Fran Lowry

May 17, 2012

May 17, 2012 (Fort Lauderdale, Florida) — People with bilateral visual field loss due to glaucoma have a heightened fear of falling, which can keep them from doing physical activities and traveling outside their homes, according to research presented at a poster session here at the Association for Research in Vision and Ophthalmology 2012 Annual Meeting.

The extent of their fear surpasses the fear of falling that people have with other conditions that affect mobility, such as stroke, heart failure, cardiovascular disease, and Parkinson's disease, lead author Pradeep Y. Ramulu, MD, PhD, from the Wilmer Eye Institute at Johns Hopkins Medical School in Baltimore, Maryland, told Medscape Medical News.

In this prospective observational study, Dr. Ramulu and his team compared fear of falling in 83 people with glaucoma and bilateral visual field loss and in 60 people with good visual acuity without significant visual field loss recruited from patients followed for suspicion of glaucoma.

The participants completed the University of Illinois at Chicago Fear of Falling Questionnaire, and the extent of their fear of falling was assessed using Rasch analysis.

The researchers found that fear of falling was greater in the glaucoma group than in the control group (P = .006), and that the more severe the visual field loss, the greater the fear of falling.

After adjustment for age, the study found that comorbid illness, being female, lower grip strength, and depressive symptoms (P < .001 for all) predicted fear of falling, but with less than half the impact of glaucoma, Dr. Ramulu reported.

On a daily basis, people with low levels of fear spent an average of 44 minutes in moderate to vigorous physical activity and an average of 4.6 hours away from home; those with a moderate or severe fear spent an average of 15 minutes in moderate to vigorous physical activity and an average of 3.5 hours away from home.

In these patients, quality of life can be improved by developing interventions to minimize that fear, Dr. Ramulu explained.

"What really stood out in our study was that the effect of having glaucoma on fear of falling was 2.5 times greater than the effect of other illnesses that affect mobility, so glaucoma does have a substantial effect," he said.

"I hope that we can train people who have more advanced levels of visual field loss to have less fear of falling.... I'd also like to see physicians figure out better methods for training and to more frequently refer patients for rehabilitation. The magnitude of the impact was more than that for other illnesses, and that was somewhat surprising," Dr. Ramulu said.

Medscape Medical News asked Dawn DeCarlo, DO, from University of Alabama at Birmingham, who moderated the poster session, to comment on this study.

"This was a very nicely done study. It supports the clinical impression that people with glaucoma do limit their activity," Dr. DeCarlo said.

She added that the study is important because it shows reduced physical activity among adults with glaucoma-related fear of falling, which indicates the need for vision rehabilitation.

Rehabilitation should include training components, such as occupational therapy and orientation, and mobility training to address fall risks and to promote independence, Dr. DeCarlo emphasized.

"I believe that people with glaucoma are dramatically underreferred for vision rehabilitation services. Increased awareness of how glaucoma affects their daily life may help more ophthalmologists and optometrists who treat glaucoma to make appropriate referrals for rehabilitation."

Dr. Ramulu and Dr. DeCarlo have disclosed no relevant financial relationships.

Association for Research in Vision and Ophthalmology (ARVO) 2012 Annual Meeting: Abstract 4417. Presented May 9, 2012.