The incidence of work-related falls on the same level is increasing, particularly among middle-aged and older female workers. Vision is an important risk factor of falls. We investigated whether objectively measured visual acuity was associated with the incidence of falls. This cohort study included 7,317 female employees aged 20-69 in Japanese supermarket stores. Monocular acuity measured during health checkups was classified into 3 levels ( ≥0.7, 0.3-0.7, <0.3). Incidence rate ratios (IRR) of work-related falls within one year were estimated. IRRs were 1.26 (95%CI: 0.92-1.72) in the 0.3-0.7 group and 2.27 (95%CI: 1.15-4.48) in the <0.3 group. Risk of work-related fall was higher in those with low visual acuity. Vision correction may contribute to fall prevention in workplaces.