 5.6 years) walked up to and on to a raised surface, under four visual conditions; binocular, +2DS blur over their non-dominant eye, +2DS blur over their dominant eye and with their dominant eye occluded. Analysis focussed on foot positioning and toe clearance parameters. Monocular blur had no effect on binocular acuity, but caused a small decline in binocular contrast sensitivity and a large decline in stereoacuity (p < 0.01). Vertical toe clearance increased under monocular blur or occlusion (p < 0.01) with a significantly greater increase under blur of the dominant eye compared with blur of the non-dominant eye (p < 0.01). Increase in toe clearance was facilitated by increasing maximum toe elevation (p < 0.01). Findings indicate that monocular blur at a level typically used for monovision correction significantly reduced stereoacuity and consequently the ability to accurately perceive the height and position of a raised surface placed within the travel path. These findings may help explain why elderly individuals with poor visual acuity in one eye have been found to have an increased risk of falling.