What are the risk factors associated with glaucoma patient falls?

Glaucoma impacts the visual fields of patients, so it’s perhaps unsurprising that it can increase a patient’s risk of falling. It has been described, that patients can have up to three to four times greater risk of falling, with ensuing risks of injuries.

The most significant factor associated with glaucoma patients is their decreased visual field, particularly inferiorly. This means they can be particularly vulnerable in environments with which they are unfamiliar, as well as their own home. Furthermore there is a huge economic impact on the nation as a whole, with a study in 2018 extrapolating costs from a regional Hospital to nationwide level suggesting £29 million over six years attributed to patients admitted with falls and glaucoma.

In this article, Gurjeet Jutley discusses falls/accidents in patients with glaucoma.

Decreased Visual Field

The visual field is the complete area of what one can perceive around oneself. Visual field loss occurs when an individual experiences damage to any part of their visual pathway, from the eye to the brain.

For all kinds of reasons, people can experience a reduction in their visual field. The causes are varied, and the type of visual field loss will depend on the exact part of the pathway that was damaged. Regardless of the causes of visual field loss, the most common symptoms are blurriness or a blind spot. However, in many cases, the sufferer may not be aware that they are experiencing visual field loss until it is advanced. This increases the risk of falls because the individual isn’t aware that they need to take extra precautions.

This lack of awareness, particularly in the early stages, can increase the risk of falls and accidents. Glaucoma is a disease that initially impacts your peripheral vision, and its insiduous nature ensures that can be difficult to recognise its evolution. The changes can initially be subtle, with one eye compensating for the other.

Symptoms of visual field deficit can include bumping into objects on the affected side, trouble reading, falls and trips and even car accidents. As glaucoma progresses, more of the peripheral vision will be lost and can even impact central vision. Early diagnosis and treatment of glaucoma are essential if some of the potential risks of a reduced field of vision are to be avoided. Hence, visual field testing and nerve assessment is important diagnostically and prognostically at the early stages of glaucoma.

The importance of visual field testing

As glaucoma develops, VF enables clinicians to evaluate stability versus progression of disease, with the speed of deterioration of the latter influencing the treatment merited. If the VF defect is more suggestive of a neurological cause, neuro-imaging such as a MRI may be necessary.

Early treatment for glaucoma reduces the risk

Glaucoma treatment aims to control the pressure in the eye, through medicine, conventional surgery or minimally invasive surgery. Early diagnosis, awareness and management is key to prevent the vicious cycle.