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Visual Impairment, Causes of Vision Loss, and Falls: The Singapore Malay Eye Study

¹From the Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia; the ²Centre for Vision Research, University of Sydney, Sydney, Australia; the ³Departments of Community, Occupational, and Family Medicine and ⁴Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; and the ⁵Singapore Eye Research Institute, Singapore National Eye Centre.

PURPOSE. To report associations of visual impairment and the main causes of vision loss with falls in an older Asian population.

METHODS. The population-based Singapore Malay Eye Study examined 3280 (78.7% response rate) Malay adults 40 to 80 years of age. Details about any fall in the previous 12 months and personal and sociodemographic information were collected. Presenting visual acuity (PVA) was measured. Mild or moderate visual impairment (0.3 < logMar < 1.0), severe visual impairment (logMAR 1.0), and the primary causes of visual impairment were determined by ophthalmologists at examination.

RESULTS. Of the 3280 participants, 3266 (99.6%) provided information about falls. Of these, 14.7% (n = 480) reported having fallen in the past 12 months. After adjustment for gender, age, body mass index, history of angina, heart attack, stroke, hypertension, diabetes, and self-rated health, the results showed that severe visual impairment in the worse eye significantly increased the risk of falling (60%; OR = 1.6; 95% CI 1.1 to 2.3). Severe visual impairment in one eye and mild or moderate visual impairment in the other also doubled the risk of falls (OR = 2.1; 95% CI 1.4–3.1). Having glaucoma (n = 21) increased the risk of falling by more than fourfold (OR = 4.2; 95% CI 1.2–12.3) after adjustment for visual acuity. Although mild or moderate visual impairment was not significantly associated with falls, odds ratios tended toward the direction of risk.

CONCLUSIONS. Findings from this Asian population provide further evidence in support of the association between severe visual impairment and falls in older persons.