Leading Age-Related Eye Diseases Linked to Higher Fall, Fracture Risk

Individuals with age-related eye diseases, including cataract, age-related macular degeneration (AMD), and glaucoma, exhibited an increased risk of falls and fractures, according to new research published in JAMA Ophthalmology.¹

The analysis of more than 3 million adults in England indicated that all individuals with eye diseases showed an elevated risk of fractures across various body sites, with a notably higher susceptibility to forearm and lower leg fractures.

“These findings contribute observational evidence supporting higher risks of falls or injuries for these populations and suggest a need to assess the medical and rehabilitation needs of at-risk individuals in future research,” wrote the investigative team, led by Jung Yin Tsang, MRes from the center for primary care and health services research at the University of Manchester.

Glaucoma, cataract, and AMD make up the three leading causes of age-related vision loss, with more than 500 million people affected globally.² Falls, another major global health issue, represent the second leading cause of unintentional death due to injury. As many eye diseases are preventable and treatable, improved management could reduce the risk of falls linked to poor vision and inform public health resources in an increasingly aging society.¹

Previous evidence has supported the implication between these 3 eye diseases and fall and fracture risk, but the extent and contribution of each disease to these risks is not well understood. In the current analysis, Tsang and colleagues aimed to assess the association of each age-related eye disease with falls and fractures, after adjusting for relevant risk factors.

The population-based cohort study used electronic health record data collected daily from the Clinical Practice Research Datalink (CPRD) GOLD and Aurum primary care databases from April 2007 to March 2020. Each case of cataract, AMD, or glaucoma was matched up to 5 matched comparators with no recorded diagnosis of primary eye diseases by age, sex, and general practice.

Overall, the study population consisted of 410,476 people with cataract, 75,622 with AMD, and 90,177 with glaucoma, and these individuals were matched to 2,034,194 without cataract, 375,548 without AMD, and 448,179 without glaucoma comparators. The mean ages for the population were 73.8 years, 79.4 years, and 69.8 years for those with cataract, AMD, or glaucoma, respectively.

At baseline, those with eye diseases exhibited poorer health and a higher level of comorbidity, including all multiple long-term conditions, compared with comparators, in both physical (cardiovascular disease, respiratory conditions, osteoporosis) and mental health (depression, bipolar, dementia) diagnoses.

Upon analysis, compared with the comparator cohort, investigators found an increased risk of falls in those with cataract (adjusted hazard ratio [HR], 1.36; 95% CI, 1.35 - 1.38), AMD (HR, 1.25; 95% CI, 1.23 - 1.27), and glaucoma (HR, 1.38; 95% CI, 1.35 - 1.41). In terms of fracture risk, the analysis revealed a similarly increased risk among those with cataract (HR, 1.28; 95% CI, 1.27 - 1.30), AMD (HR, 1.18; 95% CI, 1.15 - 1.21), and glaucoma (HR, 1.31; 95% CI, 1.27 - 1.35).

Site-specific fracture analyses showed all individuals with eye disease had an increased risk of fractures of almost all body sites compared with comparators. Tsang and colleagues noted the highest effect sizes of covariates observed were higher levels of comorbidity, though not extreme levels, or a history of fall or fracture.

An accompanying editorial from Shrinivas Pundlik, PhD, of the Schepens Eye Research Institute of Massachusetts Eye and Ear, noted those at the highest level of comorbidity index had a lower risk of falls in all 3 diseases compared with those at slightly lower levels of comorbidity index.³

Based on these data, the editorial indicates those with higher comorbidity may self-limit personal behavior and thereby decrease the relative risk compared to those with fewer comorbidities. However, Pundlik posits that those with fewer comorbidities might be more mobile and thus at a higher risk of falls or fractures.

“Introducing an exposure variable, accounting for the kind of lifestyle or the mobility level of the individuals, in the risk modeling could help mitigate potential associations of individual behavior with fall risk,” Pundlik wrote.³

References

1. _{Tsang JY, Wright A, Carr MJ, et al. Risk of Falls and Fractures in Individuals With Cataract, Age-Related Macular Degeneration, or Glaucoma. JAMA Ophthalmol. Published online December 28, 2023. doi:10.1001/jamaophthalmol.2023.5858}
2. _{Bourne R, Steinmetz JD, Flaxman S, et al; GBD 2019 Blindness and Vision Impairment Collaborators; Vision Loss Expert Group of the Global Burden of Disease Study. Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021;9(2):e130-e143. doi:10.1016/S2214-109X(20)30425-3}
3. _{Pundlik S, Luo G. Investigation of Population-Based Fall Risk in Eye Diseases. JAMA Ophthalmol. Published online December 28, 2023. doi:10.1001/jamaophthalmol.2023.6102}