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Fear of falling tied to glaucoma severity

NEW YORK (Reuters Health) – Visual field (VF) loss resulting from glaucoma is associated with an increased fear of falling, even in people not classified as blind, a new study shows.

The researcher who led the study, Dr. Pradeep Y. Ramulu, told Reuters Health doctors should be more mindful of this — “but the question is, how can you be mindful of it?”

The fear of falling is to some extent justified, Dr. Ramulu said, but more science needs to be applied “to how we train people to walk and to navigate the world.”

Patients might then be “less likely to fall and less likely to bump into things and then eventually be less likely to be fearful,” Dr. Ramulu added. But presently there are no good methods for that type of training.

In an April 3rd online paper in Ophthalmology, Dr. Ramulu and colleagues at Johns Hopkins University in Baltimore, Maryland note that half of people with glaucoma fall over the course of a year, and injuries are more common in this group than in other elderly people.

To assess the psychological impact of patients’ visual limitations, the team studied 83 glaucoma subjects with bilateral VF loss and 60 controls with good visual acuity. The mean age was about 70 years. The median better-eye mean deviation was -8.0 dB in the glaucoma group and +0.2 dB in controls. Age, race, body mass index, gender, comorbidities and other factors were comparable.

All subjects completed the University of Illinois at Chicago Fear of Falling Questionnaire, which includes questions about walking on icy ground, negotiating dark stairs, stepping off a curb, and other circumstances. The ability to perform tasks without fear of falling was expressed via log odds (logits). Lower scores implied less ability and greater fear of falling.

The use of logits, said Dr. Ramulu, allowed greater precision in assessing responses to questions of varying difficulty.

Glaucoma was associated with significantly greater fear of falling (beta = -1.20 logits). This increased with greater VF loss severity (beta = 0.52 logits per 5-dB decrement in the better eye VF mean deviation).

These results, the researchers point out “suggest that glaucoma is associated with greater fear of falling and that fear of falling is more severe with greater VF loss.”

Patients’ responses “suggest that the increase in fear of falling associated with bilateral glaucoma is large and clinically significant,” the authors said.

Other variables predicting increased fear included being female, decreased strength and greater comorbid illness, which “corroborate the results of previous studies describing risk factors for fear of falling in the elderly population,” according to the report.

Fear of falling may be an important factor linking glaucoma to decreased quality of life, the researchers conclude. Better care, they add, “can be achieved through the development, validation, and implementation of methods to address fear of falling in this at-risk population.”


Ophthalmology 2012.