The authors report on a cross-sectional study evaluating postural control and history of falls in glaucoma patients. History of falls was obtained using the Falls Screening and Referral Algorithm. Postural stability was assessed using a force platform under four conditions: static condition, dark field without visual stimulation, rotational stimulation and translational stimulation. Visual stimulation was achieved with the Oculus Rift, a head-mounted stereoscopic goggles system that projects an immersive virtual environment for the wearer. Torque moments that are generated on the force platform due to a shift in the patient’s centre of gravity are measured as standard deviations of the torque moments (STD) in Newton metres (Nm). Forty-two glaucoma patients and 38 healthy controls participated in the study. As expected, the diagnosis of glaucoma was significantly associated with a history of falling. Significantly greater STD was found in glaucoma patients for static conditions (no stimulus) as well as translational and rotational stimuli. In glaucoma patients, falls were associated with only dynamic translational stimulation once multivariate analysis was performed taking into account age, body mass index, visual field defect severity and visual acuity. In healthy subjects, none of the postural metrics were associated with falls. Despite the limitations of the study (small sample size, musculoskeletal and vestibular tests not performed, falls not evaluated prospectively), this is an interesting paper describing a novel way of evaluating postural control in glaucoma patients. 

Evaluation of postural control in patients with glaucoma using a virtual reality environment.
Diniz-Filho A, Boer ER, Carolina PBG, et al.
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Brian Ang

Royal Victorian Eye and Ear Hospital, Melbourne, Australia

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