Journal List > J Korean Ophthalmol Soc > v.57(9) > 1010402

Kang, Rim, Kim, and The Epidemiologic Survey Committee in the Korean Ophthalmological Society: Visual Acuity and Falls in South Korea: Korean National Health and Nutrition Examination Survey 2008–2012

Abstract

Purpose

To assess the influence of visual acuity (VA) and ocular condition on falls.

Methods

We analyzed 28,899 Korean adults using cross-sectional data from the Korean National Health and Nutrition Examination Survey (2008–2012). Associations between best corrected VA based on better or worse seeing eye and ocular condition and falls were identified using multivariable logistic regression. We included sociodemographic factors and comorbidities including hypertension, diabetes, arthritis, acute myocardial infarction/angina, and stroke as independent variables. VA was divided into 1.0, 0.8, 0.5–0.63, and <0.5.

Results

Among 28,899 subjects, falls occurred in 511. In multivariable logistic regression analysis, low VA based on the better seeing eye was significantly associated with falls (VA 1.0 as a reference group; adjusted odds ratio [aOR] = 1.31, 95% confidence interval [CI], 1.00–1.72 in VA of 0.8; aOR = 1.86, 95% CI, 1.07–3.24 in VA of 0.5–0.63; and aOR = 1.21, 95% CI, 0.58–2.54 in VA of <0.5; p = 0.025 for trend). There was no association between VA based on the worse seeing eye and falls. Early agerelated macular degeneration was associated with falls in univariable analysis (OR = 2.24) and age- and sex-adjusted analysis (aOR = 1.52), but not in multivariable analysis. In terms of age subgroups, subjects with VA of 0.5–0.63 were more likely to have experienced falls compared with subjects with VA of 1.0 (aOR = 5.83, 95% CI, 1.58–21.54) among subjects 50 years of age or younger. An increasing trend of falls with decreasing VA among subjects between 50 and 70 years of age was observed (p = 0.033 for trend). However, no such association was observed in elderly subjects ≥70 years of age.

Conclusions

VA should be considered for preventing falls because lower VA is associated with increased risk of falls.

References

1. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380:2197–223.
2. Stewart Williams J, Kowal P, Hestekin H, et al. Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-incomecountries: results from the WHO Study on global AGEing and adult health (SAGE). BMC Med. 2015; 13:147.
crossref
3. Rim TH, Lee CS, Lee SC, et al. Influence of visual acuity on suici-dal ideation, suicide attempts and depression in South Korea. Br J Ophthalmol. 2015; 99:1112–9.
crossref
4. Rim THT, Lee DM, Chung EJ. Visual acuity and quality of life: KNHANES IV. J Korean Ophthalmol Soc. 2013; 54:46–52.
crossref
5. Jack CI, Smith T, Neoh C, et al. Prevalence of low vision in elderly patients admitted to an acute geriatric unit in Liverpool: elderly people who fall are more likely to have low vision. Gerontology. 1995; 41:280–5.
crossref
6. Klein BE, Klein R, Lee KE, Cruickshanks KJ. Performance-based and self-assessed measures of visual function as related to history of falls, hip fractures, and measured gait time. The Beaver Dam Eye Study. Ophthalmology. 1998; 105:160–4.
7. Koski K, Luukinen H, Laippala P, Kivelä SL. Risk factors for abdominal injurious falls among the home-dwelling elderly by functional abilities. A prospective population-based study. Gerontology. 1998; 44:232–8.
8. Grisso JA, Kelsey JL, Strom BL, et al. Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group. N Engl J Med. 1991; 324:1326–31.
9. Brundle C, Waterman HA, Ballinger C, et al. The causes of falls: views of older people with visual impairment. Health Expect. 2015; 18:2021–31.
crossref
10. Hong T, Mitchell P, Burlutsky G, et al. Visual impairment and the incidence of falls and fractures among older people: longitudinal findings from the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci. 2014; 55:7589–93.
crossref
11. Reed-Jones RJ, Solis GR, Lawson KA, et al. Vision and falls: a multidisciplinary review of the contributions of visual impairment to falls among older adults. Maturitas. 2013; 75:22–8.
crossref
12. Wood JM, Lacherez P, Black AA, et al. Risk of falls, injurious falls, and other injuries resulting from visual impairment among older adults with age-related macular degeneration. Invest Ophthalmol Vis Sci. 2011; 52:5088–92.
crossref
13. La Grow SJ, Robertson MC, Campbell AJ, et al. Reducing hazard related falls in people 75 years and older with significant visual abdominal: how did a successful program work? Inj Prev. 2006; 12:296–301.
14. de Boer MR, Pluijm SM, Lips P, et al. Different aspects of visual impairment as risk factors for falls and fractures in older men and women. J Bone Miner Res. 2004; 19:1539–47.
crossref
15. Ivers RQ, Cumming RG, Mitchell P, Attebo K. Visual impairment and falls in older adults: the Blue Mountains Eye Study. J Am Geriatr Soc. 1998; 46:58–64.
16. Kwan MM, Lin SI, Close JC, Lord SR. Depressive symptoms in addition to visual impairment, reduced strength and poor balance predict falls in older Taiwanese people. Age Ageing. 2012; 41:606–12.
crossref
17. Rim TH, Nam JS, Choi M, et al. Prevalence and risk factors of abdominal impairment and blindness in Korea: the Fourth Korea National Health and Nutrition Examination Survey in 2008–2010. Acta Ophthalmol. 2014; 92:e317–25.
18. Tielsch JM, Sommer A, Witt K, et al. Blindness and visual abdominal in an American urban population. The Baltimore Eye Survey. Arch Ophthalmol. 1990; 108:286–90.
19. Hyman L, Wu SY, Connell AM, et al. Prevalence and causes of abdominal impairment in the Barbados Eye Study. Ophthalmology. 2001; 108:1751–6.
20. Klaver CC, Wolfs RC, Vingerling JR, et al. Age-specific abdominal and causes of blindness and visual impairment in an older population: the Rotterdam Study. Arch Ophthalmol. 1998; 116:653–8.
21. Muñoz B, West SK, Rodriguez J, et al. Blindness, visual abdominal and the problem of uncorrected refractive error in a Mexican-American population: Proyecto VER. Invest Ophthalmol Vis Sci. 2002; 43:608–14.
22. Muñoz B, West SK, Rubin GS, et al. Causes of blindness and visual impairment in a population of older Americans: The Salisbury Eye Evaluation Study. Arch Ophthalmol. 2000; 118:819–25.
23. Kim JS, Oh MK, Park BK, et al. Screening criteria of alcoholism by alcohol use disorders identification test (AUDIT) in Korea. J Korean Acad Fam Med. 1999; 20:1152–9.
24. Coleman AL, Stone K, Ewing SK, et al. Higher risk of multiple falls among elderly women who lose visual acuity. Ophthalmology. 2004; 111:857–62.
crossref
25. Harwood RH. Visual problems and falls. Age Ageing. 2001; 30(Suppl 4):13–8.
crossref
26. Rubin GS, Muñoz B, Bandeen–Roche K, West SK. Monocular abdominal binocular visual acuity as measures of vision impairment and predictors of visual disability. Invest Ophthalmol Vis Sci. 2000; 41:3327–34.
27. Rim TH, Choi M, Yoon JS, Kim SS. Sociodemographic and health behavioural factors associated with access to and utilisation of eye care in Korea: Korea Health and Nutrition Examination Survey 2008–2012. BMJ Open. 2015; 5:e007614.
crossref
28. Turano KA, Dagnelie G, Herdman SJ. Visual stabilization of posture in persons with central visual field loss. Invest Ophthalmol Vis Sci. 1996; 37:1483–91.
29. Spaulding SJ, Patla AE, Elliott DB, et al. Waterloo Vision and Mobility Study: gait adaptations to altered surfaces in individuals with age-related maculopathy. Optom Vis Sci. 1994; 71:770–7.
crossref
30. Hassan SE, Lovie-Kitchin JE, Woods RL. Vision and mobility abdominal of subjects with age-related macular degeneration. Optom Vis Sci. 2002; 79:697–707.

Table 1.
Characteristics of participants (n = 28,899)
Variables Fall down
p-value
Not happened (n = 28,408) Happened (n = 511)
Ocular condition
 BCVA (better seeing eye)     <0.001
  1 17,703 (62.3) 255 (49.9)  
  0.8 8,850 (31.2) 191 (37.4)  
  0.5–0.63 1,361 (4.8) 52 (10.2)  
  <0.5 495 (1.7) 13 (2.5)  
 BCVA (worse seeing eye)     <0.001
  1 11,701 (41.2) 166 (32.5)  
  0.8 13,125 (46.2) 241 (47.2)  
  0.5–0.63 2,027 (7.1) 66 (12.9)  
  <0.5 1,556 (5.5) 38 (7.4)  
 Early AMD 1,250 (4.8) 41 (9.1) <0.001
 Late AMD 122 (0.5) 3 (0.7) 0.536
 Dry AMD 27 (0.1) 1 (0.2) 0.439
 Wet AMD 97 (0.4) 2 (0.4) 0.797
 DMR 379 (17.4) 9 (13.9) 0.451
Sociodemographic and behavioral factors
 Age group     <0.001
  19–29 3,582 (12.6) 39 (7.6)  
  30–39 5,357 (18.9) 57 (11.2)  
  40–49 5,296 (18.6) 64 (12.5)  
  50–59 5,197 (18.3) 94 (18.4)  
  60–69 4,747 (16.7) 112 (21.9)  
  70–79 3,476 (12.2) 117 (22.9)  
  over 80 754 (2.7) 28 (5.5)  
 Female 16,263 (57.3) 324 (63.4) 0.005
 Income     <0.001
  Lowest quintile 5,908 (21.1) 146 (28.9)  
  2nd–4th quintiles 15,837 (56.5) 267 (52.9)  
  Highest quintile 6,268 (22.4) 92 (18.2)  
 Living in rural area 6,467 (22.8) 135 (26.4) 0.051
 Living without spouse 3,675 (13.0) 110 (21.5) <0.001
 Abnormal alcohol user 9,538 (33.6) 191 (37.4) 0.071
 Lifetime smoker 10,781 (38.7) 180 (35.4) 0.134
 Physical activity 1,123 (4.0) 15 (3.0) 0.219
 Perceptional stress     0.025
  None 4,408 (15.8) 87 (17.1)  
  Moderate 22,148 (79.5) 385 (75.8)  
  Severe 1,309 (4.7) 36 (7.1)  
 Sleep duration     <0.001
  <5 hours 1,267 (4.6) 44 (8.7)  
  5–9 hours 24,344 (87.5) 416 (82.4)  
  ≥9 hours 2,214 (8.0) 45 (8.9)  
 Obesity     0.029
  Low weight (<18.5) 1,335 (4.7) 16 (3.2)  
  Normal (18.5–25) 17,967 (63.8) 307 (60.6)  
  Overweight (≥25) 8,878 (31.5) 184 (36.3)  
 Comorbidities      
  Hypertension 6,059 (21.3) 161 (31.5) <0.001
  Diabetes mellitus 2,226 (7.8) 65 (12.7) <0.001
  Arthritis 3,632 (12.8) 121 (23.7) <0.001
  Angina or MI 674 (2.4) 20 (3.9) 0.024
  Stroke 532 (1.9) 20 (3.9) 0.001

Values are presented as n (%) unless otherwise indicated. p-value was calculated based on t-test for age and other p-values were calculated based on chi test.

BCVA = best corrected visual acuity; AMD = age-related macular degeneration; DMR = diabetic retinopathy; MI = myocardial infarction.

Table 2.
Odds ratios (OR) of visual acuity and early age-related macular degeneration for fall down using simple and multivariable logistic regression analyses with complex sampling
Ocular condition Unadjusted p-value Model 1 p-value Model 2 p-value
OR (95% CI) Adjusted OR (95% CI) Adjusted OR (95% CI)
BCVA (better seeing eye)
 1.0 1 (reference)   1 (reference)   1 (reference)  
 0.8 1.62 (1.27–2.06) <0.01 1.31 (1.01–1.72) 0.045 1.31 (1.00–1.72) 0.052
 0.5–0.63 3.08 (2.07–4.59) <0.01 1.94 (1.15–3.30) 0.014 1.86 (1.07–3.24) 0.028
 <0.5 2.27 (1.13–4.57) 0.022 1.50 (0.70–3.20) 0.300 1.21 (0.58–2.54) 0.610
  p < 0.001 for trend p = 0.010 for trend p = 0.025 for trend
BCVA (worse seeing eye)
 1.0 1 (reference)   1 (reference)   1 (reference)  
 0.8 1.21 (0.94–1.56) 0.137 0.98 (0.75–1.28) 0.861 0.97 (0.74–1.27) 0.825
 0.5–0.63 2.41 (1.65–3.53) <0.01 1.36 (0.84–2.21) 0.211 1.26 (0.76–2.10) 0.373
 <0.5 1.64 (1.06–2.54) 0.026 0.93 (0.55–1.56) 0.773 0.87 (0.52–1.47) 0.611
  p < 0.001 for trend p = 0.813 for trend p = 0.977 for trend
Early AMD
 No 1 (reference)   1 (reference)   1 (reference)  
 Yes 2.24 (1.52–3.30) <0.01 1.52 (1.01–2.30) 0.045 1.37 (0.90–2.09) 0.136

Model 1 include each outcome variable, age, and sex; Model 2 include each outcome variable, age, sex, income, residential area, spouse, alcohol use, stress, sleep duration, obesity, hypotension, arthritis, angina or myocardial infarction, and stroke.

CI = confidence interval; BCVA = best corrected visual acuity; AMD = age-related macular degeneration.

Table 3.
Subgroup analysis of visual acuity and early age-related macular degeneration (AMD) for fall down using multivariable logistic regression analyses (Model 2) with complex sampling according to age groups
Ocular condition Age <50 years (n = 14,395)
Age ≥50 and <70 years (n = 10,150)
Age ≥70 years (n = 4,375)
OR (95% CI) p-value OR (95% CI) p-value OR (95% CI) p-value
BCVA (better seeing eye)
 1.0 1 (reference)   1 (reference)   1 (reference)  
 0.8 1.30 (0.85–1.99) 0.229 1.25 (0.86–1.83) 0.242 1.14 (0.64–2.05) 0.656
 0.5–0.63 5.83 (1.58–21.54) <0.01 2.44 (1.05–5.66) 0.037 0.97 (0.52–1.78) 0.910
<0.5 No observation 1.81 (0.58–5.62) 0.303 0.85 (0.29–2.49) 0.765
  p = 0.068 for trend p = 0.033 for trend p = 0.614 for trend
BCVA (worse seeing eye)
 1.0 1 (reference)   1 (reference)   1 (reference)  
 0.8 0.95 (0.65–1.38) 0.775 0.95 (0.63–1.44) 0.818 0.68 (0.31–1.46) 0.317
 0.5–0.63 3.53 (1.30–9.61) 0.014 1.40 (0.74–2.65) 0.298 0.48 (0.22–1.05) 0.065
 <0.5 0.52 (0.07–3.88) 0.527 0.88 (0.30–2.60) 0.824 0.53 (0.22–1.25) 0.148
  p = 0.605 for trend p = 0.828 for trend p = 0.114 for trend
Early AMD
 No 1 (reference)   1 (reference)   1 (reference)  
 Yes 2.12 (0.46–9.88) 0.336 1.28 (0.67–2.47) 0.456 1.32 (0.75–2.32) 0.344

Model 2 include each outcome variable, age, sex, income, residential area, spouse, alcohol use, stress, sleep duration, obesity, hypotension, arthritis, angina or myocardial infarction, and stroke.

OR = odds ratio; CI = confidence interval; BCVA = best corrected visual acuity.

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