How Poor Vision and Peripheral Vascular Disease Affect Balance


Journal of the American Geriatrics Society Research Summary

Having trouble getting around and being unable to socialize or manage household chores, such as shopping, can make life less enjoyable. What’s more, when you have difficulties getting around on your own, it can lead to long-term nursing care—and even death—for older adults.

One of the keys to maintaining good mobility is having good balance while you perform your daily tasks. Good balance depends on input from:

  • Your vision system
  • Your balance (vestibular) system
  • Your muscle system, including information on how your muscles interact with each other

Finally, your nerves, muscles, and bones must also work together to maintain your posture and movement.

Diseases that affect any of those systems may affect your balance. And if you have a problem with more than one system, it can magnify and worsen the effect on your balance. Experts know that poor vision is a risk factor for poor balance, especially when an older adult is doing complex balancing tasks like standing on one foot.

A team of researchers decided to learn whether poor vision would be more strongly related to standing balance in older adults who had peripheral vascular disease (a common circulation problem that affects the legs) or diabetes. They published their study in the Journal of the American Geriatrics Society.

The researchers used information from 30,097 adults between the ages of 45 and 85 who lived near one of the 11 data collection sites in seven Canadian provinces (Victoria, Vancouver, Surrey, Calgary, Winnipeg, Hamilton, Ottawa, Montreal, Sherbrooke, Halifax, and St. John’s). Various questionnaires were given either by an interviewer at home or at a data-collection site. Physical exams were done at the data-collection site. Information was collected between 2010 and 2015.

Trained members of the research team measured the participants’ eyesight. Participants could wear their usual eyeglasses. Researchers used a test called the “one-leg standing test” to assess balance. This test can predict falls and disability that falls can cause.

Participants who could stand unassisted were asked to perform the balance test. Without shoes, participants stood approximately three feet from a wall and were instructed to balance on one foot while lifting the other leg to calf level with their hands on their hips. A brief demonstration was done by the interviewer. The participant was allowed to practice the procedure before the timed test.

Participants who did not attempt the balance test were compared to those who did attempt. The researchers learned that people with poorer vision were more likely to have balance problems. Other factors related to poor balance included:

Visual acuity (the medical term for the sharpness of your eyesight) and peripheral vascular disease were linked. The odds for having poor vision were almost double in people who also had peripheral vascular disease, compared to those who did not have it.

The researchers said that their study showed for the first time that the relationship between visual acuity and standing balance was much stronger in people who had peripheral vascular disease. They noted that their findings are important because poor balance increases the risk of injuries due to falls, which can lead to disability.

Healthcare providers treating older adults for peripheral vascular disease may want to encourage them to get their vision checked by their optometrist and/or ophthalmologist, suggested the researchers.

In addition, older adults with balance problems should consider having sensory testing to rule out peripheral vascular disease. The researchers said it may be possible to design therapies to try to improve balance. For example, targeting lower-leg strength may help improve muscle strength and enhance balance.

This summary is from “The Interaction of Visual Acuity and Peripheral Vascular Disease with Balance.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Afshin Vafaei, PhD; Marie-Josée Aubin, MD, MSc, MPH; Ralf Buhrmann, MD, PhD; Marie-Jeanne Kergoat, MD; Rumaisa Aljied, BSc; and Ellen E. Freeman, PhD.