title: Fear of falling and visual field loss from glaucoma.
abstract: OBJECTIVE
  To determine if visual field (VF) loss resulting from glaucoma is associated with greater fear of falling.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Fear of falling was compared between 83 glaucoma subjects with bilateral VF loss and 60 control subjects with good visual acuity and without significant VF loss recruited from patients followed up for suspicion of glaucoma.
  
  
  METHODS
  Participants completed the University of Illinois at Chicago Fear of Falling Questionnaire. The extent of fear of falling was assessed using Rasch analysis.
  
  
  METHODS
  Subject ability to perform tasks without fear of falling was expressed in logits, with lower scores implying less ability and greater fear of falling.
  
  
  RESULTS
  Glaucoma subjects had greater VF loss than control subjects (median better-eye mean deviation [MD] of -8.0 decibels [dB] vs. +0.2 dB; P<0.001), but did not differ with regard to age, race, gender, employment status, the presence of other adults in the home, body mass index (BMI), grip strength, cognitive ability, mood, or comorbid illness (P ≥ 0.1 for all). In multivariate models, glaucoma subjects reported greater fear of falling as compared with controls (β = -1.20 logits; 95% confidence interval [CI], -1.87 to -0.53; P = 0.001), and fear of falling increased with greater VF loss severity (β = -0.52 logits per 5-dB decrement in the better eye VF MD; 95% CI, -0.72 to -0.33; P<0.001). Other variables predicting greater fear of falling included female gender (β = -0.55 logits; 95% CI, -1.03 to -0.06; P = 0.03), higher BMI (β = -0.07 logits per 1-unit increase in BMI; 95% CI, -0.13 to -0.01; P = 0.02), living with another adult (β = -1.16 logits; 95% CI, -0.34 to -1.99 logits; P = 0.006), and greater comorbid illness (β = -0.53 logits/1 additional illness; 95% CI, -0.74 to -0.32; P<0.001).
  
  
  CONCLUSIONS
  Bilateral VF loss resulting from glaucoma is associated with greater fear of falling, with an impact that exceeds numerous other risk factors. Given the physical and psychological repercussions associated with fear of falling, significant quality-of-life improvements may be achievable in patients with VF loss by screening for, and developing interventions to minimize, fear of falling.
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland 21287, USA. pramulu1@jhmi.edu
authors.forename: Pradeep Y
authors.initials: PY
authors.lastname: Ramulu
authors.forename: Suzanne W
authors.initials: SW
authors.lastname: van Landingham
authors.forename: Robert W
authors.initials: RW
authors.lastname: Massof
authors.forename: Emilie S
authors.initials: ES
authors.lastname: Chan
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.forename: David S
authors.initials: DS
authors.lastname: Friedman
mesh_terms: D000058:Accidental Falls; D000203:Activities of Daily Living; D000368:Aged; D000465:Algorithms; D005239:Fear / Q000523:psychology*; D005260:Female; D005901:Glaucoma / Q000150:complications / Q000523:psychology*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000209:etiology / Q000523:psychology*; D014792:Visual Acuity / Q000502:physiology; D014794:Visual Fields