Prevalence and causes of visual field loss in the elderly and associationswith impairment in daily functioning - The Rotterdam Study

Objectives: To determine the prevalence and causes of visual field loss (VF L) and the association between VFL and indicators of impairment in daily fu nctioning. Design: Population-based cohort study. Setting: Suburb of Rotterdam, the Netherlands. Participants: Community-dwelling elderly residents (n=6250). Main Outcome Measure: Visual field loss on suprathreshold static, Goldmann kinetic perimetry, or both. Methods: Suprathreshold testing of the central visual field was performed on both eyes and repeated if results were abnorm al or unreliable. Goldmann perimetry was performed to confirm defects. Caus es were determined using ophthalmologic and neurologic examination data and medical records. Impairment was assessed using data from interviews and me dical records on disability in daily life, falling, and fractures. Results: The overall prevalence of VFL was 5.6% (3.0% in those aged 55-64 y ears to 17.0% in those greater than or equal to 85 years); glaucoma was the leading cause in all age groups. Before age 75 years, other optic nerve di seases and stroke ranked second and third, respectively, as did age-related macular degeneration and retinal vascular occlusive disease, respectively, after this age. Also, after adjustment for visual acuity, VFL was associat ed with disability, diminished enjoyment of reading and watching television , and a higher risk of incident falling. Risk of incident hip fracture was not increased. Conclusions: Visual field loss is present in 1 of every 20 community-dwelli ng elderly people and is associated with impaired daily functioning. Glauco ma is the leading cause in all age groups. Other high-ranking causes, some of which are partly preventable, vary by age.