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

Abstract

PurposeTo determine whether dizziness and falls rates change due to routine cataract surgery and to determine the influence of spectacle type and refractive factors.MethodsSelf‐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.ResultsThe 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.ConclusionsDizziness 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.

Optical characteristics of Alvarez variable‐power spectacles

“…found that, in a population of near‐emmetropic wearers (mean age 32 years), the introduction of unwanted cylindrical errors as small as 0.25 D could be detected by some individuals and that almost all wearers were dissatisfied with spectacles in which cylindrical errors were 0.50 D, with oblique errors having more deleterious effects. Changes in oblique astigmatism have also been found to be associated with increased dizziness in patients after cataract surgery, while the orientation‐dependent spectacle magnification associated with larger, particularly oblique, induced cylinder powers may cause gait and other difficulties . Nevertheless, when considering the possible acceptability of current Alvarez spectacles and their astigmatism from the point of view of safety, it must be remembered that progressive lenses, particularly those with higher additions, show very substantial amounts of astigmatism on either side of the narrow progressive corridor and that the use of such lenses, and of other forms of spectacle multifocal, is accepted, in spite of the higher rates of falls and other problems that older wearers of such lenses experience in comparison with the wear of single‐vision lenses .…”

Is there a link between dizziness and vision? A systematic review

“…The exclusion of papers not written in English may have resulted in significant papers being overlooked from this review. The assessment of the extent of the association between dizziness and vision was independently made by several researchers and then agreed upon, but as all were clinical vision scientists (two of which were authors on a recent study included in this review) there may have been a bias towards finding an association rather than the reverse.…”

Preventing falls in older people with cataract – it is not just about surgery

“…In conclusion, recent research 8,9 has shown that spectacle prescribing can have a measurable and substantial impact on the risk of falls in older adults with cataract. Together, these studies provide valuable direction for how spectacles should be prescribed to minimise risk of falls.…”

“…In this observational study, 30% of participants switched into multifocals after surgery, providing an opportunity to explore the relationship with fall risk not possible in the Australian study where only few (5%) were prescribed multifocals. In both studies, changes to spectacle prescription were shown to independently impact the occurrence of falls in older people receiving cataract surgery.…”