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Visual impairment and risk of falls and fracture
  1. R Q Ivers1,
  2. R G Cumming2,
  3. P Mitchell3
  1. 1Institute for International Health, University of Sydney; rivers{at}iih.usyd.edu.au
  2. 2Department of Public Health and Community Medicine, University of Sydney
  3. 3Department of Ophthalmology, University of Sydney

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    We welcome the article from Legood and colleagues on visual impairment and risk of injury.1 More results from the Blue Mountains Eye Study which may be of interest to readers have recently been published. In June 2002 we published a paper in Osteoporosis International detailing visual and other risk factors for wrist, shoulder, and ankle fractures in the Blue Mountains Eye Study.2 Although no visual risk factors were found to be associated with fractures of the wrist or shoulder (possibly because of limited power) we found that visual field deficits were significantly associated with an increase in ankle fractures. Another paper from this cohort study currently in press in the Journal of the American Geriatric Society will detail associations between visual impairment and risk of hip fracture.3

    In addition, we are about to begin recruitment for a randomized trial to assess the effect of improving vision on risk of falls. This trial will recruit 1100 community dwelling people aged 75 years and older. We plan to conduct relatively simple tests of vision (including visual acuity, contrast sensitivity, and visual fields) and perform an eye examination, often in subjects’ homes, and then arrange appropriate interventions (including new spectacles, cataract surgery, laser therapy, and vision related home modifications and aids). Falls during 12 months of follow up will be ascertained with a falls calendar system.

    Improving vision is likely to have other benefits besides preventing falls, including improved physical and social function and improved health related quality of life. If the intervention proves effective, our project has great potential to improve the health of many older people.

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