Fall rates in bifocal, trifocal, and progressive addition lens glasses wearers

There is evidence that wearing multifocal glasses increases the risk of falls in older people, especially when walking on stairs and in unfamiliar settings. However, it is not clear whether all types of multifocal glasses are equally associated with falls. This study comprised a secondary analysis of data from the VISIBLE randomized controlled trial to determine whether fall rates differ among older bifocal, trifocal, and progressive addition lens glasses wearers.

Two hundred eighty-one regular wearers of multifocal glasses (mean age, 80.3 years; standard deviation, 6.8 years) who were at increased risk of falls and used multifocal glasses three or more times per week participated in the study. Participants were classified into three groups: bifocal (n = 170), trifocal (n = 33), and progressive addition lens glasses wearers (n = 78). Participants underwent assessments of vision, sensorimotor function and balance (assessed with the Physiological Profile Assessment), Timed Up and Go performance, and activity levels and were then followed up for falls for 13 months.

Two hundred sixty-eight participants (95.4%) were followed up for falls for 6+ months over the following 13 months: 51 bifocal glasses wearers (31.5%) suffered multiple falls compared with 15 trifocal glasses wearers (46.9%) and 33 progressive addition lens glasses wearers (44.6%) (p=0.071). When adjusting for established fall risk factors, participants wearing progressive addition lens glasses had over twice the odds of suffering multiple falls compared with bifocal glasses wearers (odds ratio, 2.23; 95% confidence interval, 1.08 to 4.58).

These findings suggest that progressive addition lens glasses increase the risk of falls more than bifocal glasses possibly due to visual distortions and reduced awareness of blurred distant objects in the lower visual field. Education of the risks posed by progressive addition lens glasses and training in optimal glasses use may help protect older people from falls.