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Table 1 The effects of ageing on visual functions and the relation between visual functions and fall risks

From: Ageing vision and falls: a review

Visual function Author Ageing effect Relation to fall
Visual acuity Lord and Dayhew [52] Visual acuity declined as age increased (P < 0.01, n = 156) Having visual acuity larger or equal to 0.6 logMAR was shown to have 1.83 higher risk of multiple falls (95% confidence interval (CI) = 0.98–3.39, n = 156).
Coleman et al. [28] Visual acuity change in 5.6 years from baseline study was: loss of 1–5 letters = 31.9%, loss of 6–10 letters = 20.9%, loss of 11–15 letters = 7.7%, loss of > 15 letters = 4.6%, P < 0.0001, n = 4275 Loss of acuity in reading letters in Bailey-Lovie chart was shown to have 1.85–2.51 higher risk of multiple falls (P < 0.05, n = 4275).
Willis et al. [22] Subjects with worse visual acuity and visual impairment relatively older than subjects with normal vision (mean age 58.0, P = 0.07 and 74.2, P < 0.01 respectively) Increase 1 unit scale in logMAR was shown to have 1.6 higher rates of failure in standing on foam surface with eyes closed (95% confidence interval (CI) = 1.12–2.42, n = 4393).
Ivers et al. [20]   Having visual acuity worse or equal to 20/30 was shown to have 1.2 higher rates of multiple falls (95% confidence interval (CI) = 1.1–1.3, n = 3299).
Koski et al. [112]   Having poor distant visual acuity was shown to have 2.3 higher risk to major injurious fall (n = 979).
Klein et al. [113]   Having poor binocular acuity was shown to have 2.02 higher risk to multiple falls (95% confidence interval (CI) = 1.13–3.63, n = 3722).
Ivers et al. [114]   Having corrected visual acuity worse than 20/60 was shown to have hazard ratio of 8.4 for risk of hip fractures (95% confidence interval (CI) = 1.5–48.5, population attributable risk = 27%).
Dolinis et al. [50]   Having worsen vision in past 5 years was shown to have 1.34 higher risk of multiple fall (95% confidence interval (CI) = 1.06–1.68, n = 1285).
Felson et al. [115]   Having poor vision was shown to have 2.17 relative risk of hip fractures (95% confidence interval (CI) = 1.24–3.80, n = 2633).
Dargent-Molina et al. [116]   Having visual acuity worse or equal to 2/10 was shown to have 2.0 higher risk to hip fractures compared to participant who have visual acuity worse than 7/10 (95% confidence interval (CI) = 1.1–3.7).
Cummings et al. [18]   Poor visual acuity was not associated to risk of hip fracture.
Grisso et al. [117]   Loss of distant vision such as fail to recognize someone’s face across the room was shown to have 4.8 higher risk to hip fractures (95% confidence interval (CI) = 1.4–16.2) N = 174.
Ivers et al. [60]   Having visual acuity worse than < 20/100 was shown to have 2.4 times higher risk to hip fractures (95% confidence interval (CI) = 1.0–6.1).
Friedman et al. [48] Study population with median age 72.6 (range = 65.9–86.3) have median visual acuity − 0.02 logMAR (range = − 0.19– 1.7) Population’s visual acuity was not significant in predicting falls, N = 2211.
Bongue et al. [47]   Distance visual acuity in fallers and non-fallers did not show significant relation (OR 0.97, 95% confidence interval (CI) = 0.92–1.02) N = 1759.
Kulmala et al. [51]   Having visual acuity worse than 1.0 was shown to have 1.5 higher risk of falls (95% confidence interval (CI) = 0.6–4.2) N = 428.
Tromp et al. [53]   Loss of distant vision such as fail to recognize someone’s face across the room was shown to have 2.6 times higher risk to multiple falls (95% confidence interval (CI) = 1.8–3.8) N = 1285.
Lamoureux et al. [21]   Presenting visual acuity worse than 20/40 but better than 20/200 in the better eye (0.3 < logMAR < 1.0) was not significantly associated with falls. N = 3261
Contrast sensitivity Ivers et al. [20]   A 1-unit decrease at 6 cycle per degree in contrast sensitivity was shown to have 1.3 times higher risk of multiple falls (95% CI 1.1–1.6), n = 3299
Szabo et al. [118]   The mean fall risk index score in the AMD cohort (3.20) was significantly greater than that of the non-AMD cohort (3.20 and 1.21, respectively; P < 0.001).
de Boer et al. [19]   Having lower integrated contrast sensitivity was shown to have 1.53 times higher risk of multiple falls (95% CI 1.03–2.29)
Tiedemann et al. [56] Subjects’ mean of edge contrast sensitivity (MET) score 18.8, n = 688, mean age = 80.1, SD = 4.4 Contrast sensitivity (mean = 18.8 dB) correlates with 6-m walking speed (mean = 1.07 m/s) r = 0.29, P < 0.001, n = 688.
Delbaere et al. [57] Study population’s mean Physiological Profile Assessment Risk (PPA) fall risk score is 0.8 (z score) mean age = 76.9 SD = 5.1 Having higher score in PPA falls risk score was associated with slower walking speed (P = 0.029, N = 44).
Wood et al. [23] Subjects’ mean of edge contrast sensitivity (MET) score 16.6, n = 76, mean age = 77, SD = 6.9 Reduced contrast sensitivity was significantly associated with increased rates of falls, injurious falls and other injurious events such as collision with an object. (P < 0.001, P < 0.014, P < 0.037 respectively)
Lord and Dayhew [52] Contrast sensitivity declined with increase of age (r = − 0.37, P < 0.01, n = 156) Having poor visual contrast sensitivity below or equal to 18 dB was 1.76 times more likely to fall (95% confidence interval (CI) = 0.94–3.27), n = 156.
Cummings et al. [18]   Having decrease per 1 SD unit in contrast sensitivity was 1.2 times more likely to have hip fractures (95% confidence interval (CI) = 1–1.5), N = 9516.
Lord and Fitzpatrick [58]   Contrast sensitivity in fallers (mean = 17.5 dB) was significantly worse than non-fallers (mean = 18.7 dB) (P < 0.001).
Lord and Menz [119] Subjects’ mean of edge contrast sensitivity (MET) score 20.3 dB, n = 156, mean age = 76, SD = 5.1 Contrast sensitivity was significantly correlated with postural sway on foam (r = − 0.36, P < 0.01 n = 156).
Depth perception Lord and Dayhew [52] Depth perception declined with increase of age (r = − 0.32 P < 0.01, n = 156) Having poor depth perception was 2.51 times more likely to have multiple falls (95% confidence interval (CI) = 1.40–4.51, n = 156).
Lord and Menz [119] Subjects’ mean of howard dohlman score 2.7 cm, n = 156, mean age = 76, SD = 5.1 Depth perception was significantly correlated with postural sway on foam (r = 0.30, P < 0.01, n = 156).
Cummings et al. [18]   Participant in lowest quartile of distance depth perception was 1.5 times more likely to have hip fractures (95% confidence interval (CI) = 1.1–2.0), N = 9516.
Felson et al. [115]   Moderately impaired vision in one eye and good vision in the other was 1.94 times more likely to have fracture.
Friedman et al. [48] Study population with median age 72.6 (range = 65.9–86.3) have median stereoacuity 1.8 arcsec (range = 1.4–2.96) Population’s stereoacuity was not significant in predicting falls, N = 2211.
Lamoureux et al. [21]   Having bilateral visual acuity such as poor visual acuity in one eye and mild or moderate visual acuity in the other eye was 2.1 times more likely to have multiple falls (95% CI 1.4–3.1). N = 145
Lord et al. [46] Presbyopia makes elderly depends to bifocal glasses and multifocal glasses wearers have poor performance in depth perception when viewing the rods through the lower segments of their glasses (P < 0.001, n = 87) Wearing multifocal glasses was 2.29 times more likely to have multiple falls (95% confidence interval (CI) = 1.06–4.9).
Ivers et al. [60]   Having no depth perception was 6.0 times more likely to have hip fractures 95% CI 3.2, 11.1).
Visual field Broman et al. [15]   Missed visual field per 10 points increased number of bumps as much as 17% (P < 0.0001).
Freeman et al. [63]   Missed central visual field per 5 points increased risks of fall 1.06 times while missed peripheral visual field per 4 points increased risk of fall 1.08 times. Worse visual field scores were associated with the risk of falling (95% CI 1.03–1.13).
Ivers et al. [20]   Missed visual field per 5 points was 1.8 times more likely to falls.
Coleman et al. [16]   Severe binocular visual field loss was 1.50 more likely to falls (95% CI: 1.11–2.02).
Friedman et al. [48] Study population with median age 72.6 (range = 65.9–86.3) have median visual field loss 17 points (range = − 0.19–1.7) Population study visual field was not significant to predict fall risk (n = 2211).
Ivers et al. [114]   Having visual field loss was 5.5 times higher the risk of hip fractures.
Ramrattan et al. [64]   Bilateral visual field loss was associated with fall accidents (P < 0.05 n = 109).
Owsley and McGwin [120] Population’s useful field of view composite score mean was 32.8 (SD = 12.6) Lower scores on visual attention/processing speed were significantly related to poorer scores on the performance mobility assessment (P = 0.04), N = 342.
Turano et al. [121]   Loss in the overall visual field per 10 point missed was associated with 1.22 times increase in the number of bumps (P < 0.0001). Visual field loss was not associated with the number of orientation errors. N = 1504
Patino et al. [66]   Loss in central visual field was 2.36 times more likely to higher the risk of falls. Loss in peripheral visual field was 1.42 times more likely to higher the risk of fall. (95% CI 1.02–5.45 and 1.06–1.91 respectively). N = 3203
Black et al. [65]   More extensive field loss in the inferior region was 1.57 times more likely to higher risk of falls and 1.80 times more likely to falls with injury (95% CI, 1.06 to 2.32 and 1.12 to 2.98 respectively).
  Glynn et al. [122]   In patients attending glaucoma clinic, visual field impairment glaucoma patients of 40% or greater was associated with fall risk (OR, 3.0; 95% CI, 0.94 to 9.8).
  Lord and Webster [123] 1990   Fallers have more dependency to visual field when asked to align vertical rod to the true vertical (P < 0.02, N = 136).