Neurological

Visual field damage associated with long-term decline in gait function in patients with glaucoma

According to the study results published in JAMA Ophthalmology, elderly patients with glaucoma experience a progressive decline in mobility speed with worse visual field damage compared to normally sighted patients.

The study was a post-hoc analysis of a cohort study examining changes in gait over 3 years in 241 patients with glaucoma (mean age 70.8 years; women 48.2%). The patients were stratified according to their visual field damage at baseline, including normal / mild visual field damage (integrated visual field [IVF] > 28dB; n = 119), moderate visual field damage (IVF, 23-28 dB; n = 98) and severe visual field damage (IVF, <23 dB; n = 24).

To assess gait changes over time, participants in the longitudinal study walked back and forth on an electronic walkway twice each academic year at their normal pace. Researchers used mixed-effects linear models to assess the long-term change in gait results according to each visual field severity category as well as across the range of IVF sensitivity.

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The stride length increased during the 3-year follow-up period in patients with severe (-0.16 z-score unit / year; 95% CI, -0.24 to -0.07; P <0.001), moderate (-0 , 08 z-score unit / year); 95% CI, -0.12 to -0.04; P <0.001) and normal / slight (-0.06 z-score unit / year; 95% CI, -0.10 to -0.03; P = 0.001) visual field damage. Serious visual field damage was associated with a decrease in walking speed (-0.18 z-score unit; 95% CI, -0.28 to -0.07; P = 0.002) and a slower cadence (-0.15 z-score- Unit; 95% CI, -0.25 to -0.04; P = 0.006).

In the analysis, which compared long-term gait changes across the IVF sensitivity spectrum, study researchers found that every 5 units (dB) decrease in IVF was associated with a faster decrease in stride speed (-0.05 z-score unit / Year; 95% CI, -0.09 to -0.01; P = 0.01) and cadence (-0.07 z-score unit / year; 95% CI, -0.10 to -0, 03; P <0.001).

One limitation of this study was its single center design, suggesting that the results may not be fully applicable to all older adults with glaucoma. In addition, the walking test used in this study may not reflect real-world walking or mobility, and it may not assess walking up or down stairs or turning.

Based on the study results, the study researchers concluded that people with severe visual field damage who “are irregular in their gait patterns” “should walk more safely to maintain stability and prevent falls, although this was unlikely to be abnormal Gait pattern over a period of 3. changed “. -Year period, regardless of the severity of the disease. “

reference

EJY, Mihailovic A, Garzon C, et al. Relationship between visual field damage and gait disorder in patients with glaucoma. JAMA Ophthalmol. Published online July 22, 2021. doi: 10.1001 / jamaophthalmol.2021.2617

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