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JAMA Ophthalmol. 2013 Aug;131(8):1049-56. doi: 10.1001/jamaophthalmol.2013.316.

Visual impairment, uncorrected refractive error, and objectively measured balance in the United States.

Author information

1
Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.

Abstract

IMPORTANCE:

Further research is crucial to better understand the reason for falls in individuals with visual impairment (VI) and to develop appropriate fall prevention strategies.

OBJECTIVE:

To compare balance measures in individuals with normal vision, VI, and uncorrected refractive error (URE).

DESIGN AND SETTING:

Cross-sectional study based on a national survey sample.

PARTICIPANTS:

A total of 4590 adults, 40 years or older, participating in the 2001 through 2004 National Health and Nutrition Examination Survey.

MAIN OUTCOME MEASURES:

Participants completed tests of standing balance with eyes open or eyes closed on a firm or compliant (foam) surface. Eyes-closed testing on a foam surface primarily assessed vestibular balance by minimizing visual and proprioceptive inputs. The main outcome measure was time to balance failure on firm and foam surface testing. Participants also self-reported difficulty with falling during the last year.

RESULTS:

Failure during eyes-open balance testing conditions or eyes-closed balance testing on a firm surface was not more common among participants with VI-associated or URE-associated vision loss (P > .22). In eyes-closed foam surface balance testing, multivariable models demonstrated higher rates of balance loss with VI-associated vision loss (P = .02) and with URE-associated vision loss (P = .04) (hazard ratio, 1.7 per logarithm of the minimum angle of resolution [logMAR] unit change [10 lines] for both). Self-reported falling difficulty was associated with worse VI (odds ratio, 3.7 per logMAR unit change; P = .03) but not with worse URE (odds ratio, 3.4 per logMAR unit change; P = .14).

CONCLUSIONS AND RELEVANCE:

The vestibular contribution to balance (measured with eyes closed on a foam surface) was worse for individuals with VI or URE. Reduced visual inputs may weaken the vestibulo-ocular reflex, an important system that maintains the effectiveness of vestibular balance. Alternately, common degenerative pathways or lower physical activity levels may affect balance, particularly among those with VI.

PMID:
23744090
DOI:
10.1001/jamaophthalmol.2013.316
[Indexed for MEDLINE]

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