Central and Peripheral Visual Impairment and the Risk of Falls and Falls with Injury
Presented at: the Association for Research in Vision and Ophthalmology Annual Meeting, 2008, May 6–10, 2008, Fort Lauderdale, Florida.
Received 11 February 2009; received in revised form 18 June 2009; accepted 25 June 2009. published online 22 December 2009.
Objective
To evaluate whether central (CVI) and peripheral visual impairment (PVI) are independent risk factors for falls and falls with injury 4 years later.
Design
Population-based, prospective cohort study.
Participants
A population-based sample of 3203 adult Latinos.
Methods
Baseline presenting binocular central distance acuity was measured and impairment was classified as mild (20/40–20/63) or moderate/severe (≤20/80). Peripheral visual impairment was classified as mild (−6 dB < mean deviation < −2 dB in worse eye), moderate/severe (mean deviation ≤−6 dB in worse eye).
Main Outcome Measures
Falls and falls with injury in the past 12 months were assessed by self-report at the 4-year follow-up visit.
Results
Out of 3203 individuals, 19% reported falls and 10% falls with injury 4 years after the baseline examination; participants with falls were more likely to be ≥60 years of age, be female, report lower income, have >2 comorbidities, report alcohol use, report wearing bifocal glasses, and report obesity. Among those who reported falls, 7% had CVI (visual acuity >20/40) compared with 4% who did not report falls; and 49% had PVI (mean deviation < −2 dB) compared with 39% of those who did not report falls (both P<0.0001). After adjusting for confounders, moderate to severe CVI and PVI were associated with increased risk for falls (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.02–5.45; Ptrend = 0.04; and OR, 1.42; 95% CI, 1.06–1.91l Ptrend = 0.01, respectively) and with falls with injury (OR, 2.76; 95% CI, 1.10–7.02; Pvalue = 0.03; and OR, 1.40; 95% CI, 0.94–2.05 Ptrend = 0.04, respectively).
Conclusions
Both CVI and PVI were independently associated with increased risk for falls and falls with injury 4 years after the initial examination in a dose–response manner. Although vision-related interventions for preventing falls have mainly focused on correcting CVI, this study suggests that targeting both central and peripheral components may be necessary to effectively reduce rates of falls and falls with injury related to vision loss.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Available online: December 23, 2009.
1Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
2Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
Correspondence: Rohit Varma, MD, MPH, Doheny Eye Institute, Department of Ophthalmology, University of Southern California, 1450 San Pablo Street, Room 4900, Los Angeles, CA 90033
Manuscript no. 2009-191.
Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
ABSTRACT