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Loskutova E, Butler JS, Setti A, O'Brien C, Loughman J. Ability to Process Multisensory Information Is Impaired in Open Angle Glaucoma. J Glaucoma 2024; 33:78-86. [PMID: 37974328 DOI: 10.1097/ijg.0000000000002331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
PRCIS Patients with glaucoma demonstrated deficiencies in their ability to process multisensory information when compared with controls, with those deficiencies being related to glaucoma severity. Impaired multisensory integration (MSI) may affect the quality of life in individuals with glaucoma and may contribute to the increased prevalence of falls and driving safety concerns. Therapeutic possibilities to influence cognition in glaucoma should be explored. PURPOSE Glaucoma is a neurodegenerative disease of the optic nerve that has also been linked to cognitive health decline. This study explored MSI as a function of glaucoma status and severity. METHODS MSI was assessed in 37 participants with open angle glaucoma relative to 18 age-matched healthy controls. The sound-induced flash illusion was used to assess MSI efficiency. Participants were presented with various combinations of simultaneous visual and/or auditory stimuli and were required to indicate the number of visual stimuli observed for each of the 96 total presentations. Central retinal sensitivity was assessed as an indicator of glaucoma severity (MAIA; CenterVue). RESULTS Participants with glaucoma performed with equivalent capacity to healthy controls on unisensory trials ( F1,53 =2.222, P =0.142). Both groups performed equivalently on congruent multisensory trials involving equal numbers of auditory and visual stimuli F1,53 =1.032, P =0.314). For incongruent presentations, that is, 2 beeps and 1 flash stimulus, individuals with glaucoma demonstrated a greater influence of the incongruent beeps when judging the number of flashes, indicating less efficient MSI relative to age-matched controls ( F1,53 =11.45, P <0.002). In addition, MSI performance was positively correlated with retinal sensitivity ( F3,49 =4.042, P <0.025), adjusted R ²=0.15). CONCLUSIONS Individuals with open angle glaucoma exhibited MSI deficiencies that relate to disease severity. The type of deficiencies observed were similar to those observed among older individuals with cognitive impairment and balance issues. Impaired MSI may, therefore, be relevant to the increased prevalence of falls observed among individuals with glaucoma, a concept that merits further investigation.
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Affiliation(s)
- Ekaterina Loskutova
- Centre for Eye Research Ireland, School of Physics, Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - John S Butler
- Centre for Eye Research Ireland, School of Mathematical Sciences, Technological University Dublin, Dublin, Ireland
| | - Annalisa Setti
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Colm O'Brien
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - James Loughman
- Centre for Eye Research Ireland, School of Physics, Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
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Oh M, Ylitalo KR. Association of Cardiovascular Disease and Physical Activity Phenotypes with Falls among Midlife and Older Adults: 2018 Behavioral Risk Factor Surveillance System. AMERICAN JOURNAL OF HEALTH EDUCATION 2023. [DOI: 10.1080/19325037.2022.2163008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Nguyen T, Combs EM, Wright PJ, Corbett CF. Reducing Fall Risks Among Visually Impaired Older Adults. Home Healthc Now 2021; 39:186-193. [PMID: 34190702 DOI: 10.1097/nhh.0000000000000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Falls are the leading cause of death due to unintentional injuries in the older adult population, and fall-related death rates among older adults are escalating annually. Visual deficits are underrecognized and underdiagnosed, which increases fall risk. The purpose of this article is to provide a review of the common types of visual impairment, their etiology, and treatment and to present strategies to reduce falls among older adults with visual impairments. Both traditional home safety interventions and emerging technology-based interventions to reduce falls are described. Appropriate use of both traditional and emerging fall prevention interventions may reduce fall risk and falls among older adult home healthcare patients.
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Bhorade AM, Perlmutter MS, Sabapathypillai SL, Goel M, Wilson B, Gordon MO. Rate of Falls, Fear of Falling, and Avoidance of Activities At-Risk for Falls in Older Adults With Glaucoma. Am J Ophthalmol 2021; 227:275-283. [PMID: 33626364 DOI: 10.1016/j.ajo.2021.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/15/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine the relationship between glaucoma severity and rate of falls, fear of falling, and avoidance of activities at-risk for falls. DESIGN Cross-sectional study. METHODS Patients with glaucoma (n = 138) 55 to 90 years of age with mild (n = 61), moderate (n = 54), or advanced (n = 23) glaucoma in the better eye based on the Glaucoma Staging System and age-matched control subjects (n = 50) were recruited from the Eye Clinics at Washington University, St. Louis, MO. Participants completed questionnaires regarding falls, the fear of falling, and the avoidance of activities at-risk for falls. RESULTS Of the glaucoma participants, 36% reported ≥1 fall in the previous 12 months compared with 20% of control subjects (adjusted odds ratio [OR] 2.7 [95% confidence interval {CI} 1.18-6.17]; P = .018). Compared with control subjects, the mild glaucoma group trended toward a higher fall risk (adjusted OR 2.43 [95% CI 0.97-6.08]; P = .059) and the advanced group had the highest fall risk (adjusted OR 7.97 [95% CI 2.44-26.07]; P = .001). A greater risk of a high fear of falling and high avoidance of at-risk activities occurred at the moderate stage of glaucoma compared with control subjects (adjusted OR 4.66 [95% CI 1.24-17.49]; P = .023 and adjusted OR 4.49 [95% CI 1.34-15.05]; P = .015, respectively). CONCLUSIONS Patient education, interventions, and appropriate referrals to minimize falls should be considered in older adults with early glaucoma and continue with advancing disease. Minimizing a patient's fall risk may decrease their fear of falling and avoidance of at-risk activities. Reducing falls, the fear of falling, and the avoidance of at-risk activities may lower morbidity and mortality and improve emotional and social well-being of patients with glaucoma. Am J Ophthalmol 2021;221:•••-•••. © 2021 Elsevier Inc. All rights reserved.
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Maly J, Dosedel M, Kubena AA, Mala-Ladova K, Vosatka J, Brabcova I, Hajduchova H, Bartlova S, Tothova V, Vlcek J. Analysis of the fall-related risk of pharmacotherapy in Czech hospitals: A case control study. J Eval Clin Pract 2020; 26:973-982. [PMID: 31475421 DOI: 10.1111/jep.13270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/27/2019] [Accepted: 08/06/2019] [Indexed: 01/07/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Falls are among the major problems occurring in hospital setting, when drugs are viewed as important modifiable risk factor of falling. The aim was to analyse the effect of pharmacotherapy on the risk of falls in hospitalized patients. METHODS A multicentre prospective case-control study was conducted in 2017 retrieving data from four hospitals in South Bohemia, Czech Republic. An online database was constructed to collect patient and fall-related data. Each fall that occurred during hospitalization was assigned to appropriate controls (no fall during hospitalization) based on gender, age, length of hospitalization, and the number of drugs. Univariate and multivariate correlations were performed with a significance level of P < .05. RESULTS A total of 222 fall cases (107 males; median age, 81 y) and 1076 controls (516 males; median age, 80 y) were included. According to the first ATC level classification, drugs from groups S, N, and P were significantly associated with fall-related risk compared with controls (P < .05); further analysis of ATC levels showed that only psycholeptics (N05), antipsychotics (N05A), and tiapride were significantly associated with falls. Regression analysis revealed use of psycholeptics N05 (OR = 2.06; 95% CI, 1.56-2.76), or ophthalmologicals S01 (OR = 2.72; 95% CI, 1.37-5.41), as factors with the highest fall-related risk. CONCLUSIONS Apart from the commonly considered fall-risk increasing drugs, other groups, such as ophthalmologicals, should also be considered; however, regarding clinical practice, it is difficult to evaluate the effects of individual drugs in the context of other risk factors of falls, due to the multifactorial nature of falls.
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Affiliation(s)
- Josef Maly
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Martin Dosedel
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Ales Antonin Kubena
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Katerina Mala-Ladova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Jan Vosatka
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Iva Brabcova
- Institute of Nursing, Midwifery and Emergency Care, Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Hana Hajduchova
- Institute of Nursing, Midwifery and Emergency Care, Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Sylva Bartlova
- Institute of Nursing, Midwifery and Emergency Care, Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Valerie Tothova
- Institute of Nursing, Midwifery and Emergency Care, Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Jiri Vlcek
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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Yamasaki T, Yuki K, Awano-Tanabe S, Ono T, Murata H, Tsubota K, Asaoka R. Binocular superior visual field areas associated with driving self-regulation in patients with primary open-angle glaucoma. Br J Ophthalmol 2020; 105:135-140. [PMID: 32217543 DOI: 10.1136/bjophthalmol-2019-315187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/31/2020] [Accepted: 03/06/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS The aim of our study was to investigate the associations between driving self-regulation and glaucoma severity, and between driving self-regulation and glaucomatous visual field (VF) defect patterns. METHODS In 247 patients with primary open-angle glaucoma included in this prospective observational study, a battery of ophthalmic examination was performed, including visual acuity (VA) and VF. Integrated binocular VF was constructed and mean of total deviation (mTD) values in four sectors was calculated (mTDsup-peri, mTDsup-centre, mTDinf-peri and mTDinf-centre). In addition, all participants answered seven questions regarding their avoidance in driving. (1) at night, (2) in rain, (3) in fog, (4) on freeways, (5) lane changing, (6) at high speed and (7) close to the car in front. The associations between these driving behaviours and 10 variables (age, gender, best VA, worst VA, the four sectorial average TD values, years holding a driver's licence and distance driven per week) were analysed using the generalised linear model with binomial distribution, followed by the model section method using the corrected Akaike information criterion. RESULTS As a result of the model selection, it was suggested that deterioration of mTDsup-peri was associated with (1) avoiding driving at night and (2) avoiding driving in rain. On the other hand, mTDsup-centre was related to (3) avoiding driving in fog. CONCLUSION Damage in visual function was related with driving behaviours in patients with glaucoma.
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Affiliation(s)
- Tomoyo Yamasaki
- Ophthalmology, Keio Univeristy School of Medicine, Tokyo, Shinjuku-ku, Japan
| | - Kenya Yuki
- Ophthalmology, Keio Univeristy School of Medicine, Tokyo, Shinjuku-ku, Japan
| | | | - Takeshi Ono
- Ophthalmology, Keio Univeristy School of Medicine, Tokyo, Shinjuku-ku, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Ophthalmology, Keio Univeristy School of Medicine, Tokyo, Shinjuku-ku, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan .,Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu City, Japan.,Seirei Christopher University, Hamamatsu CIty, Japan
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Yuki K, Asaoka R, Ono T, Awano-Tanabe S, Murata H, Tsubota K. Evaluation of Fear of Falling in Patients with Primary Open-Angle Glaucoma and the Importance of Inferior Visual Field Damage. Invest Ophthalmol Vis Sci 2020; 61:52. [PMID: 32232347 PMCID: PMC7401838 DOI: 10.1167/iovs.61.3.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate fear of falling using the Fall Efficacy Scale-International (FES-I) in glaucoma patients and investigate its association with glaucomatous visual field loss. Methods This study included 273 patients (160 men and 113 women, average age 64.2 years) with primary open-angle glaucoma. Participants were requested to answer the FES-I questionnaire, translated into Japanese, in a face-to-face interview. The relationship between total FES-I score and the following variables was analyzed using multivariable linear regression: age, sex, better and worse best corrected visual acuity, total deviation (TD) in four visual field areas, body mass index (BMI), minutes walked per day, history of diabetes mellitus, history of systemic hypertension, number of previous falls. Results Univariate analysis suggested that total FES-I score increased with age and in woman, whereas other variables were not significantly associated with total FES-I score. However, age (coefficient, 0.23; standard error [SE], 0.04; P < 0.001), sex (coefficient, 1.79 for women; SE, 0.84; P = 0.034), mean TD in the inferior central area (coefficient, 0.92; SE, 0.22; P <0.001), and mean TD in the inferior peripheral area (coefficient, –0.86; SE, 0.21; P < 0.001) were included in the optimal model for total FES-I score. Conclusions Inferior peripheral visual field damage and preserved inferior central visual field sensitivity were associated with increased fear of falling assessed with FES-I in glaucoma.
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Lenoble Q, Corveleyn X, Tran THC, Rouland JF, Boucart M. Can I reach it? A study in age-related macular degeneration and glaucoma patients. VISUAL COGNITION 2019. [DOI: 10.1080/13506285.2019.1661319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Quentin Lenoble
- SCALab, UMR CNRS 9193, University of Lille, CNRS, Lille, France
| | - Xavier Corveleyn
- SCALab, UMR CNRS 9193, University of Lille, CNRS, Lille, France
- Laboratoire d’Anthropologie et de Psychologie Cognitives et Sociales (LAPCOS), Université Côte d’Azur, Nice, France
| | - Thi Ha Chau Tran
- Ophthalmology Department, Catholic Hospital, Lille Catholic University, Lille, France
| | - Jean-François Rouland
- SCALab, UMR CNRS 9193, University of Lille, CNRS, Lille, France
- Ophthalmology Department, Claude Huriez Hospital, University of Lille, Lille, France
| | - Muriel Boucart
- SCALab, UMR CNRS 9193, University of Lille, CNRS, Lille, France
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Ordóñez JE, Ordóñez A, Osorio UM. Cost-effectiveness analysis of iStent trabecular micro-bypass stent for patients with open-angle glaucoma in Colombia. Curr Med Res Opin 2019; 35:329-340. [PMID: 30049226 DOI: 10.1080/03007995.2018.1506022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of trabecular micro bypass stent vs laser trabeculoplasty or medications only, for patients with open-angle glaucoma in a setting of the Colombian System Health. METHODS This is a cost-effectiveness analysis that based its assumptions in external data sources, used to extrapolate the quality-of-life related to health, survival, and costs. A Markov model, with stages from 0 (ocular hypertension without glaucoma) to 5 and bilateral blindness, was developed inclusive of Colombians older than 40 years in 2018, from a societal perspective, comparing trabecular micro-bypass stents vs laser trabeculoplasty, timolol + dorzolamide + brimonidine, timolol + dorzolamide + latanoprost, or timolol + dorzolamide + brimatoprost, in terms of clinical and economic outcomes over a lifetime horizon. Both costs and health outcomes had an annual rate discount of 5%. Health outcomes were evaluated in terms of QALYs related with loss of visual acuity. Trabecular micro-bypass costs include the joint use of timolol, and the costs of laser trabeculoplasty include the combined use of timolol + dorzolamide. RESULTS Trabecular micro-bypass stents were estimated to have 127,971 more discounted QALYs vs laser trabeculoplasty; 405,982 vs timolol + dorzolamide + brimonidine; and 378,287 vs timolol + dorzolamide + latanoprost or timolol + dorzolamide + brimatoprost. Cumulative costs with trabecular micro-bypass stents at 40 years was $13,252,318 lower than laser trabeculoplasty; $6,403,534, lower than timolol + dorzolamide + brimonidine; $22,311,064, lower than timolol + dorzolamide + latanoprost; and $29,156,113 lower than timolol + dorzolamide + brimatoprost. CONCLUSIONS The trabecular micro-bypass stent is a highly cost-saving strategy due to more QALYs related to a lower rate of the population with loss of visual acuity in the long-term, and because the costs associated with additional medications and complications are lower with trabecular micro-bypass stents.
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Ramulu PY, Mihailovic A, West SK, Friedman DS, Gitlin LN. What Is a Falls Risk Factor? Factors Associated with Falls per Time or per Step in Individuals with Glaucoma. J Am Geriatr Soc 2018; 67:87-92. [PMID: 30365871 DOI: 10.1111/jgs.15609] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/17/2018] [Accepted: 08/22/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether visual field (VF) damage or other factors confer a similar risk of falling when falls are ascertained as a rate over time (falls/year) as when ascertained over activity (falls/step). DESIGN Prospective, observational cohort study. SETTING Clinic-based recruitment with real-world monitoring of falls and physical activity. PARTICPANTS Individuals with glaucoma or suspected glaucoma (N=230). MEASUREMENTS Participants recorded falls using daily calendars, with injuries identified in a follow-up questionnaire. Annual 1-week accelerometer trials were used to estimate steps. VF results from both eyes were merged to determine integrated VF sensitivity, with lower sensitivity indicating greater VF damage. Other potential risk factors for falls (age, sex, race, comorbid illness, polypharmacy) were determined using questionnaires. RESULTS The cumulative probability of falls was 45.2% at 12 months and 61.6% at 24 months; cumulative probability of injurious falls was 23.3% at 12 months and 40.0% at 24 months. Greater VF damage was associated with higher rates of falls/steps (incident rate ratio = 1.40/5 dB decrement in sensitivity; p = .004) but not with more falls/year (incident rate ratio = 1.25/5 dB decrement in sensitivity; p = .07). Several additional variables (older age, female sex, more comorbid disease) were also associated with a higher rate of falls/step (p < .02 for all) but not with falls/year (p > 0.10). Black participants had fewer falls/year than whites (p = .002) but did not differ in falls/step (p = .07). Similar results were obtained when injurious falls were analyzed. CONCLUSIONS Risk factors associated with frequent falls when walking (falls/step) are not properly identified when analyzing falls as a rate over time (falls/year). Given the clinical importance of preventing falls while preserving physical activity, falls assessment integrated with activity measurement is recommended when determining whether a risk factor is associated with falls. J Am Geriatr Soc 67:87-92, 2019.
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Affiliation(s)
- Pradeep Y Ramulu
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | | | - Sheila K West
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - David S Friedman
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
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Abstract
Falls pose substantial challenges to health care institutions. This review aims to provide a synthesis and critique of studies that investigated fall injury risk factors and to identify significant risk factors that predispose patients to injurious falls. A comprehensive literature search was conducted in PubMed, COCHRANE, Embase, Cumulative Index to Nursing and Allied Heath Literature, and Scopus. Additional records were searched through Google Scholar and bibliographies of the retrieved articles. Twenty-three primary research studies were included. Demographic, intrinsic, and extrinsic factors have been identified. Demographics include age, gender, and marital status. Intrinsic factors include body mass index, medication, and preexisting conditions, and extrinsic factors include environmental factors. Several factors were found to be inconclusive. These factors should be considered and examined further. Future research may evaluate interventions focusing on targeted risk factors of injurious falls. Clinical guidelines addressing the factors in this review may be considered after further testing and research.
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Abstract
PURPOSE OF REVIEW Numerous population-based studies suggest that glaucoma is an independent risk factor for falling and motor vehicle collisions, particularly for older adults. These adverse events lead to increased healthcare expenditures and decreased quality of life. Current research priorities, therefore, include identifying factors that predispose glaucoma patients to falling and unsafe driving, and developing screening strategies and targeted rehabilitation. The purpose of this article is to review recent studies that address these priorities. RECENT FINDINGS Studies continue to support that glaucoma patients, particularly those with advanced disease, have an increased risk of falling or unsafe driving. Risk factors, however, remain variable and include severity and location of visual field defects, contrast sensitivity, and performance on divided attention tasks. Such variability is likely because of the multifactorial nature of ambulating and driving and compensatory strategies used by patients. SUMMARY Falls and unsafe driving remain a serious public health issue for older adults with glaucoma. Ambulation and driving are complex tasks and there is no consensus yet, regarding the best methods for risk stratification and targeted interventions to increase safety. Therefore, comprehensive and individualized assessments are recommended to most effectively evaluate a patient's risk for falling or unsafe driving.
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Adachi S, Yuki K, Awano-Tanabe S, Ono T, Shiba D, Murata H, Asaoka R, Tsubota K. Factors associated with developing a fear of falling in subjects with primary open-angle glaucoma. BMC Ophthalmol 2018; 18:39. [PMID: 29433472 PMCID: PMC5810054 DOI: 10.1186/s12886-018-0706-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background To investigate the relationship between clinical risk factors, including visual field (VF) defects and visual acuity, and a fear of falling, among patients with primary open-angle glaucoma (POAG). Methods All participants answered the following question at a baseline ophthalmic examination: Are you afraid of falling? The same question was then answered every 12 months for 3 years. A binocular integrated visual field was calculated by merging a patient’s monocular Humphrey field analyzer VFs, using the ‘best sensitivity’ method. The means of total deviation values in the whole, superior peripheral, superior central, inferior central, and inferior peripheral VFs were calculated. The relationship between these mean VF measurements, and various clinical factors, against patients’ baseline fear of falling and future fear of falling was analyzed using multiple logistic regression. Results Among 392 POAG subjects, 342 patients (87.2%) responded to the fear of falling question at least twice in the 3 years study period. The optimal regression model for patients’ baseline fear of falling included age, gender, mean of total deviation values in the inferior peripheral VF and number of previous falls. The optimal regression equation for future fear of falling included age, gender, mean of total deviation values in the inferior peripheral VF and number of previous falls. Conclusion Defects in the inferior peripheral VF area are significantly related to the development of a fear of falling.
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Affiliation(s)
- Sayaka Adachi
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Kenya Yuki
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Sachiko Awano-Tanabe
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Takeshi Ono
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Daisuke Shiba
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
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Kasuga T, Aruga F, Ono K, Hiratsuka Y, Murakami A. Visual impairment as an independent risk factor for falls in hospitalized patients. Can J Ophthalmol 2017; 52:559-563. [PMID: 29217023 DOI: 10.1016/j.jcjo.2017.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/28/2017] [Accepted: 04/12/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the association between visual impairment and the risk of falls in hospitalized patients. DESIGN Individually matched case-control study. METHODS The medical records of patients who fell while hospitalized at Juntendo Tokyo Koto Geriatric Medical Center (JTKGMC) from January to December 2014 were reviewed retrospectively. Among them, 36 patients who were recorded as visiting the Ophthalmology Outpatient Clinic from 1 year before to 1 year after the fall were included as cases. As the control subjects, 36 individually matched patients were chosen who were hospitalized in the same beds in the same hospital wards. Visual impairment and blindness were defined according to U.S. criteria. Conditional logistic regression analysis was used for both univariate and multivariate analyses. Based on previous reports, multivariate analysis was performed with adjustment for age, sex, a history of falls, and use of walking aids. This study was approved by the institutional review board of JTKGMC and was performed according to the tenets of the Declaration of Helsinki. RESULTS The crude odds ratio (OR) for visual impairment was 6.0 (95% confidence interval [CI]: 0.72-49.83). For a history of falls and use of walking aids, the crude OR (95% CI) was 2.5 (0.97-6.44) and 2.8 (0.88-8.64), respectively. After adjustment for age, sex, a history of falls, and use of walking aids, the association between falls and visual impairment was significant (OR: 13.9; 95% CI: 1.0004-194.41). CONCLUSION These findings suggest that visual impairment could be an independent risk factor for falls among hospitalized patients.
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Affiliation(s)
- Toshimitsu Kasuga
- Department of Ophthalmology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan; Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan..
| | - Fumiko Aruga
- Department of Ophthalmology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Koichi Ono
- Department of Ophthalmology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Yoshimune Hiratsuka
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Adachi S, Yuki K, Awano-Tanabe S, Ono T, Murata H, Asaoka R, Tsubota K. Factors associated with the occurrence of a fall in subjects with primary open-angle glaucoma. BMC Ophthalmol 2017; 17:213. [PMID: 29178850 PMCID: PMC5702084 DOI: 10.1186/s12886-017-0613-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 11/16/2017] [Indexed: 11/22/2022] Open
Abstract
Background The aim of the study is to investigate risk factors for future falls in subject with primary open angle glaucoma (POAG). Methods All participants answered the following question at their baseline ophthalmic examination: Have you had any falls in the last year? (Yes/No). All study participants answered the same question every 12 months for 3 years. The means of total deviation values in the whole, superior peripheral, superior central, inferior central, and inferior peripheral visual fields (VF) were calculated. The relationship between these mean VF measurements, and various clinical factors against patients’ future falls was analyzed using multiple linear regression. Results Two-hundred ninety four POAG patients answered the baseline and follow-up fall questionnaires over a period of three years. Among 294 subjects, 69 patients experienced a fall during the three-year follow-up. History of falls at baseline (coefficient = 1.22), history of fear of falling at baseline (0.53), best corrected visual acuity in the worse eye (7.37), prevalence of diabetes mellitus (0.60), prevalence of systemic hypertension (0.53) were selected in the optimal model. Conclusions Visual acuity in the worse eye, history of falls, fear of falling, diabetes mellitus, and systemic hypertension are risk factors for falling in subjects with POAG. Electronic supplementary material The online version of this article (10.1186/s12886-017-0613-1) contains supplementary material, which is available to authorized users.
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Mihailovic A, Swenor BK, Friedman DS, West SK, Gitlin LN, Ramulu PY. Gait Implications of Visual Field Damage from Glaucoma. Transl Vis Sci Technol 2017; 6:23. [PMID: 28660098 PMCID: PMC5484170 DOI: 10.1167/tvst.6.3.23] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/01/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate fall-relevant gait features in older glaucoma patients. METHODS The GAITRite Electronic Walkway was used to define fall-related gait parameters in 239 patients with suspected or manifest glaucoma under normal usual-pace walking conditions and while carrying a cup or tray. Multiple linear regression models assessed the association between gait parameters and integrated visual field (IVF) sensitivity after controlling for age, race, sex, medications, and comorbid illness. RESULTS Under normal walking conditions, worse IVF sensitivity was associated with a wider base of support (β = 0.60 cm/5 dB IVF sensitivity decrement, 95% confidence interval [CI] = 0.12-1.09, P = 0.016). Worse IVF sensitivity was not associated with slower gait speed, shorter step or stride length, or greater left-right drift under normal walking conditions (P > 0.05 for all), but was during cup and/or tray carrying conditions (P < 0.05 for all). Worse IVF sensitivity was positively associated with greater stride-to-stride variability in step length, stride length, and stride velocity (P < 0.005 for all). Inferior and superior IVF sensitivity demonstrated associations with each of the above gait parameters as well, though these associations were consistently similar to, or weaker than, the associations noted for overall IVF sensitivity. CONCLUSION Glaucoma severity was associated with several gait parameters predictive of higher fall risk in prior studies, particularly measures of stride-to-stride variability. Gait may be useful in identifying glaucoma patients at higher risk of falls, and in designing and testing interventions to prevent falls in this high-risk group. TRANSLATIONAL RELEVANCE These findings could serve to inform the development of the interventions for falls prevention in glaucoma patients.
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Affiliation(s)
| | | | | | - Sheila K. West
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Laura N. Gitlin
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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Melillo P, Orrico A, Chirico F, Pecchia L, Rossi S, Testa F, Simonelli F. Identifying fallers among ophthalmic patients using classification tree methodology. PLoS One 2017; 12:e0174083. [PMID: 28334052 PMCID: PMC5363841 DOI: 10.1371/journal.pone.0174083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 03/04/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To develop and validate a tool aiming to support ophthalmologists in identifying, during routine ophthalmologic visits, patients at higher risk of falling in the following year. METHODS A group of 141 subjects (age: 73.2 ± 11.4 years), recruited at our Eye Clinic, underwent a baseline ophthalmic examination and a standardized questionnaire, including lifestyles, general health, social engagement and eyesight problems. Moreover, visual disability was assessed by the Activity of Daily Vision Scale (ADVS). The subjects were followed up for 12 months in order to record prospective falls. A subject who reported at least one fall within one year from the baseline assessment was considered as faller, otherwise as non-faller. Different tree-based algorithms (i.e., C4.5, AdaBoost and Random Forests) were used to develop automatic classifiers and their performances were evaluated by the cross-validation approach. RESULTS Over the follow-up, 25 falls were referred by 13 patients. The logistic regression analysis showed the following variables as significant predictors of prospective falls: pseudophakia and use of prescribed eyeglasses as protective factors, recent worsening of visual acuity as risk factor. Random Forest ranked best corrected visual acuity, number of sleeping hours and job type as the most important features. Finally, AdaBoost enabled the identification of subjects at higher risk of falling in the following 12 months with a sensitivity rate of 69.2% and a specificity rate of 76.6%. CONCLUSIONS The current study proposes a novel method, based on classification trees applied to self-reported factors and health information assessed by a standardized questionnaire during ophthalmological visits, to identify ophthalmic patients at higher risk of falling in the following 12 months. The findings of the current study pave the way to the validation of the proposed novel tool for fall risk screening on a larger cohort of patients with visual impairment referred to eye clinics.
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Affiliation(s)
- Paolo Melillo
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
- * E-mail:
| | - Ada Orrico
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Franco Chirico
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry, United Kingdom
| | - Settimio Rossi
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Testa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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Yonge AV, Swenor BK, Miller R, Goldhammer V, West SK, Friedman DS, Gitlin LN, Ramulu PY. Quantifying Fall-Related Hazards in the Homes of Persons with Glaucoma. Ophthalmology 2016; 124:562-571. [PMID: 28017422 DOI: 10.1016/j.ophtha.2016.11.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/09/2016] [Accepted: 11/21/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize fall-related hazards in the homes of persons with suspected or diagnosed glaucoma, and to determine whether those with worse visual field (VF) damage have fewer home hazards. DESIGN Cross-sectional study using baseline (2013-2015) data from the ongoing Falls in Glaucoma Study (FIGS). PARTICIPANTS One-hundred seventy-four of 245 (71.0%) FIGS participants agreeing to the home assessment. METHODS Participants' homes were assessed using the Home Environment Assessment for the Visually Impaired (HEAVI). A single evaluator assessed up to 127 potential hazards in 8 home regions. In the clinic, binocular contrast sensitivity (CS) and better-eye visual acuity (VA) were evaluated, and 24-2 VFs were obtained to calculate average integrated VF (IVF) sensitivity. MAIN OUTCOME MEASURES Total number of home hazards. RESULTS No significant visual or demographic differences were noted between participants who did and did not complete the home assessment (P > 0.09 for all measures). Mean age among those completing the home assessment (n = 174) was 71.1 years, and IVF sensitivity ranged from 5.6 to 33.4 dB (mean = 27.2 dB, standard deviation [SD] = 4.0 dB). The mean number of items graded per home was 85.2 (SD = 13.2), and an average of 32.7 (38.3%) were identified as hazards. IVF sensitivity, CS, and VA were not associated with total home hazards or the number of hazards in any given room (P > 0.06 for all visual measures and rooms). The bathroom contained the greatest number of hazards (mean = 7.9; 54.2% of graded items classified as hazardous), and the most common hazards identified in at least 1 room were ambient lighting <300 lux and exposed light bulbs. Only 27.9% of graded rooms had adequate lighting. IVF sensitivity, CS, and VA were not associated with home lighting levels (P > 0.18 for all), but brighter room lighting was noted in the homes of participants with higher median income (P < 0.001). CONCLUSIONS Multiple home fall hazards were identified in the study population, and hazard numbers were not lower for persons with worse VF damage, suggesting that individuals with more advanced glaucoma do not adapt their homes for safety. Further work should investigate whether addressing home hazards is an effective intervention for preventing falls in this high-risk group.
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Affiliation(s)
- Andrea V Yonge
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | | | - Rhonda Miller
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Victoria Goldhammer
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Sheila K West
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - David S Friedman
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Laura N Gitlin
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Pradeep Y Ramulu
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
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Asaoka R, Murata H, Fujino Y, Hirasawa K, Tanito M, Mizoue S, Mori K, Suzuki K, Yamashita T, Kashiwagi K, Miki A, Shoji N. Effects of ocular and systemic factors on the progression of glaucomatous visual field damage in various sectors. Br J Ophthalmol 2016; 101:1071-1075. [PMID: 27941050 DOI: 10.1136/bjophthalmol-2016-309643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/28/2016] [Accepted: 11/19/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM To investigate the effects of ocular and systemic risk factors for glaucomatous progression in different sectors of the visual field (VF). METHOD 409 eyes from 268 patients with 10 reliable VFs from the Japanese Archive of Multicentral Databases in Glaucoma (JAMDIG) were investigated. VFs were divided into six sectors (mean total deviation (mTD)s20+, mTDs10-20 and mTDs0-10, >20°, 10-20° and <10° in the superior hemifield, respectively; and mTDi20+, mTDi10-20 and mTDi0-10, >20°, 10-20° and <10° in the inferior hemifield, respectively). The relationship between sectorial progression rate and eight variables (age, mTD at baseline VF, average intraocular pressure (IOP), SD of IOP, systemic hypertension, migraine, family history of glaucoma and smoking status) was investigated. RESULT The mTD progression rate was -0.21 dB/year. Older age was related to progression of mTDs20+, mTDs10-20, mTDi20+ and mTDi10-20. Mean IOP was not related to progression in any VF sector; however, a larger SD of IOP was related to progression of mTDs20+, mTDi0-10, mTDi10-20 and mTDi20+. Smoking status was related to progression in all inferior VF sectors (mTDi0-10, mTDi10-20 and mTDi20+). CONCLUSIONS Smoking status is related to glaucomatous VF progression in all sectors of the inferior hemifield.
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Affiliation(s)
- Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Yuri Fujino
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan.,Orthoptics and Visual Science, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Shimane, Japan.,Division of Ophthalmology, Matsue Red Cross Hospital, Shimane, Japan
| | - Shiro Mizoue
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kazuhiko Mori
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Katsuyoshi Suzuki
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takehiro Yamashita
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kenji Kashiwagi
- Department of Ophthalmology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Atsuya Miki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuyuki Shoji
- Orthoptics and Visual Science, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
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