Wednesday, December 28, 2016

Does wearing bifocal glasses increase falls for the elder? Are multifocal lens implants a solution?

Wearing Bifocal and Multifocal spectacles is associated with a 40% increased risk of falls according to a study reported HERE.   That makes sense from the perspective of image jump and displacement that is present with these spectacle lenses.  Several solutions are possible.  The simplest and seemingly the cheapest is to give people separate single vision correction for distance and near.  Contact lenses would seemingly give good correction with fewer aberrations and no induced prism.  Unfortunately, contact lenses are not always a good option for the elderly with poor dexterity and poor corneal surface.

Being a legendary tight wad, I have never seen the value of so called "premium" lens implants for most people.  These are astigmatism correcting (topic) and implants designed to give usable vision at distance and near (multifocal and accommodative).  Aside from their high out of pocket cost I have concerns about the increased risk of glare at night and reduction of contrast sensitivity.  In addition,  many eyes have need for both astigmatic correction and multifocal correction -  which until recently has not been available (see release HERE).

Should we reconsider our approach?  Is the sacrifice of money and the chance of reduced quality of vision worth the reduction in aberrations and induced prism that may increase the risk of falls in already frail elderly patients.  If the use of these lenses decrease falls by this much would it be cost effective for insurers and Medicare /Medicaid to pay for these lenses?

An ideal site to study this would be the Veteran's Administration (VA) where patients can already select to have toxic and multifocal lens implants with no additional charges.  If the date from these patients shows decreased rates of falls compared to those who still need to wear bifocals or multifocal glasses we could further analyze the direct and indirect costs of these injuries as well as the non-economic pain and suffering. I think it is time to reevaluate our use of these lenses and whether they represent a true functional improvement for our mist vulnerable patients rather than a luxury.   Of course this is how we started with lens implants in the first place.

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