Intended for healthcare professionals

CCBYNC Open access

Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial

BMJ 2010; 340 doi: (Published 25 May 2010) Cite this as: BMJ 2010;340:c2265

This article has a correction. Please see:

  1. Mark J Haran, rehabilitation medicine physician1,
  2. Ian D Cameron, professor of rehabilitation medicine2,
  3. Rebecca Q Ivers, associate professor of injury prevention34,
  4. Judy M Simpson, professor of biostatistics 4,
  5. Bonsan B Lee, rehabilitation medicine physician567,
  6. Michael Tanzer, optometrist7,
  7. Mamta Porwal, research assistant7,
  8. Marcella M S Kwan, research assistant7,
  9. Connie Severino, research assistant7,
  10. Stephen R Lord, senior principal research fellow 67
  1. 1Department of Aged Care and Rehabilitation, Royal North Shore Hospital, St Leonards, Sydney, Australia
  2. 2Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, Sydney
  3. 3Injury Division, George Institute for International Health, University of Sydney
  4. 4Sydney School of Public Health, University of Sydney
  5. 5Department of Rehabilitation, Prince of Wales Hospital, Sydney
  6. 6School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney
  7. 7Prince of Wales Medical Research Institute, UNSW, Randwick, Sydney, NSW 2031, Australia
  1. Correspondence to: S Lord s.lord{at}
  • Accepted 11 April 2010


Objective To determine whether the provision of single lens distance glasses to older wearers of multifocal glasses reduces falls.

Design Parallel randomised controlled trial stratified by recruitment site and source of referral, with 13 months’ follow-up and outcome assessors blinded to group allocation.

Setting Community recruitment and treatment room assessments in Sydney and Illawarra regions of NSW, Australia.

Participants 606 regular wearers of multifocal glasses (mean age 80 (SD 7) years). Inclusion criteria included increased risk of falls (fall in previous year or timed up and go test >15 seconds) and outdoor use of multifocal glasses at least three times a week.

Interventions Provision of single lens distance glasses with recommendations for wearing them for walking and outdoor activities compared with usual care.

Main outcome measures Number of falls and injuries resulting from falls during follow-up.

Results Single lens glasses were provided to 275 (90%) of the 305 intervention group participants within two months; 162 (54%) of the intervention group reported satisfactory use of distance glasses for walking and outdoor activities for at least 7/12 months after dispensing. In the 299 intervention and 298 control participants available to follow-up, the intervention resulted in an 8% reduction in falls (incidence rate ratio 0.92, 95% confidence interval 0.73 to 1.16). Pre-planned sub-group analyses showed that the intervention was effective in significantly reducing all falls (incidence rate ratio 0.60, 0.42 to 0.87), outside falls, and injurious falls in people who regularly took part in outside activities. A significant increase in outside falls occurred in people in the intervention group who took part in little outside activity.

Conclusions With appropriate counselling, provision of single lens glasses for older wearers of multifocal glasses who take part in regular outdoor activities is an effective falls prevention strategy. The intervention may be harmful, however, in multifocal glasses wearers with low levels of outdoor activity.

Trial registration Clinical trials NCT00350855.


  • The VISIBLE study team thanks the following people and organisations for their assistance with the project: M Ding, J Evans, G Matthews, G Bigland, M Michael, J Sleeman, J Comber, and D Semmonds for visual assessments; J Jowitt, S Mount, W Rogan, L Fine, T Thurn, O Marial, X Masgoret, P Edwards, J Fullarton, L Lee, O Lee, M Lee, M Luig, R Haran, J Close, R Hinchey, P McDermott, J Zheng, Dee Why and Chester Hill Probus Clubs, Chatswood Day Centre, War Veterans Village Collaroy, and Jean Waldren for logistical support and technical advice; R Lochlin, M Armstrong, C Angstman, L Holliday, K Tattersall, C Swinton, A Haidary, A Collins, D Wilton, F Scott, R Carroll, N Rich, J Prior, E Orchiston, D Taylor, I Ford, M Roth, D Lewis, D Taylor, and S Wise for study recruitment; and all participants and recruitment centres.

  • Contributors: SRL and MJH were involved in study concept and design, study coordination, and data analysis and interpretation. IDC, RQI, JMS, and BBL were involved in study concept and design and data interpretation. MT was responsible for optometry assessment and counselling. MP and MMSK were responsible for participant recruitment, database management, and administration of questionnaires and physical tests. CS provided study coordination assistance and was involved in database management. All authors were involved in preparation of the manuscript. SRL and MJH are the guarantors.

  • Funding: This study was funded by an Australian National Health and Medical Research Council grant (reference number NHMRC ID 350855) in 2005. The research was conducted independently from the funding body.

  • Competing interests: The physiological profile assessment (FallScreen) is commercially available through the Prince of Wales Medical Research Institute.

  • Ethical approval: The University of New South Wales Human Research Ethics Committee approved the study protocol (15/02/2005). All participants gave informed consent.

  • Data sharing: no additional data available.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

View Full Text