Visual Field Damage Linked to Long-Term Gait Function Decline in Patients With Glaucoma

Compared with normally sighted patients, older patients with glaucoma experience progressive declines in mobility speeds with worse visual field damage, according to study findings published in JAMA Ophthalmology.

The study was a post hoc analysis of a cohort study that evaluated changes in gait measures over 3 years in 241 patients with glaucoma (mean age, 70.8 years; women, 48.2%). Patients were stratified according to their visual field damage at baseline, including normal/mild visual field damage (integrated visual field [IVF] >28 dB; 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 on an electronic walkway back and forth twice at their normal pace each study year. Researchers used linear mixed effects models to assess the long-term change in gait outcomes according to each visual field severity category as well as across the range of IVF sensitivity.

Stride length declined over the 3-year follow-up period in patients with severe (-0.16 z score unit/y; 95% CI, -0.24 to -0.07; P <.001), moderate (-0.08 z score unit/y; 95% CI, -0.12 to -0.04; P <.001), and normal/mild (-0.06 z score unit/y; 95% CI, -0.10 to -0.03; P =.001) visual field damage. Severe visual field damage was associated with declines in stride velocity (-0.18 z score unit; 95% CI, -0.28 to -0.07; P =.002) as well as slower cadence (-0.15 z score unit; 95% CI, -0.25 to -0.04; P =.006).

In the analysis that compared long-term gait changes across the IVF sensitivity spectrum, the study researchers found that each 5-unit (dB) decrement in IVF was associated with faster 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).

A limitation of this study was its single-center design, suggesting the findings may not be fully applicable to all older adults with glaucoma. Additionally, the walking test used in this study may not reflect real-world gait or mobility and doesn’t assess walking up or down stairs or making turns.

Based on the study findings, the study investigators concluded that people with severe visual field damage who “are irregular in their gait patterns” should “adopt safer walking to maintain stability and prevent falls, although this abnormal gait pattern remained unlikely to change over a 3-year period regardless of disease severity.”


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