Glaucoma patients have higher risk, fear of falls
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Patient education, intervention and appropriate referrals are important to consider in older adults with glaucoma, according to findings published in the American Journal of Ophthalmology.
“An individual’s fear of falling and avoidance of activities that increase the risk of falling have a significant impact on their overall well-being,” Anjali Bhorade, MD, MSCI, of the department of ophthalmology and visual sciences at the Washington University School of Medicine, and colleagues wrote. “To our knowledge, there have been no prior studies evaluating the rate of falls, fear of falling and avoidance of activities at-risk for falls in the same sample of glaucoma patients.”
Bhorade and colleagues conducted a cross-sectional study aimed at determining the relationship between glaucoma severity and the rate of falls. The researchers enrolled 138 patients with glaucoma aged 55 to 90 years and 50 age-matched control participants to answer falls and activity avoidance questionnaires and take part in clinical vision exams. They used the Glaucoma Staging System to identify patients with mild (n = 61), moderate (n = 54) and advanced (n = 23) glaucoma.
The investigators reported that the glaucoma group scored worse than controls for all vision measures including distance (P = .006) and near visual acuity (P = .01), contrast sensitivity (P = .0001), visual field mean deviation (P = .001) and Esterman disability score (P = .0001).
According to study data, 36% of glaucoma patients reported falling at least once in the prior 12 months, compared with 20% of participants in the control group (adjusted OR = 2.7; 95% CI, 1.18-6.17). The glaucoma group also had a 2.3 times greater risk for having a fall in the previous 12 months than the control group (unadjusted OR = 2.27; 95% CI, 1.05-4.93).
Further, 22.5% of glaucoma participants had a 2.6 times greater risk for reporting a high fear of falling than the control group, and 32.6% of glaucoma patients showed a high avoidance of one or more at-risk activities.
“Proper education and timely referrals are needed to prevent the potential downward spiral of physical, emotional and social effects than can ensue after a patient has a fall,” Bhorade and colleagues wrote. “Understanding the risk of and relationship between a patient’s rate of falls, fear of falling and avoidance of activities at-risk for falls is critical to improve overall safety and quality of life for individuals with glaucoma.”
Perspective
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Falls in the elderly have been attributed to a decrease in visual acuity, contrast sensitivity, reduced depth perception, age-related macular degeneration and visual field deficits. Patients with glaucoma have been shown to be three times more likely to fall, and these falls can result in injury, hospitalization, functional and/or mental decline and possibly even death.
Bhorade and colleagues conducted a cross-sectional study aimed at determining the relationship between glaucoma severity and the rate of falls. Their data showed that patients with glaucoma had a 2.3 times greater risk for having a fall in the previous 12 months and that 32.6% of glaucoma patients showed a high avoidance of one or more at-risk activities. Not surprisingly, patients with advanced glaucoma had the highest fall risk.
Most patients at the time of diagnosis lack impairments associated with glaucoma. As the disease progresses, significant visual field loss in the better seeing eye frequently impacts their quality of life. Educating our patients and helping them find resources to navigate changes in their vision and mobility are the key to maintaining both their mental and physical health.
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Bhorade A, et al. Am J Ophthalmol. 2021;doi:10.1016/j.ajo.2021.02.017
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