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3 Common Eye Diseases That Raise Risk of Falls

Study finds odds of falling are 33 percent higher with these vision loss problems


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Are people with cataracts, age-related macular degeneration (AMD) or glaucoma at greater risk of falls and fractures? That’s the question a group of researchers set out to answer in a large study, published in JAMA Ophthalmology, involving more than 3 million older adults.

Granted, no one needs a study to appreciate that vision loss — no matter the cause — can play a huge role in raising the risk of falls and the injuries that happen as a result. Previous, smaller studies have implicated all three age-related vision thieves to varying degrees. But a question mark has hovered over how large a role each one plays.​​

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Cataracts, the most common cause of vision problems, make the normally clear lens of the eye cloudy. AMD is a progressive disease that damages the macula, a part of the retina that helps you see what’s right in front of you. And glaucoma, a leading cause of blindness in people over 60, is a group of conditions that damage an essential nerve in your eye. Of the three, which is the biggest culprit when it comes to falls among older adults?  ​​

Over a 13-year period, researchers examined the medical records of a group of patients who were, on average, around 74 years of age by the end of the study and found that the three diseases were almost equally culpable. The odds of falling were, on average, 33 percent higher among the vision impaired, as compared to those who didn’t have one of these eye diseases. What’s more, there was an increased risk of injury in virtually all areas of the body, including hips, spine, skull, ribs and lower legs.

Common sense goes a long way in explaining why. “People with vision loss may have difficulty detecting hazards in their path, such as steps, curbs or uneven surfaces,” says Ashley Brissette, M.D., assistant professor of ophthalmology at Weill Cornell Medicine. “This difficulty in recognizing environmental cues increases the likelihood of stumbling or tripping.”

But there’s more at play. The study suggests that even relatively mild vision loss can affect balance, posture and gait, each of which is critical to avoiding falls. “Vision is important for maintaining balance and spatial awareness, so when there is a loss of vision, it can significantly increase the risk of falls due to misjudging depth,” Brissette says. “Vision is also one of the key sensory inputs that contribute to balance.” When it’s impaired, the instability makes it difficult to maintain “an upright position.”

“Vision loss can affect gait by limiting the ability to detect and respond to obstacles or changes in terrain,” she adds. “Additionally, fear of falling may lead to alterations in gait, creating a self-fulfilling cycle of increased fall risk.”

Other factors leading to falls

Complicating matters: Older adults are already at an increased risk of falls. According to a report from the Centers for Disease Control and Prevention, 1 in 4 people age 65 and older reported falling in 2020; worse yet, accidental falls are the leading cause of injury and injury-related deaths in that age group. Vision loss isn’t the only culprit.

“Several diseases can accompany the aging process that worsen the interaction between vision loss and injury,” says Michelle Andreoli, M.D., comprehensive ophthalmologist at Northwestern Medicine and spokesperson for the American Academy of Ophthalmology. “Diabetes, high blood pressure and other diseases that are more common with age can make injury worse, as well as worsen vision.” ​​

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What’s more, some medications commonly taken by older adults — including certain drugs that treat heart disease, diabetes, anxiety and depression — can increase the risk of falls, as the JAMA study noted. The loss of muscle mass that comes with age also figures in, affecting agility. And then there’s the practical consequence of having bladder control issues that cause you to rush to the bathroom, tripping over, say, an electrical cord or slipping on a throw rug. ​

All of the above are risk factors on their own, but they contribute to the increased risk of falls in people with vision loss. The vision-impaired participants in the JAMA study all had poorer health and a higher level of multiple health conditions at the outset, as compared to their visually unimpaired counterparts. “The interaction between various health conditions can have a compounding effect on a person’s overall stability and mobility,” Brissette says.

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How to stay safe

The good news: You don’t have to accept falls as a natural part of aging. For one thing, cataracts, AMD and glaucoma are all preventable or treatable. Early detection, though, is key. As the study notes, people in the initial stages of eye disease often have zero noticeable symptoms, and progression can be gradual. Both cataracts and AMD, for instance, usually affect just one eye at first. With glaucoma, peripheral vision is affected, but the brain compensates by filling in what’s missing.

“If vision declines slowly, sometimes people have a hard time noticing their decline,” Brissette says. But that doesn’t mean early-stage eye disease carries no risk of falls. It “may impact contrast sensitivity, making it difficult for people to discern changes in lighting and detect potential hazards, especially in low-light conditions,” she says. “People in the early stages of eye disease may not have fully adapted to changes and as a result, they may be less skilled at compensating for vision loss, making them more vulnerable to falls.”

That’s why it’s critical for people 65 and over to have a comprehensive eye exam every year or two, as recommended by the American Academy of Ophthalmology. “Eye diseases that affect vision are more common with age,” Andreoli says. “Timely diagnosis and management is essential to controlling some of these diseases.”

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