title: Investigating the Influence of Visual Function and Systemic Risk Factors on Falls and Injurious Falls in Glaucoma Using the Structural Equation Modeling.
abstract: OBJECTIVE
  To investigate the relationship between visual function and the risks of falling and injurious falls in subjects with primary open angle glaucoma (POAG).
  
  
  METHODS
  Questionnaires were conducted in 365 POAG patients to assess history of falls and falls with injury and general patient health. Structural equation modeling (SEM) was used to investigate the relationship between visual function, as measured by a patient's binocular integrated visual field and visual acuity (VA), general health and the risks of falling and injurious falls.
  
  
  RESULTS
  Among the 365 subjects, 55 subjects experienced falls in the past year. A significant difference was observed in worse-eye VA between the faller and non-faller groups (p = 0.03). SEM of fallers obtained a Root Mean Square Error of Approximation (RMSEA) of 0.035 and a Comparative Fit Index (CFI) of 0.99. The 95% confidence intervals (CI) of regression coefficients from this model suggested better VA and worse VA were significant risk factors for falling. Among the 55 fallers, 22 subjects experienced an associated injury. There was a significant difference in gender between the non-injurious and injurious faller groups (p = 0.002). SEM of injurious fallers obtained a RMSEA of 0.074 and a CFI of 0.97. In this SEM model, the 95% CI of regression coefficients suggested gender and average total deviation values in the lower peripheral visual field were significant risk factors for an injurious fall.
  
  
  CONCLUSIONS
  This study suggests that worse-eye and better-eye VAs are associated with falls. Furthermore, patients with inferior visual field loss and females were found to be at greater risk of injurious falls.
authors.affiliation: Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Yuki
authors.affiliation: Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Asaoka
authors.affiliation: Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsubota
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D015897:Comorbidity; D005260:Female; D005901:Glaucoma / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014794:Visual Fields; D014796:Visual Perception