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Pradeep Y. Ramulu, Suzanne van Landingham, Robert W. Massof, Emilie Chan, David S. Friedman, Luigi Ferrucci; Fear of Falling in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4417.
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To determine if glaucoma is associated with greater fear of falling, and to investigate the association of fear of falling with objectively-measured physical activity and travel outside the home in a population of glaucoma patients.
Glaucoma subjects with bilateral VF loss and glaucoma suspect controls with normal visual fields (VFs) and visual acuity completed the University of Illinois at Chicago Fear of Falling Questionnaire. The extent of fear of falling was assessed using Rasch analysis. Fear of falling levels were described in logits, with lower scores implying less ability and greater fear of falling. Subjects were subsequently classified into low and moderate/severe fear of falling groups based on Rasch scores. Physical activity levels and travel patterns were objectively assessed over 7 days of normal activity using accelerometer and cellular tracking devices worn on the waistband. Accelerometer data were summarized as daily minutes spent in moderate/vigorous physical activity (MVPA), while cellular tracking data were used to summarize daily hours spent outside the home.
Glaucoma and control subjects did not differ with regards to age, race, gender, employment status, the presence of other adults in the home, body mass index (BMI), grip strength, cognitive ability, mood, or comorbid illness (p≥0.1 for all). The median degree of better-eye VF loss was -8.0 decibels [dB] in glaucoma subjects vs. +0.2 dB in controls (p<0.001).In multivariable models, glaucoma subjects reported greater fear of falling as compared to controls (β= -1.20 logits; 95% CI = -1.87 to -0.53; p=0.001), and fear of falling increased with greater VF loss severity (β= -0.52 logits per 5 dB decrement in the better eye VF MD; 95% CI = -0.72 to -0.33; p<0.001).Individuals with low fear of falling levels engaged in 44 minutes of MVPA/day and spent 4.6 hours/day away from home, as compared to 15 minutes of MVPA/day (p<0.001) and 3.5 hours/day away from home (p=0.02) in subjects with moderate/severe fear of falling. In multivariable models, moderate/severe fear of falling was associated with 57% less daily MVPA and 24% less time outside the home.
Bilateral VF loss from glaucoma is associated with greater fear of falling, and greater fear of falling may explain previously-reported decreases in physical activity and travel outside the home amongst subjects with more advanced glaucoma.
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