Summary
- Changes in how you move — hesitating on stairs, avoiding night walks, reaching for handrails — may be vision-related, not simply ageing.
- Cataracts reduce depth perception and contrast sensitivity, making steps, kerbs, and distances harder to judge accurately.
- Research links untreated cataracts with significantly elevated fall risk in older adults, particularly on stairs and in low-light environments.
- Many people adapt around impaired mobility without realising vision is the cause, stopping activities rather than seeking help.
- First-eye cataract surgery reduced fall frequency by approximately one third in older adults with bilateral cataracts.
You have been walking the same MRT station route for years. But somewhere in the past few months, you have started slowing down on the stairs. Not from stiffness. Not from fatigue. You are simply not quite sure where each step is going to be.
You put it down to getting older. Your family assumes the same. What neither of you may have considered is that the problem is not your legs. It may be your eyes.
Cataracts (a progressive clouding of the natural lens inside the eye) reduce depth perception and contrast sensitivity in ways that make familiar environments feel less predictable and less safe, long before vision is obviously blurred.
Despite what some may assume, you do not have to wait for your vision to deteriorate badly before seeking out cataract treatment in Singapore.
Why Do Stairs Suddenly Feel Less Certain?
When one or both lenses are clouded, depth perception problems can develop gradually without the person noticing. Steps that should look distinct appear flat. A curb that should stand out from the pavement merges with the surrounding surface.
When contrast sensitivity (the ability to detect fine differences in light and shade) is also reduced, those distinctions become harder to make even in good lighting, affecting everything from step edges to kerbs, speed bumps, and uneven paving. (Feng et al., 2018)
In busy environments, the ability to distinguish moving objects from their background is further compromised, making shopping centres, hawker centres, and MRT stations unexpectedly difficult to navigate. (Wood et al., 2012)
What to watch for
- Hesitating at the top of stairs or slowing down significantly on steps
- Misjudging kerb heights or feeling uncertain about where the ground is
- Feeling that busy or crowded spaces have become harder to navigate
If falls or near-misses have been a concern in your daily life, book an eye assessment with Dr Allan Fong to determine whether your vision might be a contributing factor.
Cataracts And Fall Risk: What the Research Shows
A 2021 systematic review found that first-eye cataract surgery reduced the frequency of falls in older people with bilateral cataracts (cataracts affecting both eyes) by approximately one third. (Gutiérrez-Robledo et al., 2021)
Stairs represent the most consistently reported hazard for people with cataract-related visual impairment, and stair navigation is often the first daily activity to feel genuinely unsafe. Misjudging the depth or height of a step, even by a small margin, can cause a stumble that would not have occurred with clear vision.
The same applies to uneven paving, doorway thresholds, and changes in floor surface, all of which require accurate depth judgement to navigate safely. (Gutiérrez-Robledo et al., 2021)
Indoor environments with low ambient lighting compound the problem: covered walkways, car parks, and older buildings combine limited contrast with reduced visibility, making step edges and ground-level changes harder to detect. (Feng et al., 2018)
Because cataracts also affect the speed at which visual information is processed, people may not register an obstacle in time to adjust course, increasing the likelihood of collision or reactive loss of balance. (Wood et al., 2012)
How Cataracts Quietly Change the Way You Move
Night-time walking is typically the first outdoor activity to go. Artificial lighting creates glare and haloes, reducing rather than improving visibility. (Wood et al., 2012)
Crowded environments follow: the hesitation at entrances, the tendency to move to the side to let others pass, the avoidance of peak-hour travel. Reaching for handrails in spaces previously navigated without them is one of the most consistent early signals that mobility safety may be compromised.
These are not signs of physical weakness. They are compensatory behaviours driven by reduced visual certainty. (Palagyi et al., 2017)
What to watch for
- Reaching for handrails or walls in situations where you would not have done so previously
- Avoiding specific environments or times of day due to uncertainty about the ground ahead
- Family members commenting on changes in how you walk, your pace, or your confidence
If you or someone you care for has started moving differently around the home or avoiding certain outings, a one-hour assessment at Angel Eye & Cataract Centre can help assess whether vision might be a factor.
What to Expect at a Cataract Assessment in Singapore
A cataract assessment goes beyond measuring visual acuity (how clearly you can read a chart at distance). It examines the lens itself, assesses the overall health of the eye, and considers how any changes in vision may be affecting daily function, including mobility, safety and balance.
A cataract assessment goes beyond measuring visual acuity (how clearly you can read a chart at distance). It examines the lens itself, assesses the overall health of the eye, and considers how any changes in vision may be affecting daily function, including mobility, safety and balance.
A typical eye assessment at Angel Eye & Cataract Centre covers three steps:
- Vision history and mobility symptoms: reviewing how long changes have been occurring and which environments feel difficult
- Slit-lamp and retinal imaging: examining the lens and macula using the ZEISS CIRRUS PathFinder OCT platform
- Treatment options: discussing intraocular lens (IOL) choice, surgical approach, and timing based on your results
The assessment begins with a detailed conversation about your symptoms, including any falls or near-misses. The slit-lamp examination assesses lens clarity directly, supported by the ZEISS CIRRUS PathFinder, an AI-guided optical coherence tomography (OCT) platform that helps identify macular changes that may affect surgical planning.
If cataracts are confirmed, cataract surgery in Singapore is generally performed as a day procedure under topical anaesthesia, typically taking under 30 minutes.
Several IOL types are available, and for complicated cases, femtosecond laser-assisted cataract surgery (FLACS) may be recommended. Many patients report improvements in depth perception and visual confidence following the procedure, though the extent and timing of recovery varies between individuals. (Duman et al., 2019)
Frequently Asked Questions About Cataracts
Can cataracts make you feel unsteady while walking?
Why is night walking harder with cataracts?
Cataract-related lens clouding scatters light before it reaches the retina. At night, artificial light sources create glare and haloes, and contrast between surfaces is reduced, making distances and surface changes considerably harder to judge. (Wood et al., 2012)
Does cataract surgery improve walking confidence?
For many patients, yes. The benefits of cataract surgery extend beyond clearer vision: improvements in depth perception and contrast sensitivity may contribute to greater confidence on stairs and in outdoor environments, though individual outcomes vary. (Gutiérrez-Robledo et al., 2021; Feng et al., 2018)
Ready to Find Out If Your Vision Is Affecting Your Balance?
If stairs have become something you need to carefully manage, it may be time to evaluate your eyesight.
Dr Allan Fong is a Senior Consultant Eye Surgeon and Medical Director at Angel Eye & Cataract Centre, with over 26 years of experience in ophthalmology, and is the former Head of the Cataract & Comprehensive Ophthalmology Department at Singapore National Eye Centre (SNEC). He is ready to help!
Medical References
Deshpande, N., & Patla, A.E. (2007). Visual-vestibular interaction during goal directed locomotion: effects of aging and blurring vision. Experimental Brain Research, 176(1), 43–53. DOI: 10.1007/s00221-006-0593-5. PMID: 16847610.
Duman, F., Kılıç, Z., & Özcan-Ekşi, E.E. (2019). Impact of Cataract Surgery on Functional Balance Skills of Adults. Turkish Journal of Ophthalmology, 49(5), 243–249. DOI: 10.4274/tjo.galenos.2019.70104. PMID: 31650790.
Feng, Y.R., Meuleners, L.B., Fraser, M.L., Brameld, K.J., & Agramunt, S. (2018). The impact of first and second eye cataract surgeries on falls: a prospective cohort study. Clinical Interventions in Aging, 13, 1457–1464. DOI: 10.2147/CIA.S164419. PMID: 30197507.
Gutiérrez-Robledo, L.M., Villasís-Keever, M.A., Avila-Avila, A., Medina-Campos, R.H., Castrejón-Pérez, R.C., & García-Peña, C. (2021). Effect of Cataract Surgery on Frequency of Falls among Older Persons: A Systematic Review and Meta-Analysis. Journal of Ophthalmology. DOI: 10.1155/2021/2169571. PMID: 33815834. PMC: 7987466.
Palagyi, A., Ng, J.Q., Rogers, K., Meuleners, L., McCluskey, P., White, A., Morlet, N., & Keay, L. (2017). Fear of falling and physical function in older adults with cataract: exploring the role of vision as a moderator. Geriatrics and Gerontology International, 17(10), 1551–1558. DOI: 10.1111/ggi.12930. PMID: 27917612.
Wood, J.M., Tyrrell, R.A., Chaparro, A., Marszalek, R.P., Carberry, T.P., & Chu, B.S. (2012). Even moderate visual impairments degrade drivers’ ability to see pedestrians at night. Investigative Ophthalmology and Visual Science, 53(6), 2586–2592. DOI: 10.1167/iovs.11-9083. PMID: 22427575.
