People with glaucoma, AMD, cataract at increased risk for falls, fractures
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Key takeaways:
- Individuals with glaucoma, AMD or cataract had an increased risk for both falls and fractures.
- These individuals were at particularly high risk for forearm and lower leg fractures.
Individuals with glaucoma, age-related macular degeneration or cataract have a higher risk for both falls and fractures, according to research on a large cohort published in JAMA Ophthalmology.
“In this large population-based cohort study, we observed an increased risk of both falls and fractures for people with cataract, AMD or glaucoma,” Jung Yin Tsang, MRes, from the Center for Primary Care and Health Services Research at the University of Manchester, and colleagues wrote. “This took into account a higher level of comorbidity in the population with eye disease, including multiple long-term conditions and increased medication usage.”
Tsang and colleagues used health records from the Clinical Practice Research Datalink GOLD and Aurum primary care databases and hospitalization and mortality records from 2007 to 2020 to identify individuals with cataract (n = 410,476), AMD (n = 75,622) or glaucoma (n = 90,177). Researchers matched these individuals by age, sex and general practice to comparators.
According to results, people with cataract (adjusted HR = 1.36), AMD (aHR = 1.25) or glaucoma (aHR = 1.38) had an increased risk for falls compared with comparators, with similarly higher risk for fractures (aHR = 1.28, 1.18 and 1.31, respectively).
In addition, site-specific fracture analysis showed that individuals with eye disease had a higher risk for fractures of most body sites, including the hip, spine, forearm, skull, facial bones, pelvis, ribs, sternum and lower leg, with particularly high risk in the forearm and lower leg.
“The results of this study indicate that people with cataract, AMD or glaucoma have a higher risk of both falls or fractures compared with people without these eye diseases,” Tsang and colleagues wrote. “These populations would likely benefit from improved advice, access and referrals to falls prevention services and targeted interventions to prevent related adverse outcomes.”
Perspective
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It is well-documented that patients with glaucoma are at increased risk for vision-related disability. This may include difficulty achieving simple tasks to more complex ones that could limit their independence, such as driving.
In fact, patients with glaucoma are at increased risk for at-fault motor vehicle accidents, which is one of the two most common causes of unintentional injuries in older individuals. The other is falls, which Tsang and colleagues explore in this cohort study, along with the specific types of fractures caused when those falls occur.
They found that patients with glaucoma had a 252% greater proportion of falls and fractures compared with their matched norms. The authors suggest that patients with age-related diseases associated with vision loss would benefit from improved advice, access and referrals to falls prevention services, and targeted interventions to prevent related adverse events.
I would opine that in order to avail our patients of these services we must first embrace a holistic perspective that includes considering not only capturable ocular disease, but the bigger picture of how that disease can affect our patients beyond the office.
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