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Original Investigation
July 22, 2021

Association Between Visual Field Damage and Gait Dysfunction in Patients With Glaucoma

Author Affiliations
  • 1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 3Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
  • 4Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
  • 5College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
  • 6Massachusetts Eye and Ear, Harvard Medical School, Boston
JAMA Ophthalmol. Published online July 22, 2021. doi:10.1001/jamaophthalmol.2021.2617
Key Points

Question  How have gait patterns changed across the spectrum of baseline visual field damage in glaucoma?

Findings  In this post hoc analysis of a cohort study of 241 adults with glaucoma, the walking speeds, including stride velocity and cadence detected through an electronic walkway, decreased at faster rates among participants with severe visual field damage compared with those with normal or mild visual field damage.

Meaning  Mobility function declined at a faster rate in adults with glaucoma; the declines in walking speeds were fairly substantial, suggesting that individuals with visual field damage experienced more rapid gait declines than their normally sighted peers.


Importance  Gait dysfunction is common in older people with visual impairment and is a major cause of falls.

Objective  To compare 3-year longitudinal changes in gait measures across the spectrum of baseline visual field (VF) damage in glaucoma.

Design, Setting, and Participants  A post hoc analysis was designed on September 1, 2018, following a prospective cohort study, which enrolled older adults with glaucoma or suspected glaucoma from September 2013 to March 2015 and followed up for up to 3 years. Baseline VF damage was defined by integrated VF (IVF) sensitivity and categorized as normal/mild (IVF >28 dB), moderate (IVF, 23-28 dB), and severe (IVF, <23 dB). Each participant walked on an electronic walkway back and forth twice at normal pace each study year. Linear mixed-effects models evaluated longitudinal change in gait outcomes (1) stratified within each VF severity category and (2) across the range of IVF sensitivity. Analysis took place from October 2019 to October 2020.

Main Outcomes and Measures  Three-year changes in 7 gait assessments under usual-pace walking, including base support and its coefficient of variation, stride length and its coefficient of variation, stride velocity and its coefficient of variation, and cadence.

Results  Of 241 participants, the mean (SD) age was 70.8 (7.7) years, 116 (48.2%) were women, and 70 (29.0%) were African American. When comparing longitudinal gait changes over 3 years across the spectrum of IVF sensitivity, each 5-unit (dB) decrement was associated with more rapid declines in stride velocity (−0.05 z score unit/y; 95% CI, −0.09 to −0.01; P = .01) and cadence (−0.07 z score unit/y; 95% CI, −0.10 to −0.03; P < .001). When evaluating gait changes within each glaucoma severity group, shorter stride length was associated with persons with normal/mild (−0.06 z score unit/y; 95% CI, −0.10 to −0.03; P = .001), moderate (−0.08 z score unit/y; 95% CI, −0.12 to −0.04; P < .001), and severe VF damage (−0.16 z score unit/y; 95% CI, −0.24 to −0.07; P < .001), while stride velocity (−0.18 z score unit; 95% CI, −0.28 to −0.07; P = .002) and slower cadence (−0.15 z score unit; 95% CI, −0.25 to −0.04; P = .006) were associated with those with severe VF damage.

Conclusions and Relevance  At worse levels of baseline VF damage, patients with glaucoma in this study demonstrated an exacerbated decline in walking speeds (ie, stride velocity and cadence), indicating that mobility speeds decrease faster over time in older adults with glaucoma.

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