Frail individuals may be more susceptible to diseases that can cause visual field loss and/or visual field loss may predispose to frailty. Photo: Getty Images.

Previous studies conducted on the debilitating effects of specific visual field loss patterns have shown that lower hemifield deficits predispose a patient to functional disability, fall risk and quality of life—all of which may contribute to a frailer state. In a new study, researchers investigated whether certain types of visual field loss were associated with frailty and found that bilateral visual field loss is indeed correlated. Specifically, frail individuals may be more susceptible to diseases which can cause visual field loss and/or such field loss may predispose someone to frailty.

Visual field loss was determined with the Humphrey Matrix FDT perimeter. A 36-item frailty index was used to divide participants into four categories of increasing severity: non-frail, vulnerable, mildly frail and most frail.

Of the 4,897 participants (all age 40 and older), 4,402 had no visual field loss, 301 had unilateral visual field loss and 194 had bilateral visual field loss.

The study shows that visual field loss is associated with higher odds of frailty, independent of central visual acuity loss, and frail individuals may be more susceptible to diseases which can cause visual field loss and/or visual field loss may predispose to frailty, as mentioned above.

Visual field loss may play a crucial role in the pathogenesis of frailty, potentially by contributing to lower levels of physical activity and difficulties in performing daily living tasks, the authors explained, as older adults have been shown to avoid physical activity due to fear of falls, risk further increased with visual impairment.

Although no previous studies have analyzed visual field loss in the context of frailty, several suggest an association between visual field loss and reduced physical function. “In a cohort of 74 older adults with open angle glaucoma, inferior visual field reduction was associated with worse functional status, defined as an index composed of a six-minute walk test, timed-up and go test, lower limb strength, and self-reported physical activity,” the authors wrote in their study, published last week in American Journal of Ophthalmology.

Visual field loss may also predispose an individual to frailty by hindering activities of daily living and diminishing psychological well-being, previous studies have shown. “Patients with visual field loss report difficulty with activities including driving, reading, using a computer and walking, and disability-related cessation of these activities may increase risk of cognitive impairment and depression—both frailty risk factors,” the authors explained in their paper.

Because the relationship between visual field loss and frailty is likely to be complex, it may have profound implications for clinical management and outcomes in older adults, the authors noted, and visual field loss and other measures of vision impairment may serve as early markers for the development of frailty.

“Accordingly, patients with visual field loss and other frailty risk factors would benefit from referral for further frailty screening, and the evaluation of frailty in patients with unimpaired vision should include an analysis of visual function as a principal characteristic,” the authors concluded. “Given the potential consequences of vision loss on frail individuals, primary care physicians may increase the frequency of routine eye examinations for such patients.”

Bernstein IA, Fisher AC, Singh K, Wang SY. The association between frailty and visual field loss in U.S. adults. Amer Jour Ophthalmol. September 8, 2023. [Epub ahead of print.]