School of Optometry, Queensland University of Technology, Brisbane, Queensland, Australia.
Invest Ophthalmol Vis Sci. 2011 Jul 7;52(8):5088-92. doi: 10.1167/iovs.10-6644.
Age-related macular degeneration (AMD) is the leading cause of irreversible visual impairment among older adults. This study explored the relationship between AMD, fall risk, and other injuries and identified visual risk factors for these adverse events.
Participants included 76 community-dwelling individuals with a range of severity of AMD (mean age, 77.0 ± 6.9 years). Baseline assessment included binocular visual acuity, contrast sensitivity, and merged visual fields. Participants completed monthly falls and injury diaries for 1 year after the baseline assessment.
Overall, 74% of participants reported having either a fall or a non-fall-related injury. Fifty-four percent of participants reported a fall and 30% reported more than one fall; of the 102 falls reported, 63% resulted in an injury. Most occurred outdoors (52%), between late morning and late afternoon (61%) and when navigating on level ground (62%). The most common non-fall-related injuries were lacerations (36%) and collisions with an object (35%). Reduced contrast sensitivity and visual acuity were associated with increased fall rate, after controlling for age, sex, cognitive function, cataract severity, and self-reported physical function. Reduced contrast sensitivity was the only significant predictor of non-fall-related injuries.
Among older adults with AMD, increased visual impairment was significantly associated with an increased incidence of falls and other injuries. Reduced contrast sensitivity was significantly associated with both increased rates of falls and other injuries, while reduced visual acuity was only associated with increased fall rate. These findings have important implications for the assessment of visually impaired older adults.
年龄相关性黄斑变性（AMD）是导致老年人视力不可逆转损害的主要原因。本研究探讨了 AMD、跌倒风险和其他损伤之间的关系，并确定了这些不良事件的视觉风险因素。
参与者包括 76 名居住在社区的 AMD 严重程度不同的个体（平均年龄 77.0±6.9 岁）。基线评估包括双眼视力、对比敏感度和合并视野。参与者在基线评估后 1 年内每月填写跌倒和损伤日记。
总体而言，74%的参与者报告发生了跌倒或非跌倒相关损伤。54%的参与者报告跌倒，30%的参与者报告跌倒超过一次；报告的 102 次跌倒中，63%导致受伤。大多数发生在户外（52%），在上午晚些时候到下午晚些时候（61%）和在平地行走时（62%）。最常见的非跌倒相关损伤是裂伤（36%）和与物体碰撞（35%）。在控制年龄、性别、认知功能、白内障严重程度和自我报告的身体功能后，对比敏感度和视力降低与跌倒率增加相关。对比敏感度降低是跌倒发生率增加的唯一显著预测因素。
在患有 AMD 的老年人中，视力损害增加与跌倒和其他损伤的发生率增加显著相关。对比敏感度降低与跌倒和其他损伤发生率增加显著相关，而视力降低仅与跌倒率增加相关。这些发现对评估视力受损的老年人具有重要意义。
