Dizziness and falls rate changes after routine cataract surgery and the influence of visual and refractive factors

Purpose: To determine whether symptoms of dizziness and fall rates change due to routine cataract surgery and to determine the influence of visual and refractive factors on these common problems in older adults. Methods: Self-reported dizziness and falls were determined in 287 subjects (mean age of 76.5±6.3 years, 55% females) before and after routine cataract surgery for the first (81, 28%), second (109, 38%) and both eyes (97, 34%). Six-month falls rates were determined using self-reported retrospective data. Dizziness was determined using the short-form of the Dizziness Handicap Inventory. Results: The number of patients with dizziness reduced significantly after cataract surgery (52% vs. 38%; χ2 = 19.14 , p<0.001), but the reduction in number of patients who fell in the 6-months post surgery was not significant (23% vs. 20%; χ2= 0.87, p=0.35). Multivariate logistic regression analyses found significant links between post-operative falls and change in spectacle type (increased risk if switched into multifocal spectacles). Post-operative dizziness was associated with changes in best eye visual acuity and changes in oblique astigmatic correction. Conclusions: Dizziness is significantly reduced by cataract surgery and this is linked with improvements in best eye visual acuity, although changes in oblique astigmatic correction increased dizziness. The lack of improvement in falls rate may be associated with switching into multifocal spectacle wear after surgery.The Dunhill Medical Trus

Dizziness, but not falls rate, improves after routine cataract surgery: the role of refractive and spectacle changes

YesPurpose To determine whether dizziness and falls rates change due to routine cataract surgery and to determine the influence of spectacle type and refractive factors. Methods Self-reported dizziness and falls were determined in 287 patients (mean age of 76.5 ± 6.3 years, 55% females) before and after routine cataract surgery for the first (81, 28%), second (109, 38%) and both eyes (97, 34%). Dizziness was determined using the short-form of the Dizziness Handicap Inventory. Six-month falls rates were determined using self-reported retrospective data. Results The number of patients with dizziness reduced significantly after cataract surgery (52% vs 38%; χ2 = 19.14, p < 0.001), but the reduction in the number of patients who fell in the 6-months post surgery was not significant (23% vs 20%; χ2 = 0.87, p = 0.35). Dizziness improved after first eye surgery (49% vs 33%, p = 0.01) and surgery on both eyes (58% vs 35%, p < 0.001), but not after second eye surgery (52% vs 45%, p = 0.68). Multivariate logistic regression analyses found significant links between post-operative falls and change in spectacle type (increased risk if switched into multifocal spectacles). Post-operative dizziness was associated with changes in best eye visual acuity and changes in oblique astigmatic correction. Conclusions Dizziness is significantly reduced by first (or both) eye cataract surgery and this is linked with improvements in best eye visual acuity, although changes in oblique astigmatic correction increased dizziness. The lack of improvement in falls rate may be associated with switching into multifocal spectacle wear after surgery.This work was supported by The Dunhill Medical Trust(grant number SA14/0711)

Diagrammatic representation of the gait parameters, including the start positions plus trail foot placement before the block, lead heel antero-posterior placement on the block surface and medial-lateral lead toe placement on the block surface.

<p>Diagrammatic representation of the gait parameters, including the start positions plus trail foot placement before the block, lead heel antero-posterior placement on the block surface and medial-lateral lead toe placement on the block surface.</p

Mean ±1 standard deviation data for lead vertical toe clearance (mm) for 10 older participants with habitual refractive correction plus additional lenses of plano., +3.00 DC×90, −3.00 DC×90, +3.00 DC×180, −3.00 DC×180, +3.00 DC×45, −3.00 DC×45, +3.00 DC×135 and −3.00 DC×135.

<p>The top edge of the raised surface is represented at zero mm (y axis). Positive y-axis values correspond to the lead foot being higher than the raised surface. Lens conditions that were significantly different to plano condition are shown by asterisks (p<0.001).</p

Mean ±1 SD visual acuity levels (VA in logMAR) and step negotiation parameters (mm) for 10 older participants with habitual refractive correction and with dioptric blur and magnification changes caused by ±3.00DC with axes at 45°, 90°, 135° and 180°.

<p>Key: Trail foot antero-posterior position before the block (Trail), lead vertical toe clearance (VTC), lead heel antero-posterior position on the block (A–P heel) and medial-lateral position of the toe on the block (M–L toe).</p

Effects of induced astigmatism on foot placement strategies when stepping onto a raised surface

PURPOSE: Large changes in spectacle prescription can increase falls risk in older people. We investigated the effect of induced astigmatism (a common cause of distorted or blurred vision in older people) on locomotor stepping patterns to determine whether the orientation of astigmatic changes could have differential effects on gait safety when negotiating steps and stairs. METHODS: 10 older adults (mean age 76.0±6.4 years) walked up to and stepped onto a raised block whilst wearing their spectacle prescription and when blurred with ±3.00D cylinders at axes 45°, 90°, 135° and 180°. Gait measurements included foot placement before the block, toe clearance over the block edge and foot placement on the block. RESULTS: Induced astigmatism with axes at 90°, providing magnification in the horizontal meridian only, caused no change in stepping pattern. Induced astigmatism with axes at 180° caused foot placement changes in the anterior or posterior direction according to whether magnification was positive or negative in the vertical meridian (block perceived higher or lower respectively). Induced astigmatism with axes oblique at 45° and 135° (causing the block to be perceived as a parallelogram sloping downwards either to the right or left) caused gait changes in the anterior and posterior, vertical and lateral directions. Changes in lateral foot placement appeared to be an attempt to maintain constant foot clearance levels over the block edge by stepping over the perceived 'lower' side of the 'sloping' block. CONCLUSIONS: Astigmatic changes with oblique axes had the greatest effect on gait. Clinicians, including optometrists, physiotherapists, occupational therapists and nurses should counsel older patients about the effects of astigmatism on gait safety. Furthermore, partial prescribing of astigmatic corrections should be considered to reduce the risk of falling