Perspective from Kelly Malloy, OD, FAAO
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Disclosures: The authors report no relevant financial disclosures.
September 15, 2020
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Frequent falls in glaucoma patients loosely associated with balance, gait measures

Perspective from Kelly Malloy, OD, FAAO
Source/Disclosures
Disclosures: The authors report no relevant financial disclosures.
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While associated with fall rates, balance and gait measures do not explain why people with greater visual field damage fall more frequently, according to findings in a recent study.

“Although previous work suggests that balance and gait deficits both contribute to a higher risk of falls, it is less understood how balance and gait relate to falls in populations with concomitant vision loss,” Aleksandra Mihailovic, Wilmer Eye Institute at The Johns Hopkins University, and colleagues wrote. “We hypothesized that the balance and gait features predisposing individuals to a higher rate of falls over time would differ from the features predisposing individuals to a higher rate of falls per step, and that balance and gait features would mediate the association between visual field damage and higher fall rates.”

In a prospective longitudinal cohort, investigators included 239 participants with glaucoma or suspected glaucoma for analysis. They collected data on falls, balance, gait and vision at baseline and follow-up over 24-months. Multivariable negative binomial models compared balance and gait associations with average daily steps and rates of falls per time or step. Researchers also compared integrated visual field sensitivity as it is associated with falls.

Study results showed the cumulative probability of falling one or more times over the first 12 months of follow-up was 44.8%, with the cumulative probability of falling two or more times calculated at 17.7%. Gait deficits carried higher association with fewer daily steps than balance parameters (P < .03 vs. P > .019), and worse balance carried a higher association with fall rates per year and per step when compared to gait measures (P < .03 vs. P > .17). Integrated visual field remained an independent predictor of falls per step (1.36 – 1.48; P < .001 – P < .005) and neither gait nor balance mediated the association between visual field damage and fall rates.

“Balance and gait were clearly important predictors of falls in the current study ... they did not contribute to fall risk more in persons with more advanced visual field damage, nor did they explain the association between visual field damage and the risk of falling,” Mihailovic and colleagues concluded. “Future research should specifically address other potential causes of falls that, in conjunction with changes in balance and gait, could more fully explain the relationship between visual field damage and falls among glaucoma patients.”