Fear of Falling, Eye Disease, and Limitations in Daily Activities: They’re All Related

The ARVO logo. It consists of the letters ARVO, preceded by the drawing of an eye

Investigative Ophthalmology & Visual Science, the official journal of the Association for Research in Vision and Ophthalmology (ARVO), has published yet another thought-provoking study about the real-life ramifications of adult-onset vision loss.

The Association for Research in Vision & Ophthalmology

Activity Limitation Due To a Fear of Falling in Older Adults with Eye Disease was published in the December 3, 2012 online edition of Investigative Ophthalmology & Visual Science, the official journal of the Association for Research in Vision and Ophthalmology (ARVO). ARVO is an international organization that encourages and assists research, training, publication, and dissemination of knowledge in vision and ophthalmology, including low vision.

The authors are Meng Ying Wang, Jacqueline Rousseau, Hélène Boisjoly, Heidi Schmaltz, Marie-Jeanne Kergoat, Solmaz Moghadaszadeh, Fawzia Djafari, and Ellen E. Freeman, who represent the following institutions: Centre de Recherche, Hôpital Maisonneuve-Rosemont and Institut universitaire de gériatrie, Montreal, Quebec, Canada; Département d’ophtalmologie, Université de Montréal; and the Department of Geriatric Medicine, University of Calgary, Calgary, Canada.

About the Study

The purpose of the study was to examine whether older adults with age-related macular degeneration (AMD), glaucoma, or Fuchs’ corneal dystrophy reported limiting their activities, due to a fear of falling – as compared with a control group of older adults with good vision.

The research team recruited 345 patients (93 with AMD, 57 with Fuchs’, 98 with glaucoma, and 97 control patients with normal visual acuities and visual fields) from the ophthalmology clinics of Maisonneuve-Rosemont Hospital to participate in a cross-sectional study from September 2009 until July 2012. Control patients were recruited from the same clinics.

The study participants were asked if they limited their daily activities, due to a fear of falling. The researchers measured visual acuity, contrast sensitivity, and visual fields, and reviewed the medical records of all participants.

Some Helpful Definitions

Cross-sectional: A cross-sectional study involves an analysis of a population of subjects at one specific point in time, rather than studied over a longer, or more extended, period of time.

Visual acuity: A number that indicates the sharpness or clearness of your vision, usually measured with a standardized eye chart. You can learn more about visual acuity at Low Vision Terms and Descriptions on the VisionAware website.

Contrast sensitivity: The ability to detect differences between light and dark areas. Especially for individuals with low vision, increasing the contrast between an object and its background will generally make the object “stand out” and become more visible. You can learn more about contrast sensitivity at Contrast and Color on the VisionAware website.

Visual field testing: Helps determine how much side (or peripheral) vision you have and how much surrounding area you can see. You can learn more at The Difference Between a Vision Screening and an Eye Examination on the VisionAware website.

The Study Results

Between 40% and 50% of the older adult subjects with eye disease reported activity limitation due to a fear of falling, compared with only 16% of the control subjects with normal vision. Of the three groups with visual limitations, the patients with Fuchs’ corneal dystrophy were the mostly like to report activity limitation due to fear of falling, followed by those with glaucoma and with AMD, due primarily to problems with reduced contrast sensitivity.

The results also showed that people who reported activity limitation due to a fear of falling were older, were more likely to be females, had worse vision, were more likely to be depressed, and had greater numbers of co-existing medical conditions or diseases.

The Study Conclusions

The authors concluded that activity limitation due to a fear of falling is very common in older adults with visually impairing eye disease. Although this compensatory strategy may protect against falls, it may also put people at risk for social isolation and disability.

From an ARVO Press Room interview with study author Ellen E. Freeman, PhD:

“I expected all of the groups to limit their activities due to a fear of falling but I was a bit surprised that the group with Fuchs’ corneal dystrophy was the most likely to limit their activities,” says Ellen E. Freeman, PhD, Department of Ophthalmology at the University of Montreal, Québec, Canada. “I was also surprised at how frequently people with eye disease reported limiting their activities due to fear of falling. Clearly, this is something that is affecting many people with eye disease.”

Freeman points out that their findings are not only relevant to older patients with eye disease, but to their families, physicians and to those providing low vision rehabilitation services. “It is important to know more about which activities are being limited due to fear of falling. We can then develop and test interventions to help people feel more confident about their ability to safely do those activities,” she says.

“If we could develop a brief, effective intervention focused on select activities, I would like to see it offered in the clinical setting. Then, we could encourage people to see a low vision rehabilitation specialist if they want more training.”

VisionAware will provide updates of this important mobility and daily living research as they become available.

Additional Reading

For additional information and reading, see Essential Skills for Everyday Living with Vision Loss, An Introduction to Orientation and Mobility Skills, and Organizing and Modifying Your Home.