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Seeing Your Way to Better Balance by Dr. Rein

Dr. Rein Tideiksaar – President, Fall Prevent LLC
Originally posted at:  Reposted here with kind permission of the author.

The basic task of balance is to help us stay upright when standing and walking. Most importantly, stable balance helps us to carry out our everyday activities, without the fear of falling down.

What is Balance?
Balance relies on information received by the brain from our eyes, muscles and joints, and the vestibular (inner ear) system. The brain takes this information and creates steady balance. An error in any part of this system, due to normal aging or disease, can cause a loss of balance. One of the first systems to suffer the impact of aging is the sensory system, especially vision.

Vision and Balance
Vision plays a critical role in maintaining body balance by:

• Continuously providing information about the environment, our body movements and positions to the nervous system. This helps stabilize our bodies when standing and walking.

• Helping us perceive our environments clearly and analyze prevailing safe vs. hazardous conditions correctly.

Balance ability declines with the degree of vision loss. The main reason for this is that elders tend to rely more on the visual information for stable balance, and this effect increases with age. When vision declines, balance becomes more difficult to maintain. This is demonstrated when a person stands with eyes closed or walks into a dark room; in both instances balance becomes unsteady. In addition, individuals with low vision:

• Have a decreased ability to see obstacles or hazards that may lead to slips and trips, particularly in dim lighting. Young people use visual cues to perceive fall threats and take corrective action. Elders with visual impairments do not have this advantage.

• Have a heightened fear of falling. The combination of low vision and fear of falling can result in being “afraid to move about,” which can lead to muscle weakness and increased fall risk.

Vision and balance are important factors in falling. Elders with poor vision fall much more often than that those elders with normal vision. Elders with poor or low vision are also at great risk of falling and suffering injury. Not being able to see properly is associated with a two-fold risk of hip fracture.

Age-Related Visual Changes
Some of the most common aging changes affecting the eyes and balance include:

• An inability of the eyes to adjust to varying levels of light and darkness. As a result, individuals need more time to adjust to lighting changes.

• A loss of dark adaptation. This compromises a person’s vision, particularly under conditions of low lighting (when walking about or toileting at night). When moving from a dimly lit room into bright lighting and vice versa, individuals may experience temporary blindness until the eyes adjust to the dramatic change in lighting.

• A greater sensitivity to glare. Common sources of glare include sunlight shining through windows reflecting off glossy, waxed floors, bright light from unshielded light fixtures directed towards the eye, and looking directly into the sun. Glare is troublesome because it hides potential fall hazards.

• Cataract (a gradual clouding of the lens) is the most common visual problem in the older population. It affects mobility and balance as it reduces the perception of the edges of steps and sidewalks, as well as altering depth perception of the ground. Individuals with cataracts often complain of poor visual acuity, difficulty seeing in dim light, and increased sensitivity to glare.

Preventive Strategies
There are several steps individuals low vision and balance problems can take:

Visit the Eye Doctor (Ophthalmologist)

• The best way to protect your sight to get regular eye exams; they can detect disease early. If you have a visual disease, treatment can begin immediately, which may help to prevent unnecessary vision loss.

Modify the Lighting Environment
Poor lighting makes low vision doubly dangerous. The right lighting can make all the difference in maintaining balance:

• Make sure that commonly used areas of the home (stairways, hallways, bedrooms, and bathrooms) have sufficient light. Install bright lighting in all rooms to avoid tripping over objects that are not easy to see. In general, older eyes need more light to see.

• Try smart lights. Whether they are triggered by motion or come on at pre-specified times, smart lights turn on lights without having to use light switches.

• Avoid abrupt lighting changes; use of dimmer switches varies the amount of light available and prevents sudden shifts in light. LED lights provide excellent illumination without overtaxing the wiring circuits and are easily dimmable.

• Avoid lighting glare; reposition lamps or use lampshades to control glare. Floor glare can be eliminated with carpets and nonslip floor finishes that diffuse rather than reflect glare.

• Use nightlights to make navigation in the dark easier and safer. Nightlights in the bedroom and walkway to the bathroom are important, especially for those elders who get up frequently at night to toilet.

• Exterior walkways and entrances should be well lighted. Consider installing motion-sensor flood lights or increase lighting on exterior pathways, porches and doorways.

Other sensible tips to support one’s balance include:
• Don’t wear multifocal lenses while walking, particularly on stairs. This can lead to blurred vision and falling. Using single lens distance glasses instead.

• Wear glasses if you need them and clean eye glasses often to improve visibility.

• Provide low vision persons with a cane to reduce the likelihood of falling. Certain physical disabilities make walking safely very difficult. To overcome these obstacles doctors and physical therapists recommend a cane to add stability and improve balance. One of the best canes available for elders with low vision is the Stride Light® Ultrabright Walking Cane, a walking cane equipped with LED lighting. Designed by low vision therapists, Stride Light® shines a strong and clear light exactly where it’s needed–around the feet and immediate walking area to brightly illuminate obstacles such as steps and curbs to reduce the chances of tripping and falling. The cane also makes individuals feel much more confident, which helps to reduce any fear of instability or falling.


Rein Tideiksaar Ph.D., PA-C (or Dr. Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, N.J., a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr. Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician’s assistant. Check out Dr. Rein’s professional profile on LinkedIn: If you have any questions about preventing falls, please feel free to email Dr. Rein at

– See more of Dr. Rein’s posts at:

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