title: Central and peripheral visual impairment and the risk of falls and falls with injury.
abstract: OBJECTIVE
  To evaluate whether central (CVI) and peripheral visual impairment (PVI) are independent risk factors for falls and falls with injury 4 years later.
  
  
  METHODS
  Population-based, prospective cohort study.
  
  
  METHODS
  A population-based sample of 3203 adult Latinos.
  
  
  METHODS
  Baseline presenting binocular central distance acuity was measured and impairment was classified as mild (20/40-20/63) or moderate/severe (<or=20/80). Peripheral visual impairment was classified as mild (-6 dB < mean deviation < -2 dB in worse eye), moderate/severe (mean deviation <or=-6 dB in worse eye).
  
  
  METHODS
  Falls and falls with injury in the past 12 months were assessed by self-report at the 4-year follow-up visit.
  
  
  RESULTS
  Out of 3203 individuals, 19% reported falls and 10% falls with injury 4 years after the baseline examination; participants with falls were more likely to be >or=60 years of age, be female, report lower income, have >2 comorbidities, report alcohol use, report wearing bifocal glasses, and report obesity. Among those who reported falls, 7% had CVI (visual acuity >20/40) compared with 4% who did not report falls; and 49% had PVI (mean deviation < -2 dB) compared with 39% of those who did not report falls (both P<0.0001). After adjusting for confounders, moderate to severe CVI and PVI were associated with increased risk for falls (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.02-5.45; P(trend) = 0.04; and OR, 1.42; 95% CI, 1.06-1.91l P(trend) = 0.01, respectively) and with falls with injury (OR, 2.76; 95% CI, 1.10-7.02; P(value) = 0.03; and OR, 1.40; 95% CI, 0.94-2.05 P(trend) = 0.04, respectively).
  
  
  CONCLUSIONS
  Both CVI and PVI were independently associated with increased risk for falls and falls with injury 4 years after the initial examination in a dose-response manner. Although vision-related interventions for preventing falls have mainly focused on correcting CVI, this study suggests that targeting both central and peripheral components may be necessary to effectively reduce rates of falls and falls with injury related to vision loss.
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
authors.forename: Cecilia M
authors.initials: CM
authors.lastname: Patino
authors.forename: Roberta
authors.initials: R
authors.lastname: McKean-Cowdin
authors.forename: Stanley P
authors.initials: SP
authors.lastname: Azen
authors.forename: Jessica Chung
authors.initials: JC
authors.lastname: Allison
authors.forename: Farzana
authors.initials: F
authors.lastname: Choudhury
authors.forename: Rohit
authors.initials: R
authors.lastname: Varma
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000208:ethnology*; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000150:complications*; D014792:Visual Acuity; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology