October 1st, 2025
An article Importance of Screening for Contrast Sensitivity, Falls, and Mobility Limitations in Older Adults with Maculopathy by Katherine P. Agathos, Natela M. Shanidze, and Donald C. Fletcher, has been accepted for publication in the American Journal of Ophthalmology in December 2025.
New Study Highlights Need for Fall and Mobility Screening in Older Adults with Vision
Loss
San Francisco, CA – September 30, 2025 – A new study from the Smith-Kettlewell Eye Research Institute has found that older adults living with maculopathy, particularly age-related macular degeneration (AMD), face significant risks of balance problems, mobility limitations, and falls—issues that often go unaddressed in standard eye care.
The research, published in the American Journal of Ophthalmology, evaluated 125 patients
over age 55 with maculopathy and intact peripheral vision. More than half (52%) reported
balance or gait difficulties, and over one-third (36%) linked their mobility problems directly to vision loss. Alarmingly, 41% of participants reported at least one fall in the past year.
The study found that contrast sensitivity (CS)—the ability to detect differences between light and dark—was a stronger predictor of mobility challenges than visual acuity alone, which is typically emphasized in clinical practice. Patients with severe contrast sensitivity loss were far more likely to report difficulty navigating stairs, walking on uneven ground, or moving in dim light.
“These findings underscore the importance of asking patients with central vision loss about their balance and mobility,” said lead author Dr. Catherine Agathos. “Falls are a major cause of injury and loss of independence in older adults, and vision-related mobility challenges are too often overlooked in eye clinics.”
Based on patient reports, nearly one-third (31%) of participants were referred to mobility rehabilitation services such as orientation and mobility training or physical therapy. Among those with severe vision deficits, more than half received referrals.
Key Findings:
- 52% of patients reported balance or gait difficulties.
- 36% attributed mobility limitations to vision loss.
- 41% reported at least one fall in the previous 12 months.
- Contrast sensitivity was a better predictor of mobility issues than standard vision tests.
- More than 50% of patients with severe vision loss were referred for mobility rehabilitation.The researchers recommend that ophthalmology and vision rehabilitation clinics routinely
screen for falls and mobility concerns and incorporate contrast sensitivity testing into
patient evaluations. Such practices could lead to earlier interventions, helping reduce falls and improve quality of life for millions of older adults with AMD worldwide.
The study, “Importance of Screening for Contrast Sensitivity, Falls, and Mobility Limitations in Older Adults with Maculopathy,” was authored by Catherine P. Agathos, PhD, Natela M. Shanidze, PhD, and Donald C. Fletcher, MD, and is available in the American Journal of
Ophthalmology (September 2025).
About the Smith-Kettlewell Eye Research Institute
The Smith-Kettlewell Eye Research Institute is a leading center for vision research,
dedicated to studying and developing innovative solutions for visual impairments. Through groundbreaking research and technological advancements, Smith-Kettlewell aims to
improve the quality of life for individuals with vision loss.
Media Contact:
Gabriela Arias
Smith-Kettlewell Eye Research Institute
Email: garias@ski.org
Phone: 415-345-2136