Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial
Mark J Haran, Ian D Cameron, Rebecca Q Ivers, Judy M Simpson, Bonsan B Lee, Michael Tanzer, Mamta Porwal, Marcella M S Kwan, Connie Severino, Stephen R Lord, Mark J Haran, Ian D Cameron, Rebecca Q Ivers, Judy M Simpson, Bonsan B Lee, Michael Tanzer, Mamta Porwal, Marcella M S Kwan, Connie Severino, Stephen R Lord
Abstract
Objective: To determine whether the provision of single lens distance glasses to older wearers of multifocal glasses reduces falls.
Design: Parallel randomised controlled trial stratified by recruitment site and source of referral, with 13 months' follow-up and outcome assessors blinded to group allocation.
Setting: Community recruitment and treatment room assessments in Sydney and Illawarra regions of NSW, Australia.
Participants: 606 regular wearers of multifocal glasses (mean age 80 (SD 7) years). Inclusion criteria included increased risk of falls (fall in previous year or timed up and go test >15 seconds) and outdoor use of multifocal glasses at least three times a week.
Interventions: Provision of single lens distance glasses with recommendations for wearing them for walking and outdoor activities compared with usual care.
Main outcome measures: Number of falls and injuries resulting from falls during follow-up.
Results: Single lens glasses were provided to 275 (90%) of the 305 intervention group participants within two months; 162 (54%) of the intervention group reported satisfactory use of distance glasses for walking and outdoor activities for at least 7/12 months after dispensing. In the 299 intervention and 298 control participants available to follow-up, the intervention resulted in an 8% reduction in falls (incidence rate ratio 0.92, 95% confidence interval 0.73 to 1.16). Pre-planned sub-group analyses showed that the intervention was effective in significantly reducing all falls (incidence rate ratio 0.60, 0.42 to 0.87), outside falls, and injurious falls in people who regularly took part in outside activities. A significant increase in outside falls occurred in people in the intervention group who took part in little outside activity.
Conclusions: With appropriate counselling, provision of single lens glasses for older wearers of multifocal glasses who take part in regular outdoor activities is an effective falls prevention strategy. The intervention may be harmful, however, in multifocal glasses wearers with low levels of outdoor activity.
Trial registration: Clinical trials NCT00350389.
Trial registration: ClinicalTrials.gov NCT00350855 NCT00350389 NCT00350855.
Conflict of interest statement
Competing interests: The physiological profile assessment (FallScreen) is commercially available through the Prince of Wales Medical Research Institute.
Figures
References
- Donahue SP. Loss of accommodation and presbyopia. In: Yanoff M, Duker JS, eds. Ophthalmology. Mosby, 1999.
- Duke Elder S. The practice of refraction. Churchill, 1963.
- Tinetti ME. Clinical practice: preventing falls in elderly persons. N Engl J Med 2003;348:42-9.
- Lord SR, Dayhew J, Howland A. Multifocal glasses impair edge contrast sensitivity and depth perception and increase the risk of falls in older people. J Am Geriatr Soc 2002;50:1760-6.
- Johnson L, Buckley JG, Harley C, Elliott DB. Use of single-vision eyeglasses improves stepping precision and safety when elderly habitual multifocal wearers negotiate a raised surface. J Am Geriatr Soc 2008;56:178-80.
- Johnson L, Buckley JG, Scally AJ, Elliott DB. Multifocal spectacles increase variability in toe clearance and risk of tripping in the elderly. Invest Ophthalmol Vis Sci 2007;48:1466-71.
- Menant JC, St George RJ, Sandery B, Fitzpatrick RC, Lord SR. Older people contact more obstacles when wearing multifocal glasses and performing a secondary visual task. J Am Geriatr Soc 2009;57:1833-8.
- Connell BR, Wolf SL. Environmental and behavioral circumstances associated with falls at home among healthy elderly individuals. Arch Phys Med Rehabil 1997;78:179-86.
- Davies JC, Kemp GJ, Stevens G, Frostick SP, Manning DP. Bifocal/varifocal spectacles, lighting and missed-step accidents. Safety Sci 2001;38:211.
- Day L, Fildes B, Gordon I, Fitzharris M, Flamer H, Lord S. Randomised factorial trial of falls prevention among older people living in their own homes. BMJ 2002;325:128-31.
- Cumming RG, Ivers R, Clemson L, Cullen J, Hayes MF, Tanzer M, et al. Improving vision to prevent falls in frail older people: a randomized trial. J Am Geriatr Soc 2007;55:175-81.
- Haran MJ, Cameron ID, Ivers RQ, Simpson JM, Lee BB, Porwal M, et al. Preventing falls in older multifocal glasses wearers by providing single-lens distance glasses: the protocol for the VISIBLE randomised controlled trial. BMC Geriatrics 2009;9:10.
- Gibson MJ, Andres RO, Isaacs B, Radebaugh T, Worm-Petersen J. The prevention of falls in later life. Dan Med Bull 1987;34(suppl 4):1-24S.
- Clark MS, Bond MJ. The Adelaide activities profile: a measure of the lifestyle activities of elderly people. Aging Clin Exp Res 1995;7:174-84.
- Gandek B, Ware J, Aaronson NK, Apolone G, Bjorner JB, Bullinger M, et al. Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: results from the IQOLA project. J Clin Epidemiol 1998;51:1171-8.
- Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the falls efficacy scale international (FES-I). Age Ageing 2005;34:614-9.
- Brookes ST, Whitely E, Egger M, Smith GD, Mulheran PA, Peters TJ. Subgroup analyses in randomized trials: risks of subgroup-specific analyses; power and sample size for the interaction test. J Clinical Epidemiol 2004;57:229-36.
- Lord SR, Menz HB, Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Phys Ther 2003;83:237-52.
- Rosenstock I. The health belief model and preventive health behaviour. Health Educ Monogr 1978;2:354-86.
- Naidu S, Lee JE, Holopigian K, Seiple WH, Greenstein VC, Stenson SM. The effect of variably tinted spectacle lenses on visual performance in cataract subjects. Eye Contact Lens 2003;29:17-20.
Source: PubMed