Visual impairment and falls in older adults: The Blue Mountains eye study

OBJECTIVES: To examine the association between visual impairment and falls in older people. DESIGN: Cross-sectional survey of eye disease with retrospective collection of falls data. SETTING: Two postcode areas in the Blue Mountains west of Sydney, Australia. PARTICIPANTS: All people 49 years of age and older were invited to participate, 3654 (82.4%) of 4433 eligible residents took part, and 3299 answered questions about falls. MEASUREMENTS: Subjects had a detailed eye examination and answered questions about health and vision status, use of medication, and number of falls in the previous 12 months. RESULTS: Tests of visual function that had a statistically significant association with two or more falls after adjustment for confounders were visual acuity (prevalence ratio (PR) 1.9 for visual acuity worse than 20/30), contrast sensitivity (PR 1.2 for a 1-unit decrease at 6 cycles per degree), and suprathreshold visual field screening (PR 1.5 for 5 or more points missing). However, only visual acuity and contrast sensitivity were significantly associated with two or more falls per 1 standard deviation decrease. The presence of posterior subcapsular cataract (PR 2.1) and use of nonmiotic glaucoma medication (PR 2.0) had a statistically significant association with two or more falls; presence of age-related macular degeneration, diabetic retinopathy, and cortical or nuclear cataract did not. CONCLUSION: Visual impairment is strongly associated with two or more falls in older adults. In addition to poor visual acuity, visual factors such as reduced visual field, impaired contrast sensitivity, and the presence of cataract may explain this association.