June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Visually Induced Postural Reactivity in Glaucoma
Author Affiliations & Notes
  • Alberto Diniz-Filho
    Visual Performance Laboratory, Department of Ophthalmology, University of California San Diego, La Jolla, CA
    Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil
  • Erwin R Boer
    Visual Performance Laboratory, Department of Ophthalmology, University of California San Diego, La Jolla, CA
    Department of Mechanical Engineering, Delft University of Technology, Delft, Netherlands
  • Carolina Gracitelli
    Visual Performance Laboratory, Department of Ophthalmology, University of California San Diego, La Jolla, CA
    Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
  • Ricardo Y Abe
    Visual Performance Laboratory, Department of Ophthalmology, University of California San Diego, La Jolla, CA
    Department of Ophthalmology, University of Campinas, São Paulo, Brazil
  • Nienke van Driel
    Department of Mechanical Engineering, Delft University of Technology, Delft, Netherlands
  • Zhiyong Yang
    Visual Performance Laboratory, Department of Ophthalmology, University of California San Diego, La Jolla, CA
  • Felipe A Medeiros
    Visual Performance Laboratory, Department of Ophthalmology, University of California San Diego, La Jolla, CA
  • Footnotes
    Commercial Relationships Alberto Diniz-Filho, None; Erwin Boer, None; Carolina Gracitelli, None; Ricardo Abe, None; Nienke van Driel, None; Zhiyong Yang, None; Felipe Medeiros, Alcon Laboratories Inc (F), Alcon Laboratories Inc (R), Allergan (F), Allergan (R), Bausch & Lomb (F), Carl Zeiss Meditec Inc (C), Carl Zeiss Meditec Inc (F), Carl Zeiss Meditec Inc (R), Heidelberg Engineering Inc (F), Merck Inc (F), National Eye Institute (F), Novartis (C), Reichert Inc (F), Reichert Inc (R), Sensimed (F), Topcon Inc (F)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 4765. doi:
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    • Get Citation

      Alberto Diniz-Filho, Erwin R Boer, Carolina Gracitelli, Ricardo Y Abe, Nienke van Driel, Zhiyong Yang, Felipe A Medeiros; Visually Induced Postural Reactivity in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4765.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To evaluate postural reactivity in glaucoma patients using a dynamic virtual reality environment.

 
Methods
 

Patients underwent evaluation of postural stability by a force platform (Figure 1) during presentation of static and dynamic visual stimuli on stereoscopic head-mounted goggles (Figure 2). The dynamic visual stimuli presented rotational and translational ecologically valid peripheral background perturbations. Postural stability was also tested in a completely dark field to assess somatosensory and vestibular contributions to postural control. History of falls was evaluated by a standard questionnaire. Torque moments around the center of foot pressure on the force platform were measured and the standard deviations (STD) of these torque moments were calculated as a measurement of postural stability and reported in Newton meters (Nm). The ability to predict history of falls was investigated with Poisson regression models. Age, gender, body mass index, severity of visual field defect, best-corrected visual acuity, and STD on dark field condition were included as confounding factors.

 
Results
 

Forty-two glaucoma patients with repeatable visual field defects on standard automated perimetry (SAP) and 38 control healthy subjects were included. Glaucoma patients had larger overall STD than controls during both translational (5.12 ± 2.39 Nm vs. 3.85 ± 1.82 Nm, respectively; P = 0.005) as well as rotational stimuli (5.60 ± 3.82 Nm vs. 3.93 ± 2.07 Nm, respectively; P = 0.022). Postural metrics obtained during dynamic visual stimuli performed better in predicting history of falls compared to those obtained in static and dark field condition. In the multivariable model that included STD values in the mediolateral direction during translational stimulus, each 1 Nm larger STD was associated with an increase of 87% in the incident rate of falls in glaucoma patients (incidence-rate ratio = 1.87; 95% CI: 1.31 - 2.66; P = 0.001).

 
Conclusions
 

The study presented and validated a novel paradigm for evaluation of balance control in glaucoma patients based on the assessment of postural reactivity to dynamic visual stimuli using a virtual reality environment. The newly developed metrics were able to predict risk of falls and may help to provide a better understanding of balance control in glaucoma patients.  

 

 
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