Strategies To Prevent Falls For Low Vision Patients

Strategies To Prevent Falls For Low Vision Patients

According to the Centers for Disease Control and Prevention (CDC) more than one-third of adults ages 65 and older fall each year in the United States. People with vision loss are more than twice as likely to experience multiple falls than those with normal vision and approximately 25.5 million Americans report visual acuity problems even when wearing corrective lenses.

Normal vision achieved by 1 year of age; nearsightedness (inability to see in the distance) may develop in puberty; Decrease in the ability of the eyes to focus for close work and reading around 40 years of age. Need for increase lighting 3 to 4 times as much light by 80 years of age.

Role of OT:

The role of the OT with regards to low vision is to determine the cognitive, psychosocial, and physical needs of the client for independence and safety during ADL’s, IADL’s, work, play, and social and leisure activities; to function at the highest possible level.

  • Prevent accidents and injuries; Home and living environment modifications
  • Teach New Skills; teach visual techniques to utilize remaining vision efficiently and effectively
  • Modify the Task and, or the Environment; provide training in adaptive equipment and low vision specific tools.
  • Promote a Healthy and Satisfying Lifestyle; utilize a holistic approach that based on client’s goals.


  1. Macular degeneration: leading cause if central retina disorders; progressive and often irreversible due to fibrotic scarring and, or atrophy of the macula. An individual may have dry or wet macula degeneration or both. Functional Implications may include distortion or loss of central vision, decrease visual acuity-loss of detail vision, need for increase appropriate lighting. Potential areas of difficulty: recognizing faces of friends in social situations, distinguishing colors, navy blue from black, difficulty threading a needle, difficulty pouring liquids

  2. Diabetic Retinopathy: The pancreas is not able to make enough insulin for the body or the body is unable to effectively use the insulin it produces causing vascular changes and complications to all organ systems including the eyes. Typical functional losses may include mild blurry vision, irregular areas of vision loss, severe vision loss to total blindness. Potential areas of difficulty may include difficulty handwriting/writing a check to pay bills, difficulty chopping food items, reading a clock or watch, insulin syringe management.

  3. Glaucoma: Typical functional losses may include loss of peripheral vision, increase difficulty with night vision and low light conditions, blurry vision, and halo effects from lighting. Potential areas of difficulty may include locating items in a dimly lit closet or pantry, ambulating in unfamiliar environments, difficulty noticing items paced near the perimeter of a table, inadvertently knocking items to the floor.

  4. Cataracts: an opacity occurring in the normally transparent lens of the eye, generally related to the aging process but can result from trauma. Function implications may include general blurry vision, sensitivity to bright light and glare, decrease contrast sensitivity, difficulty discriminating colors. Potential areas of difficulty may include reading fine print, walking outside on a snowy day, decrease ability to determine fine detail. Cataracts may be correctable with surgery if no other complications exist.

Low Vision Terminology

  • Vision impairment: actual damage to the eye that results in loss of acuity or visual field and a reduction in the ability of the eye or visual system to perform
  • Low Vision: a visual impairment that cannot be corrected by medical or surgical intervention and is severe enough to interfere with the performance of activities of daily living but allows some usable vision or a visual impairment that may be defined as visual acuity of 20/70 or worse in the better-seeing eye with corrections. (Scheiman, Scheiman, and Whittaker)
  • Legal Blindness: A definition, used by the United States government to determine eligibility for vocational rehabilitation, schooling, and disability benefits and tax exemption programs. Best corrected visual acuity of 20/200 or worse in both eyes or visual fields less than 20 degrees per the federal government.
  • Moderate Visual Impairment: 20/70 to 20/160
  • Severe Visual Impairment (legally blind) 20/200 to 20/400
  • Profound visual impairment: 20/500 to 20/1000 or a visual field 10 degrees or less.
  • Total Blindness: These individuals have no light perception and are unable to see shapes or forms. Around 85% of people with eye disorders have some remaining sight, while only 15% of them are totally blind; most rare.


1. Adjust the lighting; lights should aim at the point of focus and not the eyes, additional floor and table lamps placed around the home; motion censored lighting placed low to the ground to light up walking path; lighting should be 60 to 100 watts if possible, in the daytime use natural light with adjustable blinds and shear curtains on windows, keep a flashlight within easy access for additional lighting at night; attach a battery operated bicycle light to a rolling walker or cane, maintain good lighting in the walkways, hallways, and stairwells, etc.

2. Proper furniture arrangement for convenience, function, and safety; place some furniture and chairs by the widow for natural lighting, remove low height coffee tables and night stands to reduce tripping hazards, place mirrors carefully to avoid glare and reflecting light, develop contract by placing a dark towel or blanket over a light colored chair or couch for easy identification.

3. Eliminate safety hazards: remove electrical cords or any cords from the pathway, use non-skid products to wash floor to decrease sliding, tape down area rugs, replace worn rugs, keep floors dry by wiping up spills immediately, use lidded cups and glasses to decrease spills, install grab bars and safety rails in the bathroom and on the stairs, mark edges with yellow or red reflective tape, mark exits with lighting and or contrast wall paint, frequent checks on smoke alarms.

4. Use contrasting colors: avoid clear glass dishes and cups are difficult to identify, colored rugs and colored tapes to identify changes in surface levels, avoid patterned rugs and upholstery which may add to the confusion, color-code household items and bills with post it notes.


General Information on Visual Impairment
American Foundation for the Blind 11 Pen Plaza, Suite 300
New York, NY 10001
Ph: (800)232-5463 or (212)502-7600 Fax: (212)502-7777
Email: afbinfo@afb.net www.afb.org

American Academy of Ophthalmology P.O. Box 7424
San Francisco, CA 94120
Ph: (415)561-8500
Fax: (415)561-8533 Email: Comm@aao.org www.eyenet.org

American Optometric Association 243 North Lindbergh Blvd
St. Louis, MO 63141
Ph: (314)991-4100
Fax: (314)991-4101

Lighthouse International
111 East 59th St
New York, NY 10022-1202
Ph: (800)829-0500, (888)222-9320 Email: info@lighthouse.org www.lighthouse.org

National Association for Visually Handicapped 22 West 21st Street
New York, NY 10010
Ph: (212)889-3141
Fax: (212)727-2931 Email: staff@navh.org www.navh.org

Specific Eye Conditions

American Diabetes Association
1701 Beauregard St
Alexandria, VA 22314
Ph: (800)342-2383 or (888)342-2383 Email: customerservice@diabetes.org www.diabetes.org

American Macular Degeneration Foundation P.O. Box 515
Northampton, MA 01061-0515
Ph: (413)268-7660

American Society of Cataract and Refractive Surgery 5000 Legato Road, Suite 850
Fairfax, VA 22033
Ph: (703)591-0614
Email: ascrs@ascrs.org www.ascrs.org

Glaucoma Foundation
116 John Street, Suite 1605
New York, NY 10038
Ph: (212)285-0080 or (800)452-8266 Email: info@glaucoma-foundation.org www.glaucoma-foundation.org


Lighthouse of Pinellas, Inc 6925 112th Cir N, #103 Largo, FL 33773
Ph: (727)544-4433 www.lhpfl.org

Magnifying Aids -Low Vision Center 4760 East Bay Dr
Clearwater, FL 33764
Ph: (727)526-2020 www.magnifyingaids.com