Eye Diseases and Impaired Vision as Possible Risk Factors for Recurrent Falls in the Aged: A Systematic Review

Table 2

Studies about relationships between eye diseases or impaired vision and the risk for recurrent falls.

Authors, year	𝑁	Mean age and range (yrs)	Registration of falls	Follow-up period	Results
Prospective studies
Unselected populations
De Boer et al., 2004 [8]	𝑛=1418; Females: 52%	Recurrent fallers: 77.3±6.9; Nonrecurrent fallers: 75.1±6.4; Range: 65−	Falls reported weekly on a calendar posted every 3 mo.; Alternatively reported by telephone.	3 yrs	Integrated contrast sensitivity (HR = 1.53, 95% CI = 1.03–2.29) and low-frequency contrast sensitivity (HR = 1.66, 95% CI = 1.11–2.48) risk factors for recurrent falling after adjustment for confounders. Subjective visual acuity impairment not a risk factor
Community-dwelling populations
Knudtson et al., 2009 [9]	𝑛=2256; Females: 58%	Nonrecurrent fallers: 71.3±8.7,; recurrent fallers: 76.0±10.2; Range: 54–95	Questions about falling during past 12 mo made 5 years after ophthalmic examination,	1 yr	Poor best-corrected monocular visual acuity, poor contrast sensitivity, and discrepant vision associated statistically significantly with 2 or more falls (𝑃>0.05) after controlling for age
Coleman et al., 2007 [10]	𝑛=4216; Females: 100%; Completed followup: 𝑛=4071	79.9±4.0; 70−	By postcard or telephone every 4 mo.	1 yr	Severe binocular visual field loss associated with recurrent falls after adjusting for age, study site, and cognitive function (OR = 1.50, 95% CI = 1.11–2.02). No association between contrast sensitivity or visual acuity and recurrent falls when adjusted for age, study site, and cognitive function
Coleman et al., 2004 [11]	𝑛=2002; Females: 100%	76.4 ± 4.8; 70−	Postcard or interview by telephone every 4 mo.	11.86 ± 1.25 mo	Declining visual acuity a risk factor for frequent falling. ORs after adjustment for baseline visual acuity and other confounders 2.08 (95% CI = 1.39–3.12) for loss of 1 to 5 letters using Bailey-Lovie chart, 1.85 (95% CI = 1.16−2.95) for loss of 6−10 letters, 2.51 (95% CI = 1.39–4.52) for loss of 11–15 letters, and 2.08 (95% CI = 1.01–4.30) for loss of >15 letters. Cataract, glaucoma, and retinal diseases not risk factors for recurrent falls
Ramrattan et al., 2001 [12]	At baseline: 𝑛=6250; Females: 58%; Completed follow-up: 𝑛=5186	68; 55−	Questions: “Did you fall >4 times in the past 2 years?” Asked 3 yrs after ophthalmic examination	2 yrs	Unilateral and bilateral visual field losses (VFLs) associated with a 6-fold risk of recurrent falls. 0.55% of participants with no VFL were recurrent fallers compared to 3.4% of participants with unilateral VFL (𝑃<0.05) or 3.4% of participants with bilateral VFL (𝑃<0005) (adjusted for age, sex, and moderate/severe disability). Association remained after adjustment for visual acuity
Lord and Dayhew, 2001 [13]	At visual tests: 𝑛=156; Females: 63%; Completed followup: 𝑛=148	76.5±5.1; 63–90	Falls marked in a questionnaire by participants monthly	1 yr	Poor depth perception (RR = 2.26, 95% CI = 1.24–4.14), binocular poor low contrast visual acuity (RR = 2.08, 95% CI = 1.17–3.71), poor stereoacuity (RR = 1.99, 95% CI = 1.11–3.59), and poor distant-edge-contrast sensitivity (RR = 1.93, 95% CI = 1.01–3.68) risk factors for recurrent falls after adjustment for age, but poor visual acuity, reduced lower visual field size, and reduced near contrast sensitivity not risk factors.
Tromp et al., 2001 [5]	𝑛=1285; Females: 51%	75.2±6.5; 64.8–88.2	Falls reported weekly on a calendar posted every 3 mo; Alternatively reported by telephone	1 yr	Subjective visual acuity impairment was a risk factor (OR = 2.6, 95% CI = 1.8–3.8) in unadjusted models.
Tromp et al., 1998 [14]	𝑛=1469; Females: 52%	72.6±6.6; 61.8–85.5	Questions about falls during the year before follow-up visit 3 yrs after baseline visit	1 yr	Subjective visual impairment a risk factor for recurrent falls (OR = 1.6, 95% CI = 1.1–2.3, unadjusted).
Luukinen et al., 1996 [15]	𝑛=788; Females: 63%	76.1±4.9; 70–92	Falling diary returned after each fall Participants not returning diary in 3 mo, were contacted by phone	2 yrs; The population examined half-way through followup.	Self-reported ophthalmic disease a risk factor (RR = 1.5, 95% CI = 1.00–2.21) for at least 2 falls.
Nevitt et al., 1989 [16]	𝑛=325; females: 82%	60−	Weekly by postcards	1 yr	Decreased depth perception an independent predictor for ≥3 falls after adjustment (OR = 2.1, 95% CI = 1.1–4.2). Decreased visual acuity, visual field loss, or poor contrast sensitivity not associated with multiple falls.
Lord et al., 1994 [3]	𝑛=414; Females: 100%; Follow-up data: 𝑛=341	73.6±6.3; 65–99	Falls recorded on a posted questionnaire every 2 mo	1 yr	After controlling for age, there was a difference in low contrast visual acuity (𝑃<0.01) and contrast sensitivity (𝑃<0.01) between nonmultiple fallers and multiple fallers. High contrast visual acuity not a significant risk factor for falls.
Residents in intermediate care
Clark et al., 1993 [17]	At baseline: 𝑛=81; Females: 94%; Followup data: 𝑛=76	83.3±5.8; 70–97	Questionnaires about falls given monthly Nursing staff hold fall record book	1 yr	Visual field defects, cataract, retinopathy, or degeneration no risk factors for multiple. Impaired visual acuity more common in multiple fallers (RR = 1.79, 95% CI = 1.06–3.03, unadjusted).
Lord et al., 1991 [18]	𝑛=95; Females: 83%; Completed follow-up: 𝑛=84	82.7±6.6; 59–97	Falls recorded monthly with questionnaire and fall record book of staff.	1 yr	Multiple fallers had poorer contrast sensitivity (𝑃<0.01, adjusted for age) than nonmultiple fallers. No difference in best-corrected visual acuity after controlling for age between multiple fallers and nonmultiple fallers.
Tinetti et al., 1986 [19]	𝑛=79; Females: 68%	79; 61–92	The staff reported falls to incident reports.	3 mo	Poor corrected distant vision in both eyes a risk factor for recurrent falling (RR = 3.5, 𝑃≤0.05 unadjusted). Results about near vision not announced.
Graafmans et al., 1996 [20]	𝑛=354; Females: 85%	83±6; 70−	Falls recorded weekly on a calendar.	28 we	Self-reported distant vision loss not a risk factor for recurrent falls (OR = 1.7, 95% CI = 0.9–3.5), when adjusted for age and sex.
Institutionalized populations
Luukinen et al., 1995 [21]	𝑛=93; Females: 76%	81.2±5.8; 70−	The staff reported falls by a postal diary after each fall.; Medical records were checked.	2 yrs; The population examined half-way through followup	An ophthalmic disease (asked by a postal questionnaire, nursing staff helped participants) an independent risk factor for recurrent falls (OR=6.7, 95% Cl = 1.33–33.4) in a logistic regression analysis.
Retrospective studies
Community-dwelling populations
Ivers et al., 1998 [22]	Data about falls available: 𝑛=3299; females: 57%	66.1±9; 49−	Participants were asked about all falls during the previous 12 mo.	1 yr; retrospectively	Poor visual acuity wearing current glasses (prevalence ratio =1.9, 95% CI = 1.2–3.0 after adjustment for confounders), poor contrast sensitivity (PR=1.2, 95% CI = 1.1–1.3), and visual field loss (PR=1.5, 95% CI = 1.0–2.3) associated with recurrent falls. Being unable to recognize a face across the street, see the TV, or read a newspaper were not significant risk factors after controlling for confounders. Posterior subcapsular cataract (PR=2.1, 95% CI = 1.0–4.3) was associated with recurrent falls, but age-related macular degeneration, DM retinopathy, glaucoma, and cortical or nuclear cataract were not.
Rossat et al., 2010 [23]	𝑛=1066	65−	Participants were asked about all falls during the previous 12 mo.	1 yr; retrospectively	Poor visual acuity was statistically significantly associated with recurrent falls (𝑃=0.006) after adjustment for potential confounders.
Van Nieuwenhuizen et al., 2010 [24]	𝑛=639; Females: 73%	78.5±7.8	Participants were asked about all falls during the previous 12 mo.	1 yr; retrospectively	Subjective impaired vision was not a risk factor for falling in a multivariate regression model.