Getting older is inevitable and aging is often accompanied by changes in vision. As people get older, many of them struggle with cataracts:
- Words in books may become blurred,
- It may be difficult to focus on a computer screen.
- Oncoming car headlights may become more bothersome.
This is because the clear lens in our eyes can become cloudy (referred to as a cataract).
Cataracts blur our vision as we age. Seniors with cataracts are more likely to suffer from trips, falls, and even motor vehicle accidents.
Cataracts increase the risk of falls in seniors
If not treated properly, cataracts can be blinding. In fact, cataracts are one of the leading causes of blindness worldwide,[mfn]https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment.[/mfn]. [mfn ][PubMed][/mfn] My mom, Susan (73), was one of them.
She found that not only was it difficult to read her computer or her phone, but objects in the distance appeared fuzzy and indistinct. Like many, she first tried to fix it by wearing bifocal glasses. However, as an ophthalmologist, I knew this wouldn’t fix the root of the problem.
In fact, bifocal, trifocal, and progressive glasses can actually increase the risk of trips and falls because they reduct depth perception. They also impair edge-contrast sensitivity (the ability to distinguish subtle differences in shading) when looking down to walk. This can cause a person to misjudge their foot placement or fail to negotiate steps or raised surfaces well.[mfn] [PubMed] [Cross Ref][/mfn], [mfn][PubMed][/mfn], [mfn] [PubMed] [Cross Ref][/mfn]
Bifocals may increase the risk of falling in seniors
Falling related to bifocal glasses is a significant danger to seniors. In fact, falls are the leading cause of injury for older people. [mfn] https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/[/mfn] They lead to more deaths in seniors than diabetes. [mfn]Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: Final data for 2014. National vital statistics reports; vol 65 no 4. Hyattsville, MD: National Center for Health Statistics. 2016[/mfn] I was, therefore, worried about my mother falling.
Needless to say, quality of vision is also vital for safe driving, among many other necessary day-to-day activities.
For these reasons, I encouraged my mom to consider cataract surgery. During this outpatient procedure, an ophthalmologist (eye surgeon) removes the cloudy lens and replaces it with a clear artificial intraocular lens (IOL). This helps patients see more clearly and with greater contrast. This procedure is quite routine and is one of the most commonly performed surgeries in the United States [mfn]https://nei.nih.gov/health/cataract/cataract_facts[/mfn]
There have been big advances in cataract surgery
We’ve seen big advances in cataract surgery in recent years, particularly in the types of IOLs available. Today, we can use the procedure to correct not only the cataract, but also presbyopia (losing the ability to see at near ranges) and astigmatism (an oblong eye shape that distorts images). Following cataract surgery, many patients achieve 20/20 vision without glasses, even after needing glasses or contacts for most of their lives.
Ultimately, my mom decided to undergo cataract surgery, and it was my honor to perform the procedure myself. She and I felt confident this route would not only be best for her overall health but that it would also improve her quality of life.
During surgery, I elected to insert the TECNIS Symfony® IOL (Johnson & Johnson Vision).* It had been available for about two years at the time of her surgery.
This is the first in a new class of advanced lenses called extended-depth-of-focus IOLs. They offer a seamless, continuous range of quality vision. In my professional assessment, this was the right choice for her, but every person considering surgery needs to speak with their physician to determine what is best for them.
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Following surgery, my mom was amazed by how clearly she could see and how vibrant colors now appeared. She no longer needs her glasses for most activities. She feels it has given her more independence to do the things she loves, like traveling, playing with her grandchildren, and just performing the tasks of daily life.
As her son, I take comfort in knowing that she’s seeing clearly and is safer from fall risks. I see patients like my mom every day and encourage children of older adults to talk with their parents and their ophthalmologists to address vision issues.
The bottom line
As you age, it is important to have your vision checked annually so that a doctor can monitor your visual acuity and check for the development of diseases such as cataracts, glaucoma, and macular degeneration.
Impaired vision can make driving, moving around, and reading more difficult, so please consult your optometrist or ophthalmologist who can help answer any vision questions you may have.
In-between appointments, it’s important to be aware of the following symptoms that might warrant an earlier return visit [mfn] https://www.aoa.org/patients-and-public/good-vision-throughout-life/adult-vision-19-to-40-years-of-age/adult-vision-41-to-60-years-of-age[/mfn]:
- Problems with glare, particularly while driving
- Difficulty with or needing more light while reading or completing close-up tasks
- Changes in how you see or distinguish colors
- Dry eyes or reduced tear production. Women more often experience dry eyes as they age due to hormonal changes
- Seeing “floaters” or flashes (tiny spots or shadowy images)
- Loss of side (peripheral) vision (a symptom of glaucoma) or
- Distorted or wavy central vision (a symptom of age-related macular degeneration)
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If you’d like to learn more about vision, here are some important resources
- Vision Impairment and Blindness. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment.
- Khairallah Moncef, Kahloun Rim, et al. Invest Ophthalmol Vis Sci. 2015 Oct;56(11):6762-9. doi: 10.1167/iovs.15-17201. [PubMed]
- 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;50:1760–66. doi: 10.1046/j.1532-5415.2002.50502.x. [PubMed] [Cross Ref]
- 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. [PubMed]
- Johnson L, Buckley JG, Scally AJ, Elliott DB. Multifocal spectacles increase variability in toe clearance and risk of tripping in the elderly. Investigative OphthalmolVis Sci. 2007;48:1466–71. doi: 10.1167/iovs.06-0586. [PubMed] [Cross Ref]
- Falls Prevention Facts. National Council on Aging. Accessed on May 17th, 2018 at https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/
- Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: Final data for 2014. National vital statistics reports; vol 65 no 4. Hyattsville, MD: National Center for Health Statistics. 2016
- Thoughts on Cataract Surgery: 2015. Review of Opthalmology Accessed on May 17, 2018 at https://nei.nih.gov/health/cataract/cataract_facts
- Adult Vision 41 to 60 Years of Age. American Optometric Association. Accessed on May 9, 2018 at https://www.aoa.org/patients-and-public/good-vision-throughout-life/adult-vision-19-to-40-years-of-age/adult-vision-41-to-60-years-of-age
*Financial disclosure: Dr. Chang works with Johnson & Johnson Vision to educate people on cataracts and healthy vision. TDWI did not receive payment for publishing this article.
First published 6/19/18, it has been medically reviewed and updated for republication on 5/2/20.
Daniel H. Chang, MD
Daniel H. Chang, M.D. is a board-certified ophthalmologist who practices at the Empire Eye and Laser Center in Bakersfield, California. He also works with Johnson & Johnson Vision to educate people on cataracts and healthy vision.
He graduated with honors from the California Institute of Technology and then received his medical and ophthalmology training from two of the top programs in the Southeast: Duke University, where he performed groundbreaking laser vision correction research; and Emory University, where he earned the position of Chief Resident in Ophthalmology.
Dr. Chang was then invited to the prestigious cornea and refractive surgery fellowship at Minnesota Eye Consultants, where he was trained on state-of-the-art vision correcting techniques. Dr. Chang has performed thousands of successful LASIK, PRK, and cataract procedures.
He has served as a principal investigator on numerous US FDA clinical trials, including several that have brought advanced vision-correcting lens implants to market. He has authored dozens of articles and publications on refractive surgery and advanced intraocular lenses.
He regularly lectures at eye meetings from the local through the international level. Additionally, he trains and advises other surgeons and physicians on vision correcting surgery techniques.
Dr. Chang is president and founding member of the Advanced Center for Eyecare, a non-profit clinic that provides medical and surgical eye care to the uninsured and underinsured people of Kern County.
Nationally, he serves on the Refractive Surgery Clinical Committee of the American Society of Cataract and Refractive Surgery (ASCRS) and on the Special Projects Committee of the American Academy of Ophthalmology (AAO).
Thanks for pointing out that bifocal glasses can impair depth perception and cause falls. My mother-in-law wears bifocals, and just last week she called us saying she had fallen. Luckily she’s okay, but we definitely want to keep if from happening again if we can. I’ll talk with her about her about considering cataract surgery.
Great article. It is great that the technology on cataract surgery keeps evolving. I did not even realize that the loss of vision resulting from cataracts causes seniors to be more likely to fall. This is just another great reason to go a head and get the surgery if you have cataracts.
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