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.