Objective To determine the association between glaucomatous visual field (VF) loss and the amount of physical activity and walking in normal life. Design Prospective observational study. Participants Glaucoma suspects without significant VF or acuity loss (controls) and glaucoma subjects with bilateral VF loss between age 60 and 80. Methods Participants wore an accelerometer over 7 days of normal activity. Main Outcome Measures Daily minutes of moderate or vigorous physical activity (MVPA) was the primary measure. Steps/day was a secondary measure. Results Fifty-eight controls and 83 glaucoma subjects provided sufficient study days for analysis. Control and glaucoma subjects were similar in age, race, gender, employment, cognitive ability and comorbid illness (p>0.1 for all). Better-eye VF mean deviation (MD) averaged 0.0 dB in controls and −11.1 dB in glaucoma subjects. The median control subject engaged in 16.1 minutes of MVPA daily and walked 5,891 steps/day, as compared to 12.9 minutes of MVPA/day (p=0.25) and 5,004 steps/day (p=0.05) for the median glaucoma subject. In multivariable models, glaucoma was associated with 21% less MVPA (95% CI = -53 - +32%; p=0.37) and 12% fewer steps/day (95% Confidence interval [CI] = -22 to +9%; p=0.21) than controls, though differences were not statistically significant. There was a significant dose-response relating VF loss to decreased activity with each 5 dB decrement in the better-eye VF associated with 17% less MVPA (95% CI = -30 to -2%; p=0.03) and 10% fewer steps/day (95% CI = -16 to -5%; p=0.001) . Glaucoma subjects in the most severe tertile of VF damage (better-eye VF MD worse than -13.5 dB) engaged in 66% less MVPA than controls (95% CI = -82 to -37%, p=0.001) and took 31% fewer steps/day (95% CI = -44 to -15%, p=0.001). Other significant predictors of decreased physical activity included older age, comorbid illness, depressive symptoms, and higher body-mass index. Conclusions Overall, no significant difference in physical activity was found between individuals with and without glaucoma, though substantial reductions in physical activity and walking were noted with greater levels of VF loss. Further study is needed to better characterize the relationship between glaucoma and physical activity.

VA loss in AMD and severe VF loss in glaucoma are associated with self-reported difficulties with IADLs. These limitations become more likely with increasing magnitude of VA or VF loss.

BackgroundThe ability to drive is important for ensuring quality of life for many older adults. Glaucoma is prevalent in this age group and may affect driving. The purpose of this study is to determine if glaucoma and glaucomatous visual field (VF) loss are associated with driving cessation, limitations, and deference to another driver in older adults.MethodsCross-sectional study. Eighty-one glaucoma subjects and 58 glaucoma suspect controls between age 60 and 80 reported if they had ceased driving, limited their driving in various ways, or preferred another to drive.ResultsTwenty-three percent of glaucoma subjects and 6.9% of suspects had ceased driving (p = 0.01). Glaucoma subjects also had more driving limitations than suspects (2.0 vs. 1.1, p = 0.007). In multivariable models, driving cessation was more likely for glaucoma subjects as compared to suspects (OR = 4.0; 95% CI = 1.1-14.7; p = 0.03). The odds of driving cessation doubled with each 5 decibel (dB) decrement in the better-eye VF mean deviation (MD) (OR = 2.0; 95% CI = 1.4-2.9; p < 0.001). Glaucoma subjects were also more likely than suspects to report a greater number of driving limitations (OR = 4.7; 95% CI = 1.3-16.8; p = 0.02). The likelihood of reporting more limitations increased with the VF loss severity (OR = 1.6 per 5 dB decrement in the better-eye VF MD; 95% CI = 1.1-2.4; p = 0.02). Neither glaucoma nor VF MD was associated with other driver preference (p > 0.1 for both).ConclusionsGlaucoma and glaucomatous VF loss are associated with greater likelihood of driving cessation and greater limitation of driving in the elderly. Further prospective study is merited to assess when and why people with glaucoma change their driving habits, and to determine if their observed self-regulation of driving is adequate to ensure safety.

Purpose To determine the association between glaucoma and travel away from home. Methods Fifty-nine glaucoma suspect controls with normal vision and 80 glaucoma subjects with bilateral visual field (VF) loss wore a cellular tracking device over 1 week of normal activity. Location data was used to evaluate the number of daily excursions away from home as well as daily time spent away from home. Results Control and glaucoma subjects were similar in age, race, gender, employment, driving support, cognitive ability, mood, and comorbid illness (p>0.1 for all). Better-eye VF mean deviation (MD) averaged 0.0 decibels (dB) in controls and –11.1 dB in glaucoma subjects. In multivariable models, glaucoma was associated with fewer daily excursions (β= -0.20; 95% CI=-0.38 to -0.02) and a greater likelihood of not leaving home on a given day (Odds ratio [OR]=1.82; 95% CI=1.05 to 3.06). Each 5 dB decrement in the better-eye VF MD was associated with fewer daily excursions (β= -0.06; 95% CI=-0.11 to -0.01) and a greater chance of not leaving home on a given day (OR=1.24; 95% CI=1.04 to 1.47). Time spent away from home did not significantly differ between the glaucoma subjects and suspects (p=0.18). However, each 5 dB decrement in the better-eye MD was associated with 6% less time away (95% CI=-12 to -1%). Conclusions Individuals with glaucoma, particularly those with greater VF loss, are more home-bound and travel away from home less than individuals with normal vision. Since being confined to the home environment may have detrimental effects on fitness and health, individuals with glaucoma should be considered for interventions such as orientation and mobility training to encourage safe travel away from home.

IMPORTANCE:Use of prone positioning in patients with acute respiratory distress syndrome (ARDS) from COVID-19 may be greater than in patients treated for ARDS before the pandemic. However, the magnitude of this increase, sources of practice variation, and the extent to which use adheres to guidelines is unknown. OBJECTIVES:To compare prone positioning practices in patients with COVID-19 ARDS versus ARDS treated before the pandemic. DESIGN, SETTING, AND PARTICIPANTS:We conducted a multicenter retrospective cohort study of mechanically ventilated patients with early moderateto-severe ARDS from COVID-19 (2020COVID-19 ( -2021 or ARDS from non-COVID-19 pneumonia (2018)(2019) across 19 ICUs at five hospitals in Maryland. MAIN OUTCOMES AND MEASURES:The primary outcome was initiation of prolonged prone positioning (≥ 16 hr) within 48 hours of meeting oxygenation criteria. Comparisons were made between cohorts and within subgroups including academic versus community hospitals, and medical versus nonmedical ICUs. Other outcomes of interest included time to proning initiation, duration of prone sessions and temporal trends in proning frequency. RESULTS:Proning was initiated within 48 hours in 227 of 389 patients (58.4%) with COVID-19 and 11 of 123 patients (8.9%) with historic ARDS (49.4% absolute increase [95% CI for % increase, 41.7-57.1%]). Comparing COVID-19 to historic ARDS, increases in proning were similar in academic and community settings but were larger in medical versus nonmedical ICUs. Proning was initiated earlier in COVID-19 versus historic ARDS (median hours (hr) from oxygenation criteria, 12.9 vs 30.6; p = 0.002) and proning sessions were longer (median hr, 43.0 vs 28.0; p = 0.01). Proning frequency increased rapidly at the beginning of the pandemic and was sustained. CONCLUSIONS AND RELEVANCE:We observed greater overall use of prone positioning, along with shorter time to initiation and longer proning sessions in ARDS from COVID-19 versus historic ARDS. This rapid practice change can serve as a model for implementing evidence-based practices in critical care.