Binocular Visual-Field Loss Increases the Risk of Future Falls in Older White Women

Authors

  • Anne L. Coleman MD, PhD,

    1. From the *Jules Stein Eye Institute and Departments of Ophthalmology and Medicine, David Geffen School of Medicine, Departments of §Biostatistics and Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CaliforniaSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California#Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota**Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota††Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania‡‡Kaiser Permanente Center for Health Research, Portland, Oregon; and Departments of §§Medicine and ∥∥Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland.
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  • Steven R. Cummings MD,

    1. From the *Jules Stein Eye Institute and Departments of Ophthalmology and Medicine, David Geffen School of Medicine, Departments of §Biostatistics and Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CaliforniaSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California#Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota**Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota††Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania‡‡Kaiser Permanente Center for Health Research, Portland, Oregon; and Departments of §§Medicine and ∥∥Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland.
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  • Fei Yu PhD,

    1. From the *Jules Stein Eye Institute and Departments of Ophthalmology and Medicine, David Geffen School of Medicine, Departments of §Biostatistics and Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CaliforniaSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California#Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota**Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota††Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania‡‡Kaiser Permanente Center for Health Research, Portland, Oregon; and Departments of §§Medicine and ∥∥Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland.
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  • Gergana Kodjebacheva MA,

    1. From the *Jules Stein Eye Institute and Departments of Ophthalmology and Medicine, David Geffen School of Medicine, Departments of §Biostatistics and Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CaliforniaSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California#Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota**Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota††Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania‡‡Kaiser Permanente Center for Health Research, Portland, Oregon; and Departments of §§Medicine and ∥∥Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland.
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  • Kristine E. Ensrud MD,

    1. From the *Jules Stein Eye Institute and Departments of Ophthalmology and Medicine, David Geffen School of Medicine, Departments of §Biostatistics and Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CaliforniaSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California#Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota**Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota††Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania‡‡Kaiser Permanente Center for Health Research, Portland, Oregon; and Departments of §§Medicine and ∥∥Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland.
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  • Peter Gutierrez MA,

    1. From the *Jules Stein Eye Institute and Departments of Ophthalmology and Medicine, David Geffen School of Medicine, Departments of §Biostatistics and Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CaliforniaSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California#Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota**Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota††Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania‡‡Kaiser Permanente Center for Health Research, Portland, Oregon; and Departments of §§Medicine and ∥∥Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland.
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  • Katie L. Stone PhD,

    1. From the *Jules Stein Eye Institute and Departments of Ophthalmology and Medicine, David Geffen School of Medicine, Departments of §Biostatistics and Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CaliforniaSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California#Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota**Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota††Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania‡‡Kaiser Permanente Center for Health Research, Portland, Oregon; and Departments of §§Medicine and ∥∥Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland.
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  • Jane A. Cauley DrPH,

    1. From the *Jules Stein Eye Institute and Departments of Ophthalmology and Medicine, David Geffen School of Medicine, Departments of §Biostatistics and Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CaliforniaSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California#Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota**Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota††Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania‡‡Kaiser Permanente Center for Health Research, Portland, Oregon; and Departments of §§Medicine and ∥∥Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland.
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  • Kathryn L. Pedula MS,

    1. From the *Jules Stein Eye Institute and Departments of Ophthalmology and Medicine, David Geffen School of Medicine, Departments of §Biostatistics and Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CaliforniaSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California#Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota**Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota††Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania‡‡Kaiser Permanente Center for Health Research, Portland, Oregon; and Departments of §§Medicine and ∥∥Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland.
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  • Marc C. Hochberg MD, MPH,

    1. From the *Jules Stein Eye Institute and Departments of Ophthalmology and Medicine, David Geffen School of Medicine, Departments of §Biostatistics and Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CaliforniaSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California#Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota**Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota††Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania‡‡Kaiser Permanente Center for Health Research, Portland, Oregon; and Departments of §§Medicine and ∥∥Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland.
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  • Carol M. Mangione MD, MSPH,

    1. From the *Jules Stein Eye Institute and Departments of Ophthalmology and Medicine, David Geffen School of Medicine, Departments of §Biostatistics and Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CaliforniaSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California#Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota**Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota††Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania‡‡Kaiser Permanente Center for Health Research, Portland, Oregon; and Departments of §§Medicine and ∥∥Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland.
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  • for the Study of Osteoporotic Fractures

    1. From the *Jules Stein Eye Institute and Departments of Ophthalmology and Medicine, David Geffen School of Medicine, Departments of §Biostatistics and Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CaliforniaSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California#Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota**Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota††Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania‡‡Kaiser Permanente Center for Health Research, Portland, Oregon; and Departments of §§Medicine and ∥∥Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland.
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  • Presented in part at the Annual Meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, April 26, 2004.

Address correspondence to Anne L. Coleman, MD, PhD, The Jules Stein Eye Institute, 100 Stein Plaza, Los Angeles, CA 90095. E-mail: colemana@ucla.edu

Abstract

OBJECTIVES: To examine the relationship between binocular visual field loss and the risk of incident frequent falls in older white women.

DESIGN: A multicenter, prospective cohort study.

SETTING: Four clinic centers within the United States in Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela Valley, Pennsylvania.

PARTICIPANTS: Four thousand seventy-one community-dwelling white women aged 70 and older participating in the Study of Osteoporotic Fractures.

MEASUREMENTS: Primary outcome was incident frequent falls, defined as two or more falls within 1 year. Primary risk factors were binocular visual field loss, distance visual acuity in the better eye, and contrast sensitivity at low spatial frequency in the better eye.

RESULTS: Of 4,071 women, 409 (10%) had severe binocular visual field loss at the eye examination, and 643 (16%) experienced frequent falls within 1 year after their eye examination. Severe binocular visual field loss was significantly associated with frequent falls when adjusting for age, study site, and cognitive function (odds ratio=1.50, 95% confidence interval=1.11–2.02). The data showed a trend for increasing odds of two or more falls with greater binocular visual field loss (P<.001). In older white women with severe binocular visual field loss, 33.3% of frequent falls were attributable to visual field loss.

CONCLUSION: Women with binocular visual field loss are at greater risk of future frequent falls. Screening for binocular visual field loss may identify individuals at high risk of falling.

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