Higher risk of multiple falls among elderly women who lose visual acuity

Objective: To determine the association between changes in visual acuity (VA) and frequent falls in older women. Design: Prospective cohort study. Participants: Two thousand two elderly community-residing women participating in the Study of Osteoporotic Fractures with measurements of VA at baseline and a follow-up examination 4 to 6 years later (mean of 5.6 years). Methods: Binocular VA with habitual correction was measured under standard illumination using Bailey-Lovie charts at baseline and fourth examinations. Change in VA was stratified into 5 categories: no change or VA gain, loss of 1 to 5 letters, loss of 6 to 10 letters, loss of 11 to 15 letters, and loss of >15 letters. A separate analysis considered decline in VA as the loss of greater than or equal to10 letters (greater than or equal to2 lines) on the Bailey-Lovie acuity measure between baseline and follow-up examinations. Main Outcome Measures: Data on falls were obtained from postcards sent every 4 months after the follow-up examination. Frequent falling was defined as greater than or equal to2 falls during a 1-year period after the follow-up examination. Results: Compared with women with stable or improved VA, women with declining acuity had significantly greater odds of experiencing frequent falling during the subsequent year. Odds ratios after adjustment for baseline acuity and other confounders were 2.08 (95% confidence interval [CI]: 1.39-3.12) for loss of 1 to 5 letters, 1.85 (95% Cl: 1.16-2.95) for loss of 6 to 10 letters, 2.51 (95% Cl: 1.39-4.52) for loss of 11 to 15 letters, and 2.08 (95% Cl: 1.01-4.30) for loss of >15 letters. In the analysis of visual decline defined as a loss of greater than or equal to10 letters, heightened risk of frequent falling was evident in each of 2 subgroups defined by splitting the sample on baseline VA, with borderline significant evidence of a more pronounced effect in those women with baseline VA of 20/40 or worse (P value for interaction, 0.083). Conclusions: Loss of vision among elderly women increases the risk of frequent falls. Prevention or correction of visual loss may help reduce the number of future falls. Ophthalmology 2004;111:857-862 (C) 2004 by the American Academy of Ophthalmology.