Risk of Falls, Fear of Falling, and Rates of Visual Field Progression in Glaucoma in the African Descent and Glaucoma Evaluation Study.

Abstract

Purpose: To assess the relationships between rates of glaucomatous visual field (VF) progression, fear of falling (FoF), history of falls, and ancestry.

Design: Prospective, multicenter, longitudinal cohort.

Subjects: Patients followed in the multisite African Descent and Glaucoma Evaluation Study with primary open-angle glaucoma and who completed a validated fear of falling questionnaire along with a self-reported history of falls in the past year were enrolled.

Methods: Baseline VF severity and VF progression rates were assessed using 24-2 VF mean deviation (MD). We used univariable and multivariable models adjusting for confounders (age, sex, ancestry, and baseline MD) using clustered robust logistic regression and linear regression.

Main outcome measures: The primary outcome measure was the relationship between history of falls (yes vs. no) as a dependent variable and MD slopes (dB/year). The secondary outcome measure was the relationship between FoF scores (continuous) as a dependent variable and MD slopes (dB/year).

Results: There were 4453 patient encounters, including at least 5 VF tests per patient with a minimum of 2 years of follow-up in 277 eyes of 183 individuals. Faster MD slopes were significantly associated with a history of falls in both univariable (odds ratio [OR]: 2.68 per dB/year faster rates; 95% confidence interval [CI]: 1.35-5.33; P = 0.005) and multivariable models (OR: 2.55; 95% CI: 1.29-5.04; P = 0.007). Rapid progressors (MD slope less than -0.5 dB/year) were 2.45-fold more likely to have a positive history of falls (95% CI: 1.22-4.91, P = 0.012). Faster MD slopes were significantly associated with worse FoF in both univariable (β: 2.97 per dB/year faster rates; 95% CI: 0.41-5.54; P = 0.023) and multivariable (β: 2.27; 95% CI: 0.17-4.36; P = 0.034) models. Patients of African descent (AD) were as likely to have a history of falls and had similar FoF scores as those of European descent (ED) (all P > 0.40).

Conclusions: A faster rate of MD progression is associated with a greater fear of falling and history of falls among AD and ED treated glaucoma patients. Rapid progressors were almost threefold more likely to have a history of falls. The 2 ancestry groups also experienced similar rates of falls and fear of fall scores.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.