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E JY, Mihailovic A, Garzon C, et al. Association Between Visual Field Damage and Gait Dysfunction in Patients With Glaucoma. JAMA Ophthalmol. 2021;139(10):1053-1060doi: 10.1001/jamaophthalmol.2021.2617.
E, J. Y., Mihailovic, A., Garzon, C., Schrack, J. A., Li, T., West, S. K., Gitlin, L. N., Friedman, D. S., & Ramulu, P. Y. (2021). Association Between Visual Field Damage and Gait Dysfunction in Patients With Glaucoma. JAMA ophthalmology, 139(10), 1053-1060. https://doi.org/10.1001/jamaophthalmol.2021.2617
E, Jian-Yu, et al. "Association Between Visual Field Damage and Gait Dysfunction in Patients With Glaucoma." JAMA ophthalmology vol. 139,10 (2021): 1053-1060. doi: https://doi.org/10.1001/jamaophthalmol.2021.2617
E JY, Mihailovic A, Garzon C, Schrack JA, Li T, West SK, Gitlin LN, Friedman DS, Ramulu PY. Association Between Visual Field Damage and Gait Dysfunction in Patients With Glaucoma. JAMA Ophthalmol. 2021 Oct 01;139(10):1053-1060. doi: 10.1001/jamaophthalmol.2021.2617. PMID: 34292297; PMCID: PMC8299359.
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JAMA Ophthalmol. 2021 Oct 01;139(10):1053-1060. doi: 10.1001/jamaophthalmol.2021.2617.

Association Between Visual Field Damage and Gait Dysfunction in Patients With Glaucoma.

JAMA ophthalmology

Jian-Yu E, Aleksandra Mihailovic, Catalina Garzon, Jennifer A Schrack, Tianjing Li, Sheila K West, Laura N Gitlin, David S Friedman, Pradeep Y Ramulu

Affiliations

  1. Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
  3. Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.
  4. Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora.
  5. College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania.
  6. Massachusetts Eye and Ear, Harvard Medical School, Boston.

PMID: 34292297 PMCID: PMC8299359 DOI: 10.1001/jamaophthalmol.2021.2617

Abstract

IMPORTANCE: Gait dysfunction is common in older people with visual impairment and is a major cause of falls.

OBJECTIVE: To compare 3-year longitudinal changes in gait measures across the spectrum of baseline visual field (VF) damage in glaucoma.

DESIGN, SETTING, AND PARTICIPANTS: A post hoc analysis was designed on September 1, 2018, following a prospective cohort study, which enrolled older adults with glaucoma or suspected glaucoma from September 2013 to March 2015 and followed up for up to 3 years. Baseline VF damage was defined by integrated VF (IVF) sensitivity and categorized as normal/mild (IVF >28 dB), moderate (IVF, 23-28 dB), and severe (IVF, <23 dB). Each participant walked on an electronic walkway back and forth twice at normal pace each study year. Linear mixed-effects models evaluated longitudinal change in gait outcomes (1) stratified within each VF severity category and (2) across the range of IVF sensitivity. Analysis took place from October 2019 to October 2020.

MAIN OUTCOMES AND MEASURES: Three-year changes in 7 gait assessments under usual-pace walking, including base support and its coefficient of variation, stride length and its coefficient of variation, stride velocity and its coefficient of variation, and cadence.

RESULTS: Of 241 participants, the mean (SD) age was 70.8 (7.7) years, 116 (48.2%) were women, and 70 (29.0%) were African American. When comparing longitudinal gait changes over 3 years across the spectrum of IVF sensitivity, each 5-unit (dB) decrement was associated with more rapid declines in stride velocity (-0.05 z score unit/y; 95% CI, -0.09 to -0.01; P = .01) and cadence (-0.07 z score unit/y; 95% CI, -0.10 to -0.03; P < .001). When evaluating gait changes within each glaucoma severity group, shorter stride length was associated with persons with normal/mild (-0.06 z score unit/y; 95% CI, -0.10 to -0.03; P = .001), moderate (-0.08 z score unit/y; 95% CI, -0.12 to -0.04; P < .001), and severe VF damage (-0.16 z score unit/y; 95% CI, -0.24 to -0.07; P < .001), while stride velocity (-0.18 z score unit; 95% CI, -0.28 to -0.07; P = .002) and slower cadence (-0.15 z score unit; 95% CI, -0.25 to -0.04; P = .006) were associated with those with severe VF damage.

CONCLUSIONS AND RELEVANCE: At worse levels of baseline VF damage, patients with glaucoma in this study demonstrated an exacerbated decline in walking speeds (ie, stride velocity and cadence), indicating that mobility speeds decrease faster over time in older adults with glaucoma.

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