Central and peripheral visual impairment and the risk of falls and falls with injury

Abstract

Objective: To evaluate whether central (CVI) and peripheral visual impairment (PVI) are independent risk factors for falls and falls with injury 4 years later.

Design: Population-based, prospective cohort study.

Participants: A population-based sample of 3203 adult Latinos.

Methods: Baseline presenting binocular central distance acuity was measured and impairment was classified as mild (20/40-20/63) or moderate/severe (<or=20/80). Peripheral visual impairment was classified as mild (-6 dB < mean deviation < -2 dB in worse eye), moderate/severe (mean deviation <or=-6 dB in worse eye).

Main outcome measures: Falls and falls with injury in the past 12 months were assessed by self-report at the 4-year follow-up visit.

Results: Out of 3203 individuals, 19% reported falls and 10% falls with injury 4 years after the baseline examination; participants with falls were more likely to be >or=60 years of age, be female, report lower income, have >2 comorbidities, report alcohol use, report wearing bifocal glasses, and report obesity. Among those who reported falls, 7% had CVI (visual acuity >20/40) compared with 4% who did not report falls; and 49% had PVI (mean deviation < -2 dB) compared with 39% of those who did not report falls (both P<0.0001). After adjusting for confounders, moderate to severe CVI and PVI were associated with increased risk for falls (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.02-5.45; P(trend) = 0.04; and OR, 1.42; 95% CI, 1.06-1.91l P(trend) = 0.01, respectively) and with falls with injury (OR, 2.76; 95% CI, 1.10-7.02; P(value) = 0.03; and OR, 1.40; 95% CI, 0.94-2.05 P(trend) = 0.04, respectively).

Conclusions: Both CVI and PVI were independently associated with increased risk for falls and falls with injury 4 years after the initial examination in a dose-response manner. Although vision-related interventions for preventing falls have mainly focused on correcting CVI, this study suggests that targeting both central and peripheral components may be necessary to effectively reduce rates of falls and falls with injury related to vision loss.

Figure 1

Falls and falls with injury^a stratified by severity of central^b and peripheral^c visual impairment. a. Falls with Injury (n=3201) model has 2 less individuals than falls model (n=3203) due to missing data. b. 2 Severity categories for central visual impairment: normal (< 20/40 in both eyes), n= 3069; mild (20/40–20/63), n=108; moderate/severe (20/80 or worse), n=46. c. Severity categories for peripheral visual impairment: normal (mean deviation ≥ −2 dB in both eyes), n=1889; mild (−6 dB