Addressing Vision Challenges
This information is intended as a general introduction to this topic. As each person is affected differently by balance and dizziness problems, speak with your health care professional for individual advice.
These strategies may help you address vision issues related to dizziness and imbalance. In addition, neuro-ophthalmologists and developmental optometrists can help with post trauma vision syndrome and visual midline shift syndrome.
Be good to your eyes
Poor vision can have a big impact on your balance and ability to judge distance and depth. Get your vision tested at least every 2 years or if you notice any changes in vision.
Always allow time for your eyes to adjust to darker or brighter areas. This is particularly important as we age.
Eat foods that are good for you eyes, including those rich in lutein (LOO-teen), zeaxanthin (zee-ah-zan-thin), vitamin C and omega-3 fatty acids. Diets excessively high in sugar and refined carbohydrates can put you at risk of developing cataracts.
Problems with visual-spatial tasks
There is a connection between the visual and vestibular system. You may find that your depth perception and hand-eye coordination are compromised. Be careful as your brain adjusts – you may be at increased risk of falling.
Major change in eyeglass prescription
You are at short-term greater falls risk after a major change in eyeglass prescription. Your brain needs time to adjust to unaccustomed magnification that may cause objects to appear to be closer or farther away than they actually are.
Bifocal or progressive lens glasses may change your depth perception and make you even dizzier – take extra care. Sometimes these types of lenses can make things seem closer or farther away than they really are. This is because of how the lenses are made. They have a central part that is clear and the rest of the lens has peripheral (on the edges) distortion.
Bifocal and progressives glasses can contribute to falls. You may be better off with separate pairs of eyeglasses if you have a lot of dizziness. Consider having a pair for distance, a pair for reading and a pair for computer use. Though it is more costly and a nuisance to have a couple of extra pairs of eyeglasses, it can help with dizziness.
You may only need separate pairs of glasses for up to a year. Depending on your condition, once visual or vestibular rehabilitation therapy has improved the functioning of your eyes, you may be able to go back to wearing progressives or bifocals safely.
As we age, our eyes gradually lose the ability to see things clearly close up. This condition is call presbyopia (meaning “old eye”). It often develops shortly after age 40.
Monovision is a strategy that can be used to make up for for presbyopia by correcting one eye for distance vision and the other for reading. It can be done with laser eye surgery, contact lenses, or intraocular lenses implanted as part of cataract surgery. Resulting vision is functional, however having eyes with unequal correction can cause significant reduction in depth perception and increase falls risk.
Monovision is not advised as an option for anyone with ongoing balance and dizziness issues. People who have monovision because of lack of vision in one eye also need to be attentive to the risk of falling.
More than half of the population have a cataract or will have had cataract surgery by age 80. Older adults with cataracts appear to double their risk of falling after surgery on their first eye and before surgery on the second. This is because they are functioning with eyes that are no longer equal. The discrepancy can lead to significant issues with visual sharpness and depth of field. For this reason, be extra cautious during the period between cataract surgeries to prevent a fall.
It is helpful to minimize the time between cataract surgeries. Most eye surgeons now schedule surgery on the second eye within 2 weeks after the first. Do not let this short-term vision issue between surgeries deter you from having cataracts removed.
Multifocal lens wearers who need to wait longer between cataract surgeries might want to consider updating their prescription rather than go without glasses if they intend to continue using multifocal lenses after the second surgery.
Research suggests that dizziness is significantly reduced by first (or both) eye cataract surgery, however there is no reduction in falls rate. This is likely related to use of multifocal lenses after surgery.
Double vision (diplopia)
Double vision is a condition in which a single object appears double. Vertical or horizontal prism can be added to glasses to immediately relieve double vision.
Prism can be ground into a lens or applied to an existing lens as a temporary sticker. Prisms work by refracting (bending) light from a straight path to a different direction. This is how prism lenses “trick” your brain into combining double images into a single image.
Installing prism is a simple procedure that could be done in the first eye exam performed by a developmental optometrist.
Many dizzy patients say they do not have double vision but they actually have a component of double vision. They may describe seeing a “ ghost image” or might say, “I don’t see double, but my whole world is slanted.”
Light sensitivity (photophobia)
Wearing dark sunglasses and a hat indoors may help your symptoms but it will not help healing. Instead of wearing sunglasses indoors, it is much better to use lightly tinted lenses. Every patient is unique – the colour of tint that works best is specific to the individual.
Developmental optometrists must test to see which tint in most comfortable for you. Degrees of tint are graded from 1 to 3. The first degree is usually enough for comfort indoors. Layers of different colours of tint can be stacked on top of one another when testing. The lab will make a pair of glasses with that precise tint.
Damage to the brain from a stroke, concussion or other trauma may cause visual neglect (unilateral spatial neglect). This is a neurological condition that results in not being aware of one side of the body.
One treatment for visual neglect uses yoked prism to give the patient more awareness in the neglected visual field. Yoked prisms are lenses that move the field of vision in one direction – either right or left.
Johal S. Balance and dizziness: the visual connection. 2016. Talk presented to Balance & Dizziness Canada.
Lord SR, Dayhew J, Howland, A. Multifocal Glasses Impair Edge-Contrast Sensitivity and Depth Perception and Increase the Risk of Falls in Older People. Journal of the American Geriatrics Society. 2002. 50: 1760-1766. Available from: http://bit.ly/2OwuR6j
Smith CE, Wilcox LM, Allison RS, Karanovic O, Wilkinson F. Monovision: Consequences for depth perception from fine and coarse disparities. Investigative Ophthalmology & Visual Science. 2009. 50(13):2887. Available from: http://bit.ly/2HNpSxq
Supuk E, Alderson A, Davey CJ, Green C, Litvin N, Scally AJ, Elliott DB. Dizziness, but not falls rate, improves after routine cataract surgery: the role of refractive and spectacle changes. Ophthalmic Physiol Opt. 2016 Mar; 36(2): 183-190. Available from: https://bit.ly/2lYSlGO
Page updated September, 2019.
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