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Editors Selection IGR 19-4

Quality of Life: Visual impairment and loss of balance

Comment by Pradeep Ramulu on:

54435 Dual tasking and balance in those with central and peripheral vision losses, Kotecha A; Chopra R; Fahy RT et al., Investigative Ophthalmology and Visual Science, 2013; 0:

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Literature suggests that glaucoma patients may have worse balance, which may in turn play a causative role in falls and decreased activity. Kotecha and colleagues authors previously found that balance did not differ between glaucoma and control patients (or with severity of VF loss) on either a firm surface or a foam surface designed to reduce somatosensory input. However, they did find that the visual contribution to balance decreased with greater levels of VF loss, while the somatosensory inputs to balance increased.

In the current study, the authors test balance under an even broader variety of conditions, including balance on both a firm surface (where somatosensory inputs can function) and a foam surface (which dampens somatosensory input), and under both quiet and multitasking conditions (generated by having them perform mathematical calculations while standing). Twelve glaucoma and 12 AMD subjects were studied, and compared to 12 control patients with normal vision. Within the glaucoma group, more postural sway (indicating worse balance) was found with foam-surface testing as compared to firm surface testing. However, no significant difference in postural sway was noted amongst glaucoma subjects with multitasking as compared to quiet conditions. Glaucoma and control subjects did not differ in balance measures under any of the 4 conditions, though group differences approached statistical significance under foam surface multitasking conditions (p = 0.06).

The authors' move towards testing balance under situations which recapitulate real-world demands is an important one. Indeed, falls do not occur while simply standing, but rather during dynamic processes (i.e., walking or postural changes), and/or when distracted by other tasks. The authors' finding that balance differences between glaucoma and control subjects was greatest during distracted conditions suggests that they may need to devote greater attention to keeping their balance, and this knowledge should be considered in future trials devoted to fall prevention.

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