For low vision specialists and those who consult them
(Another) paper on visual impairment and falls
In the most recent edition of Ophthalmology, there is a paper by Patino and colleagues reporting the relationship between visual impairment and falls. This paper is part of the large LALES (Los Angeles Latino Eye Study), which is a population-based study of the Latin American population of Los Angeles.
They found that about one-fifth of their sample had fallen in the previous four years, and that about 10% of the sample had injured themselves when falling. Most of the injuries were relatively minor, although some people broke their wrist, rib or hip.
Visual impairment was associated with falling and with injury. Those with central visual field loss were 2.4 times more likely to report a fall, and 2.8 times more likely to fall and injure themselves, than people without central vision loss. Peripheral vision loss made people 1.4 times more likely to fall. There was also a ‘dose effect’ in that the worse the visual impairment, the greater the likelihood of falls. Visual impairment is likely to contribute to falls in at least two ways: the increased likelihood of tripping over an unseen object, and impaired balance as a consequence of poor vision.
The authors found that people with bifocal glasses were more likely to have fallen, but this factor was found to be attributable to the older age and greater comorbidity of people who were bifocal wearers.
This is by no means the first study to examine visual loss and falls, but it includes a wider range of ages than some of the other large studies (eg. the Salisbury Eye Evaluation).
Of course the obvious question is ‘what can we do to stop people falling?’ The most important strategy is to ensure that eye disease is identified early, to reduce the impact of diseases such as glaucoma on the visual field. For those with visual impairment, home adjustment (to remove trip hazards), orientation and mobility training, optimal refractive correction and a medication review are all useful techniques to reduce the likelihood of falls.