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A. A. Black, J. M. Wood, J. E. Lovie-Kitchin, B. M. Newman; Visual Field Loss and Falls Among Older Adults With Glaucoma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5458.
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To examine the visual factors associated with falling among older adults with glaucoma.
65 community-dwelling older adults with open-angle glaucoma, aged 75 ± 6 years (from 65 to 90 years), participated in this study. An eye examination was performed, including tests of binocular visual acuity (high-contrast), binocular contrast sensitivity (Pelli-Robson), visual fields (monocular Humphrey Field Analyser SITA 24-2 and binocular 96-point visual field) and nerve fibre layer thickness with the Stratus Optical Coherence Tomographer. Visual field loss was graded according to the Advanced Glaucoma Intervention Study (AGIS) criteria. Data were also collected on demographic characteristics (age and gender) and physical performance measures (self-reported physical activity and six-minute walk test). The main outcome measure was the number of falls reported in the previous 12 months. The relationship between the vision measures and number of falls was evaluated using negative binomial regression and incidence rate ratios (IRR) adjusted for potential confounding factors (age, gender and physical performance measures).
In the previous 12 months, 23 (35%) participants experienced at least one fall: 16 (25%) participants fell only once and seven (11%) participants fell two or more times (up to six falls). After adjusting for the potential confounding factors, the negative binomial models showed that the rate of falls doubled for every 9dB reduction in the better-eye 24-2 mean deviation (IRR 1.08), 8 point increase in the better-eye AGIS score (IRR 1.09), or 35 points missed on the binocular 96-point visual field (IRR 1.02). Visual acuity, contrast sensitivity and retinal nerve fibre thickness were not associated with falling.
Visual field loss, measured using a range of strategies, was shown to be the primary vision component associated with falls among older adults with glaucoma. Additional research will further evaluate this association using prospective falls data in this population. These findings provide valuable directions for developing fall risk assessments and falls prevention strategies for this population.
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