Predictors of Falls for Patients With Glaucoma
By Lynda Seminara
Selected By: Richard K. Parrish II, MD
American Journal of Ophthalmology, April 2019
Falls are particularly problematic for the visually impaired, and many experts recommend including vision screening in fall-prevention programs. Ramulu et al. evaluated whether falls are more common at home or away from home. They also assessed how damage to the integrated visual field (VF) affects fall rates at both locations. They found that most falls occurred at home and that the risk of any step resulting in a fall was highest at home. In addition, they found that those patients with more severe VF damage were at particular risk of falling, regardless of the location.
This three-year observational study included 225 patients with confirmed or suspected glaucoma (average age, 70.4 years). Patients with neovascular or uveitic glaucoma were excluded. Fall-related data were documented on calendars, and follow-up questionnaires were used to determine fall location (home or away). The number of steps taken was estimated by integrating tracking data from accelerometers and global positioning systems. Main outcome measures were the association of integrated VF sensitivity with fall rates, both per year and per step, stratified by location.
During the study period, participants accrued more steps away from their homes (2,366 outside vs. 1,524 steps at home; p < .001). Steps taken at home and away did not differ with respect to integrated VF sensitivity (p = .22). Fifty-seven percent of falls occurred at home, with each step taken at home being twice as likely to result in a fall (rate ratio [RR] = 2.02 vs. away steps; p < .001). Worse integrated VF sensitivity was not associated with a higher annual rate of home falls or away falls. In contrast, it was linked to more home falls per step (RR = 1.34/5 dB worse sensitivity, p = .03) and more away falls per step (RR = 1.47/5 dB worse sensitivity; p = .003).
In light of their findings, the authors stressed the importance of considering environmental modifications for visually impaired people. They recommend incorporating the delivery of modification services into the routine care of patients with moderate or advanced glaucoma.
The original article can be found here.