Abstract:
IMPORTANCE:Further research is crucial to better understand the reason for falls in individuals with visual impairment (VI) and to develop appropriate fall prevention strategies. OBJECTIVE:To compare balance measures in individuals with normal vision, VI, and uncorrected refractive error (URE). DESIGN AND SETTING:Cross-sectional study based on a national survey sample. PARTICIPANTS:A total of 4590 adults, 40 years or older, participating in the 2001 through 2004 National Health and Nutrition Examination Survey. MAIN OUTCOME MEASURES:Participants completed tests of standing balance with eyes open or eyes closed on a firm or compliant (foam) surface. Eyes-closed testing on a foam surface primarily assessed vestibular balance by minimizing visual and proprioceptive inputs. The main outcome measure was time to balance failure on firm and foam surface testing. Participants also self-reported difficulty with falling during the last year. RESULTS:Failure during eyes-open balance testing conditions or eyes-closed balance testing on a firm surface was not more common among participants with VI-associated or URE-associated vision loss (P > .22). In eyes-closed foam surface balance testing, multivariable models demonstrated higher rates of balance loss with VI-associated vision loss (P = .02) and with URE-associated vision loss (P = .04) (hazard ratio, 1.7 per logarithm of the minimum angle of resolution [logMAR] unit change [10 lines] for both). Self-reported falling difficulty was associated with worse VI (odds ratio, 3.7 per logMAR unit change; P = .03) but not with worse URE (odds ratio, 3.4 per logMAR unit change; P = .14). CONCLUSIONS AND RELEVANCE:The vestibular contribution to balance (measured with eyes closed on a foam surface) was worse for individuals with VI or URE. Reduced visual inputs may weaken the vestibulo-ocular reflex, an important system that maintains the effectiveness of vestibular balance. Alternately, common degenerative pathways or lower physical activity levels may affect balance, particularly among those with VI.
journal_name
JAMA Ophthalmoljournal_title
JAMA ophthalmologyauthors
Willis JR,Vitale SE,Agrawal Y,Ramulu PYdoi
10.1001/jamaophthalmol.2013.316subject
Has Abstractpub_date
2013-08-01 00:00:00pages
1049-56issue
8eissn
2168-6165issn
2168-6173pii
1695904journal_volume
131pub_type
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