Do multifocal / bifocal spectacles increase the risk of serious falls in the elderly? Are multifocal / toric lens implants a solution?

Our elderly patients are vulnerable to falls which can be a life changing or even life ending incident.  Wearing bifocal / multifocal lens implants may increase the risk of falls (read HERE).  There are NO studies demonstrating increased safety with these newer, more expensive implants, but it does make a certain amount of sense.

The question posed is whether we should be considering multifocal lens implants to eliminate the aberrations and induced prism inherent in multifocal spectacles?

JAMA listed the cost of falls at over $70 B per year (2013) ranking 5 out of 155 conditions.  Eye care was lumped with all “special senses” at 8/155 and close to $60B per year.    This includes cataract surgery, injections for macular degeneration, etc.   If half of the 2B cataract surgeries per year were given more expensive multifocal lenses the extra cost would be about $2.5B per year.  If falls decreased only 10% that would save over $7B per year – plus considerable suffering.