Fear of falling and visual field loss from glaucoma

Abstract

Objective: To determine if visual field (VF) loss resulting from glaucoma is associated with greater fear of falling.

Design: Prospective, observational study.

Participants: Fear of falling was compared between 83 glaucoma subjects with bilateral VF loss and 60 control subjects with good visual acuity and without significant VF loss recruited from patients followed up for suspicion of glaucoma.

Methods: Participants completed the University of Illinois at Chicago Fear of Falling Questionnaire. The extent of fear of falling was assessed using Rasch analysis.

Main outcome measures: Subject ability to perform tasks without fear of falling was expressed in logits, with lower scores implying less ability and greater fear of falling.

Results: Glaucoma subjects had greater VF loss than control subjects (median better-eye mean deviation [MD] of -8.0 decibels [dB] vs. +0.2 dB; P<0.001), but did not differ with regard to age, race, gender, employment status, the presence of other adults in the home, body mass index (BMI), grip strength, cognitive ability, mood, or comorbid illness (P ≥ 0.1 for all). In multivariate models, glaucoma subjects reported greater fear of falling as compared with controls (β = -1.20 logits; 95% confidence interval [CI], -1.87 to -0.53; P = 0.001), and fear of falling increased with greater VF loss severity (β = -0.52 logits per 5-dB decrement in the better eye VF MD; 95% CI, -0.72 to -0.33; P<0.001). Other variables predicting greater fear of falling included female gender (β = -0.55 logits; 95% CI, -1.03 to -0.06; P = 0.03), higher BMI (β = -0.07 logits per 1-unit increase in BMI; 95% CI, -0.13 to -0.01; P = 0.02), living with another adult (β = -1.16 logits; 95% CI, -0.34 to -1.99 logits; P = 0.006), and greater comorbid illness (β = -0.53 logits/1 additional illness; 95% CI, -0.74 to -0.32; P<0.001).

Conclusions: Bilateral VF loss resulting from glaucoma is associated with greater fear of falling, with an impact that exceeds numerous other risk factors. Given the physical and psychological repercussions associated with fear of falling, significant quality-of-life improvements may be achievable in patients with VF loss by screening for, and developing interventions to minimize, fear of falling.

FIGURE 1

Comparison of item measure scores derived from the current study and from the original validation sample.

FIGURE 2

Distribution of fear of falling item measure and person measure scores. Fear of falling item and person measure scores are mapped to the same scale. Lower person measure scores indicate greater fear of falling in the individual, while lower item measure scores indicate less task difficulty. Item measure scores are found at the midpoint of the modeled no fear to little/moderate fear and little/moderate to severe fear transition points.

FIGURE 3

Fear of falling levels by severity of visual field loss. Lower fear of falling scores indicate greater fear of falling, evidenced by fear with easier tasks. The relationship between fear of falling scores and better-eye mean deviation is plotted as a linear relationship using bivariate regression.