Do you remember playing “Pin the Tail On the Donkey” and what fun it was to watch the blindfolded kids stumble and sway as they tried to walk a straight line after being twirled? The brain needs vision to keep the body balanced. Otherwise (unless you’re blind and learn to compensate), you might wander around looking a bit drunk, misjudge distances, stumble and even fall.

So you’d think that getting a new, updated prescription for eyeglasses or contacts, or surgery to remove cataracts, would make you steadier, more sure-footed and safer, right?

Not so fast. Studies show that updated vision correction, even if it technically improves your ability to see, is associated with a dangerous adjustment period that could land you in the hospital or worse.

Take heed—there’s a right way and a wrong way to get used to vision correction, and knowing the right way could literally save your life…

A TOO-COMMON HAZARD

How can seeing better lead to a potentially fatal fall? David B. Elliott, PhD, professor of clinical vision science at University of Bradford in West Yorkshire, United Kingdom, reviewed several studies on the association between vision correction and falls in older people to find out—and look for ways that people can stay safe.

In one study of more than 28,000 men and women over age 60, risk of serious falls more than doubled after a first cataract operation. Even after cataracts in both eyes were repaired, risk of serious falls increased by more than one-third.

Another study found that, for older adults, getting a pair of glasses or other vision correction was potentially more dangerous than muddling along with bad eyesight. In this study, 300 men and women who were age 70 or older were divided into two groups—one, a treatment group and the other, a control group. The treatment group had eye exams and, if needed, got glasses or cataract surgery. The control group had no special intervention. Members of this group may have had a vision check and received new glasses on their own if they so wished, but they were not encouraged to do so as part of the study.

You would think that people who specifically had vision correction would be better off, but in the first year of the study, there were 30% more falls in the treatment group than in the control group. Almost three-quarters of people in the treatment group who had significant changes in vision correction—whether they had received glasses for the first time or had major updates to their existing eyeglass prescriptions—fell at least once, and 53% of those who had more minor changes did so as well. This suggests that falls may, in part, be attributable to vision correction that is too much too soon for older adults, according to Dr. Elliott.

What explains it? For one, older people may have challenges adapting to lens magnification. Take, for instance, the simple action of stepping off a curb or walking down stairs. The magnification of a new pair of glasses can make the step appear further away than it actually is. And when an astigmatism (a distortion in the shape of the cornea) is compensated for with glasses, it can initially be difficult to get used to the new way of seeing. Floors and walls can initially appear to be sloped, and this can naturally mess up balance.

SAFETY AND NEW GLASSES

No one is suggesting that you should suffer with poor eyesight as a strategy to prevent falls, but powerful new glasses aren’t always the best solution. Firstly, know that folks most at risk for falls related to vision correction are seniors (people age 75 or older) and people who are otherwise frail or have medical conditions that can throw off balance, such as Parkinson’s disease, stroke, arthritis, diabetes, low blood pressure, inner ear disease and dementia. People who are on sedative or antidepressant medications or who take more than four prescription medications a day are also at higher risk. Based on the medical evidence, Dr. Elliott offers these tips about new glasses to keep you safe…

  • New prescriptions. If you are an older person who already is wearing glasses and feel that your vision is just fine with them, but an optometrist says you need a stronger prescription, assert your option to refuse or to request that a small, incremental improvement be made instead of a full-blown correction. The point here is, if it “ain’t broke”—by your needs and standards—don’t feel pressured into having to “fix it.”
  • New frames. Do you need a new pair of eyeglass frames? Choose frames that are similar in design and fit to the old pair. The more the new pair of glasses is similar to the old pair, the easier—and safer—the adjustment to the glasses will be.
  • Bifocal and progressive lenses. If you know that you are prone to being off balance or otherwise fit into the high-risk category, avoid bifocal or progressive lenses if you’ve never worn these types of glasses. For safety’s sake, it would be better for you to purchase both near and distance glasses. This advice even holds true for bifocal-lens wearers once they fall into the high-risk category. Does this extra step need to be expensive? Not necessarily. Consider purchasing prescription glasses for distance and one or two pairs of less expensive, nonprescription magnifying glasses (“readers”) for reading and computer use (I do, by the way).

If you are already using bifocal or progressive lenses, get used to a new prescription first by carefully walking around and paying attention to how your surroundings look through your new glasses. This has been shown to help prevent falls. Another tip is to tuck your chin in while going up or down stairs so you look through the upper (distance) part of the lens, not the lower (near-vision) part.

GOOD ADVICE FOR YOUNG AND OLD

And, frankly, even though studies on falls and vision correction focus on older adults, taking time to get used to new glasses is smart advice for anyone of any age. I was a glasses-wearer as a grade-school child—and had astigmatism as well. As a growing child, I needed a new pair of glasses nearly every year. I remember how odd the world looked for the first few days of new-glasses wear…skewed, with things seeming slanted or closer than they actually were. I also remember being diligent—as young as I was—in taking the advice of the thoughtful pediatric optometrist who always advised me to watch my step and take it slow while getting used to my new glasses.