Older adults with glaucoma at increased risk of falls

Older adults with glaucoma are at increased risk of falls resulting in injury, reports a study in the November issue of Optometry and Vision Science, official journal of the American Academy of Optometry. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Risk is particularly high for patients whose downward (inferior) field of view is affected by glaucoma, according to the study by Alex A. Black, Ph.D., and colleagues of Queensland University of Technology, Queensland, Australia.

Over One Year, More than 40 Percent of Glaucoma Patients Fall
The researchers followed up 71 older adults (average age 74) with glaucoma for one year, after assessment of visual loss. The assessment included evaluation of the patients' visual field loss—a simple test showing what portions of the field of vision are affected by glaucoma.

Visual factors affecting the risk of falls during the follow-up year were analyzed. Overall, 44 percent of the patients fell at least once, including a 31 percent rate of falls resulting in injury. (None of the falls caused serious injury, such as a fracture.)

For all visual measures, greater reduction in vision was associated with an increased risk of falls. This was so regardless of age or sex.

After adjustment for other variables, the strongest risk factor was visual loss in the inferior field—that is, the view downward toward the feet. Patients with more extensive inferior field loss were at 57 percent higher risk of falls overall, and 80 percent higher risk of falls with injury.

The increase in risk associated with inferior visual field loss remained significant after adjustment for other visual factors—including visual acuity, contrast sensitivity, and visual loss in the superior (upward) field. Among patients with glaucoma, defects of the inferior visual field are slightly less common than defects of the superior field.

Falls are a major cause of injury, health care use, and death among older adults. Visual field loss is an important risk factor for falls and fractures, and glaucoma is the main cause of visual field loss in older adults. However, the relationship between glaucoma and the risk of falls has been unclear.

"Falls are common among older adults with glaucoma and occur more frequently in those with greater visual field impairment, particularly in the inferior field region," Dr. Black and coauthors conclude. They believe that assessing inferior visual field loss in patients with glaucoma could help identify a high-risk group who can then be targeted for interventions to prevent falls.