Association Between Visual Field Damage and Gait Dysfunction in Patients With Glaucoma

Jian‐Yu, E; Mihailović, Aleksandra; Garzón, Catalina; Schrack, Jennifer A.; Li, Tianjing; West, Sheila K.; Gitlin, Laura N.; Friedman, David S.; Ramulu, Pradeep Y.

doi:10.1001/jamaophthalmol.2021.2617

Cited by 17 publications

(15 citation statements)

References 48 publications

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“…Inferior peripheral visual field damage and preserved inferior central visual field sensitivity were associated with increased fear of falling in glaucoma ( 40 ). At worse levels of visual field damage, patients with glaucoma demonstrated an exacerbated decline in walking speeds (ie, stride velocity and cadence) in older adults with glaucoma ( 41 ). And fear of falling and changes in gait are both risk factors for falls.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of falls in elderly patients with visual impairment

Ouyang

Zheng

Lin

et al. 2022

Front. Public Health

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ObjectiveTo examine the risk factors for falls in elderly patients with visual impairment (VI) and assess the predictive performance of these factors.MethodsBetween January 2019 and March 2021, a total of 251 elderly patients aged 65–92 years with VI were enrolled and then prospectively followed up for 12 months to evaluate outcomes of accidental falls via telephone interviews. Information of demographics and lifestyle, gait and balance deficits, and ophthalmic and systemic conditions were collected during baseline visits. Forward stepwise multivariable logistic regression analysis was performed to identify independent risk factors of falls in elderly patients with VI, and a derived nomogram was constructed.ResultsA total of 143 falls were reported in 251 elderly patients during follow-up, with an incidence of 56.97%. The risk factors for falls in elderly patients with VI identified by multivariable logistic regression were women [odds ratio (OR), 95% confidence interval (CI): 2.71, 1.40–5.27], smoking (3.57, 1.34–9.48), outdoor activities/3 months (1.31, 1.08–1.59), waking up frequently during the night (2.08, 1.15–3.79), disorders of balance and gait (2.60, 1.29–5.24), glaucoma (3.12, 1.15–8.44), other retinal degenerations (3.31, 1.16–9.43) and best-corrected visual acuity (BCVA) of the better eye (1.79, 1.10–2.91). A nomogram was developed based on the abovementioned multivariate analysis results. The area under receiver operating characteristic curve of the predictive model was 0.779.ConclusionsGender, smoking, outdoor activities, waking up at night, disorders of balance and gait, glaucoma, other retinal degeneration and BCVA of the better eye were independent risk factors for falls in elderly patients with VI. The predictive model and derived nomogram achieved a satisfying prediction of fall risk in these individuals.

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Section: Discussionmentioning

confidence: 99%

Risk factors of falls in elderly patients with visual impairment

Ouyang

Zheng

Lin

et al. 2022

Front. Public Health

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“…Established evidence supported that it was harder to maintain posture balance for glaucoma patients with advanced VF defects 29. In addition, worse VF defects were also associated with severe gait dysfunction, which impacted stride velocity and cadence 30. As for patients with central VF affected, compromised visual acuity might also play an important role given its impact on mobility abilities such as speeds of walking and step-climbing 31.…”

Section: Discussionmentioning

confidence: 99%

Daily Patterns of Accelerometer-Measured Movement Behaviors in Glaucoma Patients: Insights From UK Biobank Participants

Yuan

Zhang

et al. 2022

Asia-Pacific Journal of Ophthalmology

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Purpose: The purpose of this study is to compare daily patterns of accelerometer-measured movement behaviors between glaucoma patients and those without glaucoma. Methods: From 2013 to 2015, 106,053 UK Biobank participants took part in a 7-day accelerometer test. Based on established algorithms, continuous accelerometer data were classified into 4 movement behaviors: moderate to vigorous physical activity (MVPA), light physical activity, sedentary behaviors, and sleep. Glaucoma and other covariates were defined according to baseline assessments and inpatient diagnosis records. Negative binomial regression models were used to compare daily patterns of movement behaviors between glaucoma patients and those without glaucoma. Results: Accelerometer data from 1262 glaucoma patients and 81,551 participants without glaucoma were included. Compared with participants without glaucoma, glaucoma patients spent 4.7% less time on MVPA in multivariable models [mean=28.3 vs 31.4 min/d; incidence-rate ratio (IRR) 0.953, 95% confidence interval (CI): 0.910–0.998; P=0.044], which was mainly attributed to the decreased MVPA time during 18:00–23:59 (IRR=0.863, Bonferroni-corrected 95% CI: 0.768–0.970; P=0.002). Subgroup analyses indicated that compared with those with normal body mass index, the decreased MVPA time was more pronounced in participants with overweight and obesity (IRR=0.912, Bonferroni-corrected 95% CI: 0.851–0.978; P for interaction=0.007). No significant association was found between glaucoma and time spent on other movement behaviors including light physical activity, sedentary behaviors, and sleep. Conclusions: Daily patterns of movement behaviors were significantly changed in glaucoma patients. Compared with those without glaucoma, glaucoma patients spent less time on MVPA, especially in the evening.

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“…The Falls in Glaucoma Study is a longitudinal cohort study that has provided important clarifications about the association between glaucoma and falls. In their most recent work, E and colleagues followed up patients with glaucoma for 3 years and obtained several standardized metrics to assess gait performance, including stride velocity, stride length, cadence, and base of support, as well as their variabilities over time. This original work examined how the amount of visual field damage at baseline was associated with gait over time and found that patients with worse visual field damage at baseline had a faster decline in walking speed, as measured by stride velocity and cadence over the duration of the study.…”

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confidence: 99%

“…Any research involving a complex, multifactorial subject, such as gait, may be limited by multiple potential confounders, and this is well acknowledged by the authors. E and colleagues attempted to adjust for the potential effects of age, sex, race, living arrangements, education level, polypharmacy, comorbidity, and cognitive function. However, given the relatively small sample size and complexity of these potential confounders, they had to resort to a simplified approach, which may leave some effects unaccounted for.…”

mentioning

confidence: 99%

“…E and colleagues attempted to adjust for the potential effects of age, sex, race, living arrangements, education level, polypharmacy, comorbidity, and cognitive function. However, given the relatively small sample size and complexity of these potential confounders, they had to resort to a simplified approach, which may leave some effects unaccounted for. For example, when assessing comorbidities, they used a score representing the summation of whether 16 possible comorbidities were present for each participant .…”

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confidence: 99%

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