Stephen Robinovitch and colleagues (Jan 5, p 47)1 provide video-based evidence of the common characteristics of, and reasons for, falls in older people. The leading causes of falling included incorrect weight shifting (41%), trip or stumble (21%), and hit or bump (11%). However, some of these falls might be due to visual impairment. This issue was not mentioned in the Article. Visual impairment is a commonly cited cause of falling in older people. Several cross-sectional and prospective population-based studies have identified the link between severe vision loss and falls.2 Compared with normal-sighted people, those with visual impairment are twice as likely to fall and have recurrent falls and fractures, and can limit their activities owing to a fear of falling.3 Patients with glaucoma are particularly susceptible to falling because of a visual field defect associated with poor postural stability and a greater likelihood of bump.2 Given the high prevalence of visual impairment in elderly people, visual impairment and eye disease deserve further investigation as potential causes of falling. Although visual impairment is an established risk factor for falls, very few randomised controlled trials have been designed to examine the effectiveness of visual intervention for fall prevention; most interventions (eg, providing new glasses) seem to have no effect,4 with the exception of first eye cataract surgery (which reduces risk of fall by 34%).5 The lack of effect highlights the need for novel visual aids and treatment strategies specifically for fall prevention, instead of simply focusing on improving visual acuity.
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