Binocular Visual‐Field Loss Increases the Risk of Future Falls in Older White Women

Abstract

OBJECTIVES: To examine the relationship between binocular visual field loss and the risk of incident frequent falls in older white women. DESIGN: A multicenter, prospective cohort study. SETTING: Four clinic centers within the United States in Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela Valley, Pennsylvania. PARTICIPANTS: Four thousand seventy‐one community‐dwelling white women aged 70 and older participating in the Study of Osteoporotic Fractures. MEASUREMENTS: Primary outcome was incident frequent falls, defined as two or more falls within 1 year. Primary risk factors were binocular visual field loss, distance visual acuity in the better eye, and contrast sensitivity at low spatial frequency in the better eye. RESULTS: Of 4,071 women, 409 (10%) had severe binocular visual field loss at the eye examination, and 643 (16%) experienced frequent falls within 1 year after their eye examination. Severe binocular visual field loss was significantly associated with frequent falls when adjusting for age, study site, and cognitive function (odds ratio=1.50, 95% confidence interval=1.11–2.02). The data showed a trend for increasing odds of two or more falls with greater binocular visual field loss (P<.001). In older white women with severe binocular visual field loss, 33.3% of frequent falls were attributable to visual field loss. CONCLUSION: Women with binocular visual field loss are at greater risk of future frequent falls. Screening for binocular visual field loss may identify individuals at high risk of falling.

Visual sensitivity loss in the central 30° of visual field is associated with diabetic peripheral neuropathy

“…Mobility is known to be impaired with visual field loss [4] and the risk of falls is increased [3,5,28]. Given that patients with DPN also have greater likelihood of gait compromise [29] the risk of injury from falls may be further amplified by the twin mechanisms of impaired mobility control and reduced peripheral vision sensitivity.…”

Visual loss and falls: a review

“…A multi-centre, prospective, cohort study confirmed the association between visual field loss and falls. 41 Severe binocular visual field loss was significantly associated with frequent falls when adjusting for age, study site, and cognitive function (OR 1.50, 95% CI 1.11-2.02). The data also showed a trend for increasing odds of two or more falls with greater binocular visual field loss (Po0.001).…”

“…Patients with diabetic retinopathy have been included in various studies of falls and visual loss as part of larger groups with visual impairment; 19,41 however, this important group have not been studied separately.…”

Review of safety and mobility issues among older pedestrians

“…Whereas the effect of vision loss on safety has been investigated much more often in older drivers than in older pedestrians, some data are available. The risk of falling increases with declines in visual acuity (for a review, see Harwood, 2001;Ivers et al, 1998), adaptation to the dark (McMurdo and Gaskell, 1991), the binocular visual field (Coleman et al, 2007;Freeman et al, 2007), and contrast sensitivity (Ivers et al, 1998;Lord et al, 1991). Visual acuity loss has also been shown to cause problems in discriminating vehicles from the rest of the road environment (Oxley et al, 1995), and declines in contrast sensitivity are thought to hinder the perception of fixed or moving objects such as sidewalks or oncoming vehicles (Oxley et al, 1995).…”