title: Risk of musculoskeletal injuries, fractures, and falls in medicare beneficiaries with disorders of binocular vision.
abstract: OBJECTIVE
  Disorders of binocular vision are increasingly prevalent among fee-for-service Medicare beneficiaries 65 years or older. Visual impairment is a recognized risk factor for fractures. Despite the association of visual impairment and fracture risk, to our knowledge, no study has examined the influence that disorders of binocular vision (strabismus, amblyopia, diplopia, and nystagmus) may have on musculoskeletal injury and fracture risk in the elderly population.
  
  
  OBJECTIVE
  To evaluate associations between disorders of binocular vision and musculoskeletal injury, fracture, and falls in the elderly.
  
  
  METHODS
  A retrospective study of 10-year (2002-2011) musculoskeletal injury, fracture, or fall prevalence in a 5% random sample of Medicare Part B fee-for-service claims for beneficiaries with disorders of binocular vision. Participants included Medicare beneficiaries living in the general community who were 65 years or older with at least 1 year of Medicare Part B enrollment.
  
  
  METHODS
  Diagnosis of a disorder of binocular vision.
  
  
  METHODS
  Ten-year prevalence of musculoskeletal injury, fracture, or fall in individuals with and without disorders of binocular vision. Analyses were adjusted for age, sex, race/ethnicity, region of residence, systemic and ocular comorbidities, and duration of follow-up.
  
  
  RESULTS
  There were 2,196,881 Medicare beneficiaries identified. Of these, 99,525 (4.5%) had at least 1 reported disorder of binocular vision (strabismus, 2.3%; diplopia, 2.2%; amblyopia, 0.9%; and nystagmus, 0.2%). During the 10-year study period, there were 1,272,948 (57.9%) patients with documented musculoskeletal injury, fracture, or fall. The unadjusted odds ratio (OR) for the association between disorders of binocular vision and any of the 3 injury types was 2.23 (95% CI, 2.20-2.27; P < .001). The adjusted OR was 1.27 (95% CI, 1.25-1.29; P < .001).
  
  
  CONCLUSIONS
  Medicare beneficiaries with a disorder of binocular vision have significantly higher odds of sustaining a musculoskeletal injury, fracture, or fall. This finding is an important step forward in understanding and developing strategies to prevent these injuries, which are associated with high morbidity in the elderly.
authors.affiliation: Jules Stein Eye Institute, Department of Ophthalmology, UCLA (University of California, Los Angeles).
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Pineles
authors.affiliation: Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Michael X
authors.initials: MX
authors.lastname: Repka
authors.affiliation: Jules Stein Eye Institute, Department of Ophthalmology, UCLA (University of California, Los Angeles).
authors.forename: Fei
authors.initials: F
authors.lastname: Yu
authors.affiliation: H. Dunbar Hoskins Jr, MD Center for Quality Eye Care, Foundation of the American Academy of Ophthalmology, San Francisco, California.
authors.forename: Flora
authors.initials: F
authors.lastname: Lum
authors.affiliation: Jules Stein Eye Institute, Department of Ophthalmology, UCLA (University of California, Los Angeles)4Fielding School of Public Health, Department of Epidemiology, UCLA.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Coleman
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D008297:Male; D016345:Medicare Part B; D009141:Musculoskeletal System / Q000293:injuries*; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D014786:Vision Disorders / Q000453:epidemiology*; D015348:Vision, Binocular; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*