• Pradeep Y Ramulu, Aleksandra Mihailovic, Sheila K West, Laura N Gitlin, and David S Friedman.
• Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA; Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: pramulu@jhmi.edu.
• Am. J. Ophthalmol. 2019 Apr 1; 200: 169-178.

ObjectiveTo determine where glaucoma patients most often fall and how integrated visual field (IVF) damage affects falls rates per year (falls/year) and per step (falls/step) at and away from home.DesignProspective, observational cohort study.MethodsIn 225 patients with glaucoma or suspected glaucoma, falls data were collected via calendars, fall location was classified through follow-up questionnaires, and steps taken at and away from home were judged by integrating data from annual week-long accelerometer and GPS trials. Main outcome measures were the association of IVF sensitivity with fall rates per year or step, stratified by location.ResultsParticipants took more away steps than home steps (2366 vs 1524, P < .001), and differences in away vs home steps did not vary with IVF sensitivity (P = .22). A total of 57% of falls occurred at home, with each home step twice as likely to result in a fall as compared to each away step (rate ratio = 2.02, P < .001). Worse IVF sensitivity was not associated with a higher rate of home falls/year or away falls/year (P > .1 for both), but was associated with a higher rate of home falls/step (rate ratio = 1.34/5 dB worse sensitivity, P = .03) and away falls/step (rate ratio = 1.47/5 dB worse sensitivity, P = .003).ConclusionsIn this glaucoma population, most falls occurred at home, and the risk of any step resulting in a fall was higher at home. Those with greater VF damage were more likely to fall for each step taken both at and away from home. Efforts such as home environmental modification should be considered in the visually impaired to prevent falls while maintaining physical activity.Copyright © 2019 Elsevier Inc. All rights reserved.

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