The relationship between visual function and balance: The SEE project

Purpose: The purpose of this study was to examine the relationship between various measures of visual function and balance. Methods: The SEE project assessed 2490 community-dwelling adults aged 65 to 84, for binocular visual acuity, contrast sensitivity, visual fields, glare disability, stereoacuity, and a variety of eye diseases. Self assessment of balance was evaluated, and balance was measured by observation of side-by-side, semi-tandem, and tandem stands. Results: 6.9% of subjects reported severe difficulty with balance. This prevalence increased with age, from 4.8% in the 65-69 year olds, to 14.0% in subjects aged 85-89. Adjusted for age, the following variables showed significant associations with severe difficulty with balance: stereoacuity (p<0.005, OR 1.13 for doubling of stereoacuity), contrast sensitivity (p<0.01, OR 1.27 for a 50% decrease in contrast sensitivity), and visual fields (p<0.05, OR 1.17 for 50% decrease in visual fields). Visual acuity had borderline significance (p=0.07, OR 1.18 for reduction of 3 lines) and glare disability was not associated with balance (p>0.4). When entered into a multiple logistic regression, stereoacuity(p<0.01) had the strongest association with severe difficulty with balance after adjusting for age. Conclusions: Visual impairment is modestly associated with a self-report of severe difficulty with balance. Of the components of visual impairment, stereoacuity is most strongly associated with balance; however, contrast sensitivity and visual fields also have a modest association.