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.

Poor Vision in the Elderly can lead to physical and cognitive decline

Science Daily reports a study out of Germany published in the Journal of the American Geriatric Society demonstrating what we all already know.  When people (Especially older people) lose vision their ability to participate in meaningful mental and physical activity declines.  This of course effects the quality of life and their ability to care for their other medical issues.

The Problem

Why is it important to prevent visual loss and restore blindness in the elderly? After all, they may not have too many more years to benefit from expensive interventions. The study quoted in the attached link demonstrates that elderly individuals who develop significant visual loss (20%) also have significantly more physical and cognitive problems. It stands to reason. If you cannot take care of yourself – Drive to appointments, read instructions and prescriptions, etc it is going to be hard to do the necessary activities to provide adequate healthcare to themselves. Further, the simple act of doing these tasks are probably helpful in preserving physician and mental fitness.

Suggestion

We need to examine how extending additional care to the visually impaired will reduce other disparities in the health care so that these patients can lead more productive and meaningful lives. This would involve earlier diagnosis of diseases that lead to visual loss but have little early symptoms – such as glaucoma. We also need to find more accessible treatment options for those with treatable visual loss such as macular degeneration. Possibly bringing this service to the patient in terms of more accessible delivery. visual restoration with innovations and better use of existing technology to restore functional vision. Medicare will pay tens of thousands of dollars for surgical rehabilitation with such devices as a Intraocular Minature Telescopic Implant or a Retinal Prosthesis but will not pay a fraction of that for more conventional treatments and devices that have a greater chance of success.

 

Communities for the Visually Impaired Elderly

Communities for the visually impaired would allow the concentration and focus of needed resources resources including vision and health care facilities and transportation. In addition, the housing could be specially designed for the visually impaired to make their day to day living less difficult and stressful.

I believe such efforts would be cost effective but even more beneficial in improving quality of life for our most experienced patients.