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The Aging Eye: Preventative Strategies to Combat Visual Loss

Dr. Rein Tideiksaar - June 04, 2012 07:57 AM

Vision plays a critical role in maintaining balance. Vision helps stabilize our bodies when standing and walking. Good eyesight is also needed to perceive our environments clearly and analyze prevailing safe vs. hazardous conditions correctly. Conversely, impaired or low vision is an important risk factor for both falls and injury. In fact, low vision is associated with a two-fold risk of hip fracture. The reason for this is that elders with low vision have decreased ability to see obstacles or hazards that may lead to slips and trips, particularly in dim lighting. Lastly, elders with low vision have a heightened fear of falling that can increase their risk -- the combination of low vision and fear of falling can result in being "afraid to move about," which can lead to muscle weakness and increased fall risk.

Causes of Visual Loss

Common causes of age-related vision loss include:

•    A gradual clouding of the lens of the eye that prevents light from reaching the retina. Elders with cataracts often complain of poor visual acuity, difficulty seeing in dim light, and increased sensitivity to glare.

•    Develops when too much fluid pressure in the eye destroys nerve fibers within the retina. The disease affects peripheral or side vision. Glaucoma is known as ‘the silent thief of sight’ because there are no noticeable symptoms. If not treated early, glaucoma can cause blindness.

Macular degeneration
•    An eye disease that occurs when the macula (the central part of the retina responsible for sharp vision) is damaged. Causes blurred or distorted central vision and permanent loss of central vision.

Age-Related Visual Changes

Several changes occur to aging eyes, which increase the likelihood of falling:

•  The ability of the eyes to adjust to varying levels of light and darkness decreases. As a result, elders need more time to adjust to lighting changes. Dark adaptation is especially affected and can compromise a person’s visual capacity, particularly under conditions of low lighting (when walking about or toileting at night). When moving from a dimly lit room into bright lighting and vice versa, elders often experience temporary blindness until the eyes adjust to the dramatic change in lighting.

•  A greater sensitivity to glare can lead to visual difficulties. Common sources of glare include sunlight shining through windows reflecting off glossy, waxed floors, bright light from unshielded light fixtures directed towards the eye, and looking directly into the sun. Glare is troublesome because it hides potential fall hazards.

•  Restriction of a person’s peripheral or side vision leads to an inability to see objects in the pathway that lie outside the person’s view, increasing the likelihood of slips and trips.

•  A loss of visual acuity and contrast sensitivity makes the perception of objects in the environment more difficult, such as door thresholds and upended carpet edges; this becomes more difficult in low lighting.

•  A decline in depth perception can make it difficult to perceive objects that lie in areas of shadows, low light, or excessive brightness.

Visual limitations can hinder the ability of elders to safely navigate slip/trip hazards in their path, whether in their own home or in a shopping center. Young people use visual cues to perceive fall threats and take corrective action. Elders with visual impairments do not have this advantage. 

Preventive Strategies

If you or someone else notices that you experience difficulties with vision and/or have fallen because of a missed step or an object on the floor that you didn’t see, there are two things you can do immediately:

Visit the Eye Doctor (Ophthalmologist)

• The best way to protect your sight to get regular eye exams; they can detect disease early. If you have a visual disease, treatment can begin immediately, which may help to prevent unnecessary vision loss.

Modify the Environment

• Impaired vision makes poor lighting doubly dangerous. Make sure that commonly used areas of the home (stairways, hallways, bedrooms, and bathrooms) have sufficient light. To increase lighting, use 3-way light bulbs or rheostat (or dimmer) light switches.

•  Make sure that all lighting fixtures can be turned on using a light switch so that the room is well lit when entering or exiting.

•  Avoid abrupt lighting changes; use of dimmer switches varies the amount of light available and prevents sudden shifts in light.

•  Avoid lighting glare; reposition lamps or use lampshades to control glare. Floor glare can be eliminated with carpets and nonslip floor finishes that diffuse rather than reflect glare.

• Use nightlights to make navigation in the dark easier and safer. Nightlights in the bedroom and walkway to the bathroom are important, especially for those elders who get up frequently at night to toilet.

• Make the stairways/steps safe by placing brightly colored tape or sticker strips on step edges. Add a different colored strip to first and last steps to identify change of level (most stairway falls occur on the top and bottom step). Consider installing lighting fixtures below eyelevel, near the top and bottom step; lighting helps to judge step heights.

•  Prevent tripping over things on the floor by ensuring that all walkways in the home free of clutter.

• Use color and contrast to define balance-aiding objects in the home (grab bars and handrails).

Lastly, other sensible tips to aid vision include:

•  Don’t wear multifocal lenses while walking, particularly on stairs. This can lead to blurred vision and falling. Using single lens distance glasses instead.

•  Wear glasses if you need them and clean eye glasses often to improve visibility.

•  Inability to identify proper medications can put elders at fall risk. Pill organizers with bright or raised markings can prevent medication-related accidents.

•  Provide low vision elders with a cane/ other assistive devices to reduce the likelihood of falling.

•  Tai chi (a gentle martial art that helps build strength/improve balance) is a good form of exercise for elders with visual impairment and poor balance.

Click here to read Dr. Rein Tideiksaar’s blog, “Five Keys to Preventing Osteopathic Fractures”.

Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at

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