Age, sex among factors associated with glaucoma patients’ fear of falling
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Older age, female sex, inferior peripheral visual field damage and preserved inferior central visual field sensitivity in patients with glaucoma were associated with an increased fear of falling, according to findings published in Investigative Ophthalmology & Visual Science.
Kenya Yuki, of the department of ophthalmology at Keio University School of Medicine, Japan, and colleagues sought to evaluate fear of falling using the Fall Efficacy Scale-International (FES-I) in patients with glaucoma, while investigating its association with glaucomatous visual field loss.
“Fear of falling is psychologically damaging and is related to lower [quality of life],” Yuki and colleagues wrote. “It can lead to decreased physical functioning, reduced activities in daily living, increased depressive symptoms, impaired balance and low mobility.”
The researchers examined data of 273 patients with primary open-angle glaucoma (average age, 64.2 years; 160 men). FES-I score and its relationships with several variables including age, sex, BMI, better and worst best corrected visual acuity, total deviation in four visual field areas, history of diabetes and number of previous falls were examined.
Univariate analysis showed total FES-I score increased with age and in women, while other variables showed no significant association with total FES-I score.
Age (coefficient, 0.23, standard error, .04; P < .001) and sex (coefficient, 1.79 for women; SE, 0.84; P = .034) were included in the optimal model for total FES-I score. Mean TD in the inferior central area (coefficient, 0.92, SE, 0.22; P < .001) and mean TD in the inferior peripheral area (coefficient, –0.86, SE, 0.21; P < .001) were also included in the model. – by Earl Holland Jr.
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Derek MacDonald, OD, FAAO
When managing patients with glaucoma, it is tempting to focus on the quantitative parameters we can measure — like retinal nerve fiber layer and macular ganglion cell/inner plexiform layer thickness, pattern standard deviation and visual field index — and the sole evidence-based risk factor that we can influence, IOP. However, it is critical that we continually remind ourselves to treat the patient, not the pressure.
The ultimate goal in treating glaucoma is not simply to reach a target pressure; it is to preserve visual function and enhance quality of life. That requires us to venture beyond the safety of the numbers and explore how patients are doing when they are not in our office. We must see more than just their optic nerve head and consider the impact of concurrent ocular and systemic conditions (and their treatments) on activities of daily living.
Fear of falling is a common concern among the elderly, and given the potentially devastating consequences, justifiably so. Anything that we can do to mitigate both the fear and the likelihood, from counseling on the impact of field loss to striving to minimize the adverse effects of treatment, is arguably as important as reaching that target IOP.
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