長者視力問題增加跌倒風險

跌倒是老年人一個十分嚴重的健康議題。根據統計, 1/3 在社區生活的老人家每年至少跌倒一次。跌倒不單只令長者失去活動能力和情緒低落, 研究甚至顯示因跌倒導致盆骨骨裂的老人, 6個月後死亡率有所增加。視力衰弱是老人跌倒的其中一個主因, 研究指出有12-20% 75歲或以上的老人有視力問題。引致跌倒的視覺功能問題不單單是視力, 還包括視覺對比度、立體感及視野範圍。以下文章則介紹了幾種長者視力衰弱的原因。

1. 屈光不正和不適當的眼鏡


屈光不正患者的模擬視力

很多老人家在年輕時視力很好, 但隨著年齡增長會出現遠視、近視和散光等屈光不正情況。在華人的老年人口當中, 超過10%的人有未被矯正的屈光不正問題。屈光不正使老人家的視力只及正常成人的50%或以下。除此之外, 如果老人家的新眼鏡度數上有大改變, 這亦會增加他們跌倒的風險。大幅度的度數更改改變了影像的大小, 令長者難以適應。另外如果老人家沒有足夠配戴漸進眼鏡和雙光眼鏡的經驗, 他們配戴這些眼鏡時亦會增加走路跌倒的機會。在替長者驗配眼鏡時, 眼科視光師會考慮到以上的因素並處方能在清晰視力和容易適應中取得平衡的眼鏡度數。


2. 白內障


白內障患者的模擬視力

在老年人中有接近50%的視力問題都源自白內障。白內障除了令視力模糊外,它亦會降低視覺對比度、對眩光(刺眼的強光)變得敏感和降低夜間的視力。對於白內障患者,眼科視光師可以定期觀察病程變化、提供有關白內障手術的意見、替患者驗配太陽眼鏡減慢白內障加深和驗配染色鏡片增強視覺功能。


3. 青光眼


青光眼患者的模擬視力

青光眼造成超過12%的老人有視力障礙問題。由於青光眼導致的視野收窄毫無痛楚, 病人難以自行察覺視野有變, 使青光眼時常被延誤診斷。青光眼病人的中央視力沒有太大影響, 但周邊視野卻一直收窄, 使病人容易撞到障礙物, 甚至因失去下面視野而跌落樓梯。研究顯示, 青光眼增加長者跌倒風險3-4倍。眼科視光師可以通過全面眼睛檢查, 在病人的視野影響生活前診斷青光眼。


4. 黃斑點病變


黃斑點病變患者的模擬視力

黃斑點病變是導致已發展地區長者喪失視力的頭號主因。黃斑點病變剝奪患者的中央視力, 大大影響患者的活動能力。黃斑點病變如青光眼一樣, 早期可以毫無病徵。根據研究, 2/3 的黃斑點病變患者出現平衡問題, 導致動作遲緩及增加跌倒風險。眼科視光師在診斷、處理和跟進社區長者的黃斑點病變中扮演著重要的角色。


5. 糖尿上眼


糖尿上眼患者的模擬視力

糖尿上眼是因糖尿病導致的眼鏡視網膜病變。糖尿上眼差不多影響所有視覺功能, 包括視力、視覺對比度、眩光敏感度、色覺和視野。病人的視力可能出現模糊和佈滿黑點。糖尿病本身也會影響周邊身體部分的神經線, 令患者出現活動障礙。病人需要留意早期糖尿上眼沒有任何病徵, 他們每年最少需要接受一次全面眼睛檢查以跟進病程。


應該每年最少需要接受一次全面眼睛檢查確保他們走路時有足夠的視覺功能。

註冊眼科視光師(第一部份) 鄧光佑


以上護眼資訊由瑞士寶視光中心提供

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參考資料:

Baril, F. (2013). Prevention of falls among seniors with a visual impairment.

Brundle, C., Waterman, H. A., Ballinger, C., Olleveant, N., Skelton, D. A., Stanford, P., & Todd, C. (2015). The causes of falls: views of older people with visual impairment. Health Expectations, 18(6), 2021-2031.

Dhital, A., Pey, T., & Stanford, M. R. (2010). Visual loss and falls: a review. Eye, 24(9), 1437-1446.

Elliott, D. B. (2014). The Glenn A. Fry award lecture 2013: blurred vision, spectacle correction, and falls in older adults. Optometry and vision science, 91(6), 593-601.

Fong, D. S., Barton, F. B., Bresnick, G. H., & Early Treatment Diabetic Retinopathy Study Research Group. (1999). Impaired color vision associated with diabetic retinopathy: Early Treatment Diabetic Retinopathy Study report no. 15. American journal of ophthalmology, 128(5), 612-617.

Freeman, E. E., Munoz, B., Rubin, G., & West, S. K. (2007). Visual field loss increases the risk of falls in older adults: the Salisbury eye evaluation. Investigative ophthalmology & visual science, 48(10), 4445-4450.

Kuang, T. M., Tsai, S. Y., Liu, C. J., Ko, Y. C., Lee, S. M., & Chou, P. (2016). Seven-year incidence of uncorrected refractive error among an elderly Chinese population in Shihpai, Taiwan: The Shihpai Eye Study. Eye, 30(4), 570-576.

Lamoreux, E. L., Chong, E., Wang, J. J., Saw, S. M., Aung, T., Mitchell, P., & Wong, T. Y. (2008). Visual impairment, causes of vision loss, and falls: the Singapore Malay Eye Study. Investigative Ophthalmology & Visual Science, 49(2), 528-533.

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