Área Técnica: Glaucoma
FEAR OF FALLING AND POSTURAL REACTIVITY IN PATIENTS WITH GLAUCOMA
The purpose of this study was to evaluate the relationship between fear of falling and postural reactivity using a dynamic virtual reality environment in glaucoma patients.
Fear of falling is an important health concern in individuals with vision impairment. Fear of falling was assessed by a standardized questionnaire and item response theory was used to obtain a summary score of fear of falling (lower scores meaning greater fear). Patients underwent evaluation of postural balance control by a force platform during presentation of static and dynamic visual stimuli with stereoscopic head-mounted goggles (Oculus Rift). In the dynamic condition, a peripheral translational stimulus (tunnel) was used to induce vection and assess postural reactivity. Standard deviations of torque moments (SDTM) around the center of foot pressure were calculated in Newton meters (Nm) as a measurement of postural stability. The relationships between fear of falling and postural metrics were investigated using linear regression models.
This was a prospective cross-sectional study involving 42 patients with glaucomatous visual field loss and 38 control subjects. Subjects with glaucoma reported greater fear of falling compared to controls (-0.22 vs. 0.22; P=0.029). Overall SDTM during translational stimulus was 5.1±2.4 Nm in glaucoma vs. 3.8±1.8 Nm in controls (P=0.005). In glaucoma patients, postural metrics obtained during dynamic visual stimulus were more associated with fear of falling (R2=25.6%) than standard automatic perimetry (SAP) binocular mean sensitivity (MS) (R2<1.0%; P<0.001). In a multivariable model adjusting for age, gender, race, body mass index, SAP binocular MS, and visual acuity, each 1 Nm larger SDTM was associated with a worsening of 0.40 units in the fear of falling.
In glaucoma patients, evaluation of postural reactivity to a dynamic visual stimulus using a virtual reality environment was more strongly associated with fear of falling than visual field testing and traditional balance assessment.