Elsevier

Ophthalmology

Volume 117, Issue 2, February 2010, Pages 199-206.e1
Ophthalmology

Original article
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.
https://doi.org/10.1016/j.ophtha.2009.06.063Get rights and content

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.

Section snippets

Methods

Data for this analysis were collected as part of LALES, a population-based longitudinal study of eye disease in Latinos living in Los Angeles, California, who were ≥40 years of age at the time of study enrollment. Details of the study design and data collected have been described previously.19 Briefly, a census of all residential households in 6 census tracts in La Puente was completed to identify individuals eligible to be included in the study. Eligibility included Latino (self-described) men

Results

Of the 7789 eligible participants identified for LALES, 6357 (82%) completed an ophthalmic examination at baseline. At the 4-year follow-up evaluation, 4654 (73%) completed the clinical examination and 3720 completed both the clinical and ophthalmic examinations. The current analysis is restricted to 3203 participants with complete information on recent falls and falls with injury, measures of visual impairment, and covariates. The falls with injury models have 2 fewer participants (n = 3201)

Discussion

In this population-based, prospective cohort study of Latino adults we showed that both CVI and PVI were associated with increased risk of falls and falls with injury independent of each other, age, gender, and comorbidities. Impairment in central vision increased the risk of falls 2.4 times and falls with injury 2.8 times, whereas PVI increased their risk by 1.4-fold for both outcomes. Furthermore, the risk of falls and falls with injury increased as the severity of both measures of visual

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    • Cited by (0)

    Manuscript no. 2009-191.

    Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

    Supported by Grants EY11753 and EY03040 from the National Eye Institute, Bethesda, Maryland, and an unrestricted Grant from the Research to Prevent Blindness, Inc, New York, New York.

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    A complete listing of the Los Angeles Latino Eye Study Group is available in Appendix 1 at http://aaojournal.org.

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