March 2012
Volume 53, Issue 14
ARVO Annual Meeting Abstract  |   March 2012
Visual Impairment, Uncorrected Refractive Error, and their relationship to Objectively Measured Balance in the U.S
Author Affiliations & Notes
  • Jeffrey R. Willis
    Ophthalmology/Internal Medicine, Johns Hopkins University/GBMC, Baltimore, Maryland
  • Susan Vitale
    Div Epidemiol & Clinical Applications, National Eye Inst/NIH, Bethesda, Maryland
  • Pradeep Y. Ramulu
    Ophthalmology, Wilmer Eye Institute/Johns Hopkins, Baltimore, Maryland
  • Footnotes
    Commercial Relationships  Jeffrey R. Willis, None; Susan Vitale, None; Pradeep Y. Ramulu, None
  • Footnotes
    Support  NIH Grant EY018595, RPB Special Scholar Award
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 3179. doi:
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      Jeffrey R. Willis, Susan Vitale, Pradeep Y. Ramulu; Visual Impairment, Uncorrected Refractive Error, and their relationship to Objectively Measured Balance in the U.S. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3179.

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

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Purpose: : To compare balance measures in individuals with normal visual acuity, visual impairment (VI) and uncorrected refractive error (URE).

Methods: : Cross-sectional study utilizing data from 2001-2004 National Health and Nutritional Examination Survey, focusing on adults aged ≥40. VI was defined as better-eye post-refraction visual acuity worse than 20/40. URE was defined as better-eye presenting visual acuity of 20/50 or worse, improving to 20/40 or better with refraction. Balance was evaluated via the Romberg Test of Standing Balance on Firm/Compliant Surfaces, where participants stood feet together under four conditions: 1)eyes-open on a firm surface, 2)eyes-closed on a firm surface, 3)eyes-open on a compliant surface, and 4)eyes-closed on a compliant surface. The final test condition’s aim was to assess for vestibular balance by eliminating visual and proprioceptive inputs. Balance failure was defined as inability to maintain balance within a 15 or 30 second interval for conditions 1&2 and for conditions 3&4, respectively. Multivariate analysis was used to control for age, sex, race/ethnicity, peripheral neuropathy, and self-reported history of diabetes, stroke, and arthritis.

Results: : 4,670 eligible participants (74.5%) had complete vision, balance, and peripheral neuropathy data. Inability to balance on a firm surface with eyes-open was almost negligible across those with normal vision, URE, and VI (<1.0% for each). In multivariate models, the odds of failing to balance on either a firm surface with eyes-closed or on a compliant surface with eyes-open did not significantly differ between those with normal vision, URE, and VI (p>0.29). The odds of failing to maintain balance on a compliant surface with eyes-closed was significantly greater in those with VI relative to those with normal vision [76.3% vs. 35.7%, adjusted Odds Ratio (aOR) 2.1, 95% CI 1.0-4.4], but not significantly different between those with URE and normal vision (47.3% vs. 35.7%, aOR 1.4, 95% CI 0.9-2.1).

Conclusions: : Individuals with VI, but not URE, have significantly worse vestibular balance than those with normal vision. Future research is needed to examine the relationship between the visual and vestibular systems, and how this interaction affects balance and contributes to falls in the visually impaired.

Keywords: low vision • quality of life • clinical (human) or epidemiologic studies: prevalence/incidence 

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