Faster glaucoma progress tied to higher fall rate

By David Douglas

NEW YORK (Reuters Health) - Glaucoma patients with rapid visual field (VF) loss are at greater risk of falls than those with slower progression, new research shows

"This study was the first to investigate the relationship between rates of disease progression in glaucoma and risk of falls," said Dr. Felipe A. Medeiros of the University of California, San Diego, La Jolla. "We already knew from previous investigations that patients with glaucomatous visual field loss were at higher risk for falling. However, no study had looked at the relationship between velocity of glaucoma progression and risk of falls."

"We found that glaucoma patients who had fast visual field progression were those at higher risk of falling, even after adjusting for the amount of visual field damage at the time of falls," he told Reuters Health by email.

The study, online June 9 in JAMA Ophthalmology, includes data from 116 glaucoma patients with a mean age of 73.1 years. Of this group, 29 (25%) reported at least one fall in the previous year.

The mean rate of change in binocular mean sensitivity was significantly greater for patients who reported a history of falls compared to those who did not (-0.36 versus -0.17 dB/y).

Even after adjusting for visual acuity, disease severity, comorbidity index, and other confounders, a history of fast visual field loss was significantly associated with falls (rate ratio 2.28 per 0.5 dB/y faster).

"In other words," continued Dr. Medeiros, "for two patients with the same level of visual field damage, the one who has been progressing faster would be at higher risk for falls. The results indicate that patients with fast progression may be less able to develop compensatory strategies to reduce risk of falling."

"It is an important finding," he concluded, "as it relates rates of disease progression to a clinically relevant outcome directly affecting patients' lives."

Dr. Ecosse Lamoureux, coauthor of an accompanying editorial, told Reuters Health by email that the work "showed that the rate of VF loss may be as important as determining the severity of glaucoma. Understanding the phenomenon of the rate of VF loss, for example, can inform patients experiencing rapid VF loss about their risks of falling and offer potential strategies to adapt to their rapidly changing circumstances."

"Moreover," said Dr. Ecosse, of the Singapore National Eye Centre, "research into rapid VF loss could also be applied to other eye diseases that affect the field of view, such as diabetic retinopathy and age-related macular degeneration, and lead to better disease management and a decrease in the risk of falls."

The National Eye Institute and other organizations supported this research. The authors reported no disclosures.

SOURCE: https://bit.ly/1YtqAAk

JAMA Opthalmol 2016.