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Fabio B Daga, Alberto Diniz-Filho, Erwin R Boer, Carolina Pelegrini Gracitelli, Ricardo Yuji Abe, Felipe A Medeiros; Fear of Falling and Postural Reactivity in Patients with Glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):No Pagination Specified.
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© ARVO (1962-2015); The Authors (2016-present)
Fear of falling is an important health concern in individuals with vision impairment. Subjects with greater fear of falling may restrict their activities and be at increased risk for future falls. The purpose of this study was to evaluate the relationship between fear of falling and postural reactivity using a dynamic virtual reality environment in glaucoma patients.
This was a prospective cross-sectional study involving 42 patients with glaucomatous visual field loss and 38 control subjects. Fear of falling was assessed by a standardized questionnaire and item response theory was used to obtain a summary score of fear of falling (lower scores meaning greater fear). Patients underwent evaluation of postural balance control by a force platform during presentation of static and dynamic visual stimuli with stereoscopic head-mounted goggles (Oculus Rift). In the dynamic condition, a peripheral translational stimulus (tunnel) was used to induce vection and assess postural reactivity. Standard deviations (STD) of torque moments around the center of foot pressure were calculated in Newton meters (Nm) as a measurement of postural stability. The relationships between fear of falling and postural metrics were investigated using linear regression models.
Subjects with glaucoma reported greater fear of falling compared to controls (-0.22 vs. 0.22; P=0.029). Overall STD during translational stimulus was 5.1±2.4 Nm in glaucoma vs. 3.8±1.8 Nm in controls (P=0.005). In glaucoma patients, postural metrics obtained during dynamic visual stimulus were more associated with fear of falling (R2=25.6%) than SAP binocular MS (R2<1.0%; P<0.001). In addition, postural metrics were more predictive of fear of falling during dynamic visual stimulation versus static (R2=8.4%; P=0.023) and dark field (R2=14.5%; P=0.047) conditions. In a multivariable model adjusting for age, gender, race, body mass index, SAP binocular MS, and visual acuity, each 1 Nm larger STD was associated with a worsening of 0.40 units in the fear of falling questionnaire score (P<0.001; adjusted R2=58.5%). The improved prediction of fear of falling with dynamic stimulation was seen only in glaucoma subjects, not in controls.
In glaucoma patients, evaluation of postural reactivity to a dynamic visual stimulus using a virtual reality environment was more strongly associated with fear of falling than visual field testing and traditional balance assessment.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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