Patients with glaucoma have a three to four times greater risk of falling, which exceeds the risks associated with age-related macular degeneration, cataract, or diabetes. Here are some steps clinicians can share with their patients to help reduce falls
It is well recognized that falling is a leading cause of injury-related death in the United States. Importantly, a high percentage of older patients fall at least once during a year’s time, and as a result from 10% to 20% sustain a severe physical injury such as a hip fracture or head trauma.
In addition to physical consequences, falls can result in decreased quality of life, with consequent restricted activities, social isolation, dependence on caregivers, and depression.
Increased risk of falls by older patients is not limited to those with physical disabilities, i.e., those with impaired visual fields (VFs) are at increased risk of falling, said Anjali M. Bhorade, MD, MSCI, associate professor of Ophthalmology, Washington University School of Medicine, St. Louis, MO.
Patients with glaucoma have a three to four times greater risk of falling, which exceeds the risks associated with age-related macular degeneration, cataract, or diabetes.
A number of steps can be implemented to decrease falls in patients with glaucoma, according to Dr. Bhorade, that include identification of the at-risk patients, the locations and circumstances surrounding the falls, and the modifiable risk factors, and development and implementation of programs to prevent falls.
The risk factors for falls in patients with glaucoma include decreased VF sensitivity, particularly in the inferior hemifield, and possibly the velocity of progression of the VF deterioration. In addition, female gender, older age, body mass index, and poor balance, posture, and strength, have all been associated with increased risk or fear of falling.
However, Dr. Bhorade pointed out, studies of the risk factors associated with falling disagree regarding the thresholds of VF sensitivity, visual acuity, contrast sensitivity, medications, and gender possibly because the studies that calculate the risk of falls over a year’s time may not be accurately assessing the risks. She suggested that the rates of falls may be predicted more accurately based on specific activities.
Dr. Bhorade recounted the recent findings of the prospective Falls in Glaucoma Study (Am J Ophthalmol. 2019;200:169-78) that included 225 subjects with glaucoma or glaucoma suspects who recorded falls using calendars. Patients received a follow-up phone call after a fall to determine the injuries sustained and the location and circumstances of the fall. All patients wore an accelerometer for 1 week during the year of the study and a GPS was used to estimate the steps taken by the patients both at home and while outside the home.
“The investigators found that the risk factors for falls were associated with less physical activity, i.e., worse VF sensitivity, older age, female gender, black race, and use of multiple medications,” Dr. Bhorade noted.
Anjali M. Bhorade, MD, MSCI
This article was adapted from Dr. Bhorade's presentation at the American Academy of Ophthalmology 2019 meeting. Dr. Bhorade has no financial interest in the subject of this report.