Decreased visual field reduces mobility away from home
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Individuals with severe visual field damage do not tend to encounter restrictions to activities performed in the home, but their level of movement decreased in other locations, according to a study from the Wilmer Eye Institute.
“Physical activity occurs in a variety of locations and settings, and many interventions to improve physical activity focus on increasing activity in a specific location, such as at home or within an activity or fitness center,” Jian-Yu E, MD, SeD, MPH, and colleagues wrote.
E and colleagues used GPS tracking to see how far 229 study participants traveled from their homes and how intense their physical activity levels were for 7 consecutive days. The mean age of participants was 71 years, and 51% were men.
Researchers calculated individuals’ visual field (VF) damage, which was defined as, “average sensitivity within the integrated VF (IVF).” Half of the participants had normal or mild VF damage, 40% had moderate VF damage, and 10% had severe VF damage.
They used multivariable negative binomial regression to test for correlation between low activity levels and severe IVF sensitivity. The investigators’ objective was to discover where glaucoma patients perform physical activity and which locations were the safest to do so.
Results showed that despite differences in VF levels, patients generally spent the same amount of time out of their homes or on excursions per week.
Researchers saw the lowest moderate and vigorous physical activity (MVPA) in severe VF groups. Individuals with severe VF damage had 48% fewer minutes of MVPA per day (RR = 0.52; 95% CI, 0.27-1) and 53% fewer minutes of MVPA per excursion (RR = 0.47; 95% CI, 0.23 0.96) compared with normal and mild VF damage.
According to study data, participants with severe VF damage spent more time at home than patients with normal or mild VF damage, but all groups had similar MVPA levels and number of steps at home. Investigators wrote that this indicates a “specific lack of confidence for performing activity outside the home in more severe glaucoma patients.” Further, these individuals could be at a higher risk for “worse mobility, possibly as a result of social isolation, depression and difficulties accessing health services outside the home.”
More research is needed to determine what features would improve home safety and how effective they would be, according to E and colleagues.
Some limitations of this study include a lack of generalizability because participants came from a single center and were mostly well-educated and cognizant. Also, the study did not show temporal relationships between VF damage and activity, suggesting the need for a longitudinal analysis.
“These findings highlight the importance of maintaining a safe home environment (where activity is less restricted) and increasing confidence in performing activity when leaving the home,” E and colleagues concluded.
Perspective
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Regular physical activity has been shown to improve both mental and physical health: preventing or delaying type 2 diabetes, heart disease, high blood pressure, stroke and, yes, even glaucoma. There is recent evidence suggesting that aerobic exercise can reduce eye pressure, subsequently slowing rates of visual field loss and decreasing the risk for glaucoma. MVPA is generally safe for most people but may be more difficult for those with more severe vision impairments.
To address this concern, Ramulu and colleagues looked into how visual field loss affected moderate and vigorous physical activity in and out of the home for patients with glaucoma. Results showed that while patients with severe visual field damage have less physical activity outside of home, all groups had similar levels of MVPA and number of steps at home.
Observing patients’ overall comfort level with orientation and mobility during an examination may not be enough to judge their overall comfort and physical skill level, as it's only a small representation of their normal daily activities. A frank conversation and appropriate referrals can help these patients maintain a safe home environment and increase confidence in performing activity when outside their home.
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