Reading Glasses, Bifocals and Varifocals: Falls and Choices

Why glasses matter more as we age

• Clear vision supports balance, since the brain uses sight to judge the ground, steps and obstacles.
• Poor vision, including uncorrected refractive error, is a recognised contributor to falls and fractures.
• Older eyes also develop cataract, glaucoma, macular degeneration and diabetic changes that glasses cannot fix, so the eye check is about health, not just lenses. See a hearing and vision check-up schedule after 60.
• Wearing the right glasses, in good condition, at the right time, is a simple safety measure; see falls risk assessment at home.

The main types of glasses

Single-vision distance glasses. One power throughout, for seeing far. Best for walking, going outdoors, climbing stairs, and driving if allowed.

Single-vision reading glasses. One power for near work. Good for reading, sewing and phone use, but everything beyond arm's length is blurred, so they must be taken off for walking.

Bifocals. Two powers in one lens, usually distance above and a defined reading segment below, with a visible line. They allow reading without changing glasses, but the line creates a sudden jump in focus and the lower part of the lens blurs the floor when looking down.

Trifocals. Three zones: distance, middle (computer or kitchen) and near. Useful for some tasks but with even more jump.

Varifocals (progressive lenses). A smooth gradient of power from distance at the top to near at the bottom, with no visible line. They look like ordinary glasses and give clear vision at all distances through the right part of the lens, but the edges have distortion and the viewing zones are narrow. Looking down at the feet through the reading zone blurs the ground.

Occupational or computer glasses. Designed for a middle distance such as a screen or a stove.

Photochromic and tinted lenses. Darken in sunlight; useful for glare but may be too dark indoors or in shade, where stairs may be harder to see.

The falls risk with multifocals

Research, including a well-known randomised trial in older people who regularly wore multifocals, found that giving them single-vision distance glasses for outdoor walking reduced falls in people who were active outdoors, though not in those who were less active. The explanation is that multifocal lenses impair depth perception and contrast sensitivity when looking down at steps and kerbs, because the wearer sees the ground through the near zone. People often tilt their heads to look through the right part of the lens and may misjudge a step. Falls guidance such as that from NICE advises careful consideration of the risks. See falls: prevention, assessment and management guidance.

This does not mean multifocals are forbidden. Many older adults use them safely. It means the family should:

• Ask the optometrist about options if your parent has had falls, unsteadiness or trouble with stairs.
• Consider single-vision distance glasses for walking outdoors, on stairs, and in unfamiliar places, and reading glasses for sitting tasks, if your parent is willing to swap.
• Teach safe use of multifocals: look at the stairs with the head tilted down, not just the eyes, so the ground is seen through the distance part; take extra care when new; remove them for stairs if they cause trouble.
• Avoid wearing new multifocals for the first time on stairs, in crowds or at night.
• Be careful about changing glasses without allowing time to adapt.

Choosing the right glasses

• Get a full eye examination first, with a test for glaucoma, cataract and retinal disease. See cataract surgery: when you need it.
• Describe daily life: reading, hobbies, screens, stairs, walking outdoors, driving and cooking. The optometrist can recommend lenses to match.
• Discuss falls and balance honestly.
• Consider two pairs: one for distance and mobility, one for reading, and perhaps a third for computer or stove.
• Think about lens options: anti-reflective coating reduces glare from lights and car headlights; thinner lenses are lighter for strong prescriptions; hard coating protects from scratches; UV protection is useful.
• Choose frames that fit well, are light, and have a lower edge that does not block the downward view. Larger lenses may give a bigger reading area in varifocals; shallow frames reduce the usable zone. Adjustable nose pads help avoid slipping. See eyeglass frames for older women and glasses frames for men of 50, 60 and 70.
• Check the fit: the optical centres must line up with the pupils. A poor fit causes headaches, distortion and falls. Ask the optician to measure and adjust, and to re-adjust after wear.
• Test the glasses in the shop: walk, look down at the floor and at a step, read, and look at a distant object.

Adapting to new glasses

It can take days to weeks to adapt, especially to varifocals or a big change in prescription.

• Wear them consistently for a few days, rather than switching back and forth.
• Start in a safe place: sit and read, walk around the house, then go outdoors.
• Avoid stairs and uneven ground at first, or go slowly with a rail.
• Look through the right zone: move the head rather than the eyes.
• Report persistent problems to the optician, who can adjust or change the lenses. Do not "put up with it" for months.
• Old glasses: do not mix pairs or switch to an old prescription without advice, and discard very old ones to avoid confusion. Keep one spare pair.

Ready-made reading glasses

Ready-made reading glasses sold in shops and on roadsides are cheap and convenient. They may be adequate for some people with similar vision in both eyes and no eye disease, for occasional use. But:

• They are the same power in both lenses, and the optical centres are fixed, which may not suit the person's eye spacing.
• They do not correct astigmatism or different power in each eye.
• They can mask developing eye disease, delaying diagnosis. If reading glasses seem to be needed more often, or vision changes quickly, see the eye doctor.
• Poor quality lenses may cause headaches and eye strain.
• They do not fix distance problems.

Use them as a stop-gap only after an eye check, and never as a replacement for a prescription when vision is blurred, or one eye is worse than the other.

Keeping glasses safe and clean

• Keep them in a fixed place, with a case near the chair and bed; use a neck cord or holder if they are often misplaced. A bright-coloured case helps.
• Clean daily with lukewarm water, a drop of mild washing-up liquid and a soft microfibre cloth, not clothing or paper that scratches.
• Check the fit regularly; frames loosen with time and heat. Ask the optician for tightening.
• Do not leave glasses in a hot car or direct sun.
• Replace scratched lenses.
• Have a spare pair, which can be a lifesaver if glasses break.
• Do not wear glasses with a cracked frame.
• Be careful in the monsoon: fogging and water droplets; anti-fog sprays may help.

Special situations

• After cataract surgery: the prescription changes; wait for the surgeon's advice before new glasses; see home care after cataract surgery.
• Diabetes: vision may fluctuate with sugar; wait until sugar is stable before a new prescription; see diabetic eye care for older adults.
• Glaucoma or macular degeneration: glasses may help but cannot restore lost vision; see glaucoma and macular degeneration: practical home support.
• Dementia: glasses are easily lost or not worn; label them and encourage regular wear. See caring for a parent with dementia at home.
• Parkinson's disease: may affect eye movement and near focusing; mention to the doctor. See Parkinson's freezing and falls: cues and equipment.
• Night driving: glare and halos may limit safe night driving; see safe driving tips for the elderly.

Costs

Costs vary widely with lens type and frame. Single-vision lenses are generally less costly than progressive lenses. Weigh the cost against safety and comfort, and ask the optician to explain options. Government and charitable eye camps may provide free or low-cost glasses; ask the local eye hospital.

When to ask a professional

See an optometrist or ophthalmologist for an eye examination at least every one to two years after sixty, sooner if vision changes. Ask them about glasses for falls prevention and stair safety. Ask a physiotherapist or doctor about balance and falls. Seek urgent help for sudden vision loss, flashes, a curtain, eye pain or distortion; call 112 for weakness, speech difficulty or confusion.