Visual impairment, postural stability and falls among older adults with glaucoma

Abstract

Purpose: To investigate the impact of glaucomatous visual impairment
on postural sway and falls among older adults.Methods: The sample comprised 72 community-dwelling older
adults with open-angle glaucoma, aged 74.0 5.8 years (range
62 to 90 years). Measures of visual function included binocular
visual acuity (high-contrast), binocular contrast sensitivity (Pelli-
Robson) and binocular visual fields (merged monocular HFA
24-2 SITA-Std). Postural stability was assessed under four conditions:
eyes open and closed, on a firm and on a foam surface. Falls
were monitored for six months with prospective falls diaries.
Regression models, adjusting for age and gender, examined the
association between vision measures and postural stability (linear
regression) and the number of falls (negative binomial
regression).
Results: Greater visual field loss was significantly associated with
poorer postural stability with eyes open, both on firm (r = 0.34,
p < 0.01) and foam (r = 0.45, p < 0.001) surfaces. Eighteen (25
per cent) participants experienced at least one fall: 12 (17 per
cent) participants fell only once and six (eight per cent) participants
fell two or more times (up to five falls). Visual field loss was
significantly associated with falling; the rate of falls doubled for
every 10 dB reduction in field sensitivity (rate ratio = 1.08, 95%
CI = 1.02–1.13). Importantly, in a model comprising upper and
lower field sensitivity, only lower field loss was significantly
associated with the number of falls (rate ratio = 1.17, 95%
CI = 1.04–1.33).
Conclusions: Binocular visual field loss was significantly associated
with postural instability and falls among older adults with glaucoma.
These findings provide valuable directions for developing
falls risk assessment and falls prevention strategies for this
population.