A stated priority of the National Eye Institute is to "Develop new technologies and rehabilitation strategies to minimize the impact of visual impairment". Glaucoma is a frequent cause of visual impairment, and affects over 2 million Americans. Falls are a major hazard in glaucoma patients, who have a falls rate two to four times higher than normal and a one in three risk of suffering an injurious fall over the course of year. This proposal is aimed at gathering data necessary for designing future falls prevention programs. Innovative aspects of the proposal include prospective, longitudinal assessment of falls over a 3 year period through the use of falls calendars, utilization of remote-sensing technology to evaluate real-world mobility outcomes, and direct assessment of the home environment to identify environmental risk factors.
Aim 1 of the grant is to characterize the relationship of VF loss severity on fall rates in glaucoma patients. Fall rates will be measured a a rate over time, as well as a rate over steps taken. Steps will be measured in the subject's normal routine using a waistband accelerometer. Understanding the relationship between disease severity and fall rates will identify which glaucoma patients are at a particularly high rik of falling, and therefore merit interventions to prevent falls.
Aim 2 of the proposal will identif potentially modifiable risk factors for falls in glaucoma patients. Risk factors to be evaluated wll include features of the patient (e.g. balance and lower extremity strength), features of the environment (e.g. the number of hazards noted in a direct assessment of the home), and activity patterns (e.g. the amount of accelerometer-defined walking and the amount of travel outside the home as measured through a cellular tracking device). Outcomes from aim 2 will guide which features of the person should be targeted in programs to prevent falls in glaucoma.
Aim 3 of the proposal will characterize the downstream consequences of falls in glaucoma. Specifically, this aim will characterize whether higher fall rates are associated with increases in fear of falling, decreases in self-reported quality of life, decreases in daily walking and physica activity (measured through annual week-long accelerometer trials), and decrease in the number of excursions outside the home or the amount of time spent outside the home (measured through the use of annual week- long trials with a cellular tracking device. Outcomes from Aim 3 will guide which strategies should be used to prevent falls in glaucoma, while also addressing other aspects of mobility restriction.

Public Health Relevance

Falls are the leading cause of accidental death and injury-related hospitalization in older Americans, and nearly one-third of individuals with glaucoma will have an injury-related fall in a given year. The current proposal aims to describe: (1) what leve of glaucoma disease severity produces a higher risk of falling, (2) which features of glaucoma patients (i.e. balance, strength) or their home environment predispose them to falls, and (3) what the long-term mobility consequences of falls are in individuals with glaucoma. Information gathered from these aims will lay the groundwork for future programs aimed at preventing falls and improving mobility outcomes in glaucoma.

National Institute of Health (NIH)
National Eye Institute (NEI)
Research Project (R01)
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Special Emphasis Panel (BNVT)
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Wiggs, Cheri
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Johns Hopkins University
Schools of Medicine
United States
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Nguyen, Angeline M; van Landingham, Suzanne W; Massof, Robert W et al. (2014) Reading ability and reading engagement in older adults with glaucoma. Invest Ophthalmol Vis Sci 55:5284-90