Eyeworld

EW GLAUCOMA 48 September 2018 by Vanessa Caceres EyeWorld Contributing Writer "Poor balance, slower gait speed, and greater variability in gait are all associated with increased risk of falling, though it remains to be determined if this is why persons with glaucoma fall more often," Dr. Ramulu said. It may be that persons with glaucoma have difficulty with hazard perception, but this would be hard to test, he said. The interest in falls led Dr. Ra- mulu and others to conduct FIGS, a 3-year prospective cohort of patients with glaucoma or suspected glau- coma who were recruited at their institution between 2013 and 2015. Vision, gait, and balance tests were repeated every year, and respon- dents completed questionnaires about falling, driving, and quality of life. Although some of the work is still under review for publication, Dr. Ramulu revealed that there does not appear to be any clear circum- stance to explain why those with glaucoma fall more. Tips to help prevent falls Knowing that patients with glauco- ma may fall more, even if it is not clear why, what can ophthalmolo- gists do to better educate about the risk? Below are a few suggestions. 1. Provide verbal and written guidance. When a patient has glau- coma, particularly if he or she is old- er and has more visual field damage, talk about the risk for falls. Have handouts available at the office that address falls. One resource that Dr. Ramulu and colleagues like is the National Falls Prevention Resource Center (www.ncoa.org/center-for- healthy-aging/falls-resource-center) from the NCOA. 2. Encourage patients to have a home visit for a review of falls prevention and falls risk. This kind of visit can be done by occupation- al therapists, said Scott Trudeau, PhD, OTR/L, productive aging and interprofessional collaborative prac- tice program manager, American Occupational Therapy Association, Bethesda, Maryland. Although there are general factors that can decrease the risk for falls, each person will have individualized needs, Dr. words, homes were not necessarily made safer just because someone had more glaucoma damage. Researchers found that the bathroom had the largest number of hazards of any room in the home; ambient lighting was the most com- mon hazard overall (less than 300 lux and exposed light bulbs). Only 27.9% of graded rooms had enough lighting, the researchers reported. In a study published this year from the Johns Hopkins research- ers, 4 it was found that falls among 142 patients with glaucoma oc- curred in or around the home 71% of the time. The likelihood of where falls would occur did not change significantly with more visual field damage. Tripping (43.6%), slipping (31.3%), uneven flooring (23.5%), and poor vision (15.9%) were the most commonly cited fall circum- stances. Among the 330 falls total that occurred, 43% had some sort of injury; the factors associated with likelihood of injury included floor type and number of comorbidities. Those with severe glaucoma were more likely to have a fall resulting in a fracture (9.4%) or the need for an ER visit (18.8%). Apart from vision loss, it is not completely clear why falls are higher among those with glaucoma, said Pradeep Ramulu, MD, chief of the glaucoma division, Wilmer Eye Institute, Johns Hopkins School of Medicine, one of the study authors. focused on the fear of falling among those with POAG. 2 Among the 392 subjects, 87.2% reported that they had a fear of falling at least once during a 3-year period. Older age, being female, and having visual field damage in the inferior periph- eral area all were related to the fear of falling. Careful consideration about the fear of falling is import- ant for both ophthalmologists and patients who have visual damage in this area, Dr. Asaoka said. Tracking where falls happen A group of researchers from Johns Hopkins University, Baltimore, have focused research on falls locations and falls hazards among those with glaucoma. They did their research as part of the Falls in Glaucoma Study (FIGS). In one study they published last year in Ophthalmology, 3 the re- searchers focused on characterizing falls-related hazards in the homes of those with glaucoma or those sus- pected of having glaucoma. Using a Home Environment Assessment for the Visually Impaired, an evaluator assessed the homes of 174 partici- pants for 127 potential falls hazards in eight home regions. Researchers also performed clinical exams. The study found no significant difference in the number of home hazards among those with visual field damage compared with those who had less damage; in other Heightened awareness important to lower risk, researchers say F alls can be a real danger to those age 65 and over. Among Americans age 65 or older, one in four has a fall each year, according to the Centers for Disease Control and Prevention. Falls are the leading cause of fatal injury among older adults and the most common cause of nonfatal trauma-related hospital admissions, the National Council on Aging (NCOA) reported. Even just the risk of falling can make a difference in the life of an older adult, causing fear and the limiting of social activities, in turn leading to physical decline, social isolation, and depression, the NCOA reported. With the aging of the U.S. population, ophthalmologists are in a position to help patients with glaucoma who are older stay vigilant about their fall risk and help them prevent falls. Here's what some recent studies have found about the risk of falls in glaucoma patients. History of falls, systemic disease increase risk In a group of 294 patients with primary open angle glaucoma (POAG), the risk of falls was higher dependent upon visual acuity in the worse eye, history of falls, fear of falling, having diabetes, and system- ic hypertension, reported Adachi et al. 1 Among the participants, 69 had experienced a fall during a 3-year follow-up. "Ophthalmologists should advise patients about the risk of falls when visual acuity in the worse eye is decreased, there is a history of falls, and there is fear of falling," said Ryo Asaoka, MD, assistant pro- fessor, Department of Ophthalmol- ogy, University of Tokyo Graduate School of Medicine, Tokyo, Japan. Dr. Asaoka was the corresponding author for the study. Dr. Asaoka and fellow authors also examined falls in a study that Risk for falls common among those with glaucoma

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