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Joseph Da, Aleksandra Mihailovic, David S Friedman, Sheila K West, Pradeep Y Ramulu; Adaptations for fall preventions in patients with glaucoma. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4263. doi: https://doi.org/.
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Glaucoma puts individuals at the increased risk of falls due to visual field (VF) damage and poor contrast sensitivity (CS). We evaluated utilization of falls prevention services by glaucoma patients who fell in the prior year.
Cross sectional study of the 245 individuals receiving care for suspected or primary glaucoma. Humphrey 24-2 VFs were obtained to calculate average integrated VF (IVF) sensitivity, and to classify VF damage as mild (IVF>28 dB), moderate (IVF=23-28 dB) or severe (IVF<23 dB). Patients reporting a fall in the prior year were classified as fallers. Utilization of falls prevention services was evaluated using a questionnaire. Logistic regression models were used to evaluate if services were more likely to be used by individuals with worse VF damage or those who fell in the prior year.
Mean participant age was 70.6 years and 49% were female. Fifty percent had mild, 40% moderate and 10% severe VF damage. Forty-two percent reported a fall in the past year and 67% said falls prevention was an important goal to them. Those with moderate and severe VF damage were more likely to report falls prevention as being important when compared to those with mild VF loss (odds ratio [OR]=2.4, 95% confidence interval [CI]=1.3-4.3, p=0.003, and OR=3.1, 95%CI=1.1-8.9, p=0.03, respectively). Fallers were more likely to report falls prevention being important to them as compared to non-fallers (OR=1.8, 95%CI=1.0-3.1, p=0.04). Out of all participants, 71% met with a doctor to identify medications that could make them prone to falls, 6.9% received orientation and mobility training and 39.4% had a falls specialist redesign their home. Those with severe VF damage were more likely to have received orientation and mobility training (OR=7.5, 95%CI=2.2-24.7, p=0.001). Fallers were more likely to meet with a doctor to identify medications that could make them prone to falls (OR=1.9, 95%CI=1.0-3.3, p=0.04) and more likely to have a falls specialist redesign their home compared to non-fallers (OR=2.2, 95%CI=1.3-3.6, p=0.004). Other interventions, such as strength/balance training, environmental/house modifications, and the use of assistive devices, were not significantly associated with either severity of the VF loss or fallers.
Both severity of VF damage and a recent fall increase interest in falls prevention and utilization of falls prevention services, though overall uptake of some of these services remains poor.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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