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Evaluation of Postural Control in Patients with Glaucoma Using a Virtual Reality Environment.

Publication ,  Journal Article
Diniz-Filho, A; Boer, ER; Gracitelli, CPB; Abe, RY; van Driel, N; Yang, Z; Medeiros, FA
Published in: Ophthalmology
June 2015

PURPOSE: To evaluate postural control using a dynamic virtual reality environment and the relationship between postural metrics and history of falls in patients with glaucoma. DESIGN: Cross-sectional study. PARTICIPANTS: The study involved 42 patients with glaucoma with repeatable visual field defects on standard automated perimetry (SAP) and 38 control healthy subjects. METHODS: Patients underwent evaluation of postural stability by a force platform during presentation of static and dynamic visual stimuli on stereoscopic head-mounted goggles. The dynamic visual stimuli presented rotational and translational ecologically valid peripheral background perturbations. Postural stability was also tested in a completely dark field to assess somatosensory and vestibular contributions to postural control. History of falls was evaluated by a standard questionnaire. MAIN OUTCOME MEASURES: Torque moments around the center of foot pressure on the force platform were measured, and the standard deviations of the torque moments (STD) were calculated as a measurement of postural stability and reported in Newton meters (Nm). The association with history of falls was investigated using Poisson regression models. Age, gender, body mass index, severity of visual field defect, best-corrected visual acuity, and STD on dark field condition were included as confounding factors. RESULTS: Patients with glaucoma had larger overall STD than controls during both translational (5.12 ± 2.39 Nm vs. 3.85 ± 1.82 Nm, respectively; P = 0.005) and rotational stimuli (5.60 ± 3.82 Nm vs. 3.93 ± 2.07 Nm, respectively; P = 0.022). Postural metrics obtained during dynamic visual stimuli performed better in explaining history of falls compared with those obtained in static and dark field condition. In the multivariable model, STD values in the mediolateral direction during translational stimulus were significantly associated with a history of falls in patients with glaucoma (incidence rate ratio, 1.85; 95% confidence interval, 1.30-2.63; P = 0.001). CONCLUSIONS: The study presented and validated a novel paradigm for evaluation of balance control in patients with glaucoma on the basis of the assessment of postural reactivity to dynamic visual stimuli using a virtual reality environment. The newly developed metrics were associated with a history of falls and may help to provide a better understanding of balance control in patients with glaucoma.

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Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

June 2015

Volume

122

Issue

6

Start / End Page

1131 / 1138

Location

United States

Related Subject Headings

  • Visual Fields
  • Visual Field Tests
  • Visual Acuity
  • User-Computer Interface
  • Surveys and Questionnaires
  • Prospective Studies
  • Posture
  • Postural Balance
  • Ophthalmology & Optometry
  • Middle Aged
 

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Diniz-Filho, A., Boer, E. R., Gracitelli, C. P. B., Abe, R. Y., van Driel, N., Yang, Z., & Medeiros, F. A. (2015). Evaluation of Postural Control in Patients with Glaucoma Using a Virtual Reality Environment. Ophthalmology, 122(6), 1131–1138. https://doi.org/10.1016/j.ophtha.2015.02.010
Diniz-Filho, Alberto, Erwin R. Boer, Carolina P. B. Gracitelli, Ricardo Y. Abe, Nienke van Driel, Zhiyong Yang, and Felipe A. Medeiros. “Evaluation of Postural Control in Patients with Glaucoma Using a Virtual Reality Environment.Ophthalmology 122, no. 6 (June 2015): 1131–38. https://doi.org/10.1016/j.ophtha.2015.02.010.
Diniz-Filho A, Boer ER, Gracitelli CPB, Abe RY, van Driel N, Yang Z, et al. Evaluation of Postural Control in Patients with Glaucoma Using a Virtual Reality Environment. Ophthalmology. 2015 Jun;122(6):1131–8.
Diniz-Filho, Alberto, et al. “Evaluation of Postural Control in Patients with Glaucoma Using a Virtual Reality Environment.Ophthalmology, vol. 122, no. 6, June 2015, pp. 1131–38. Pubmed, doi:10.1016/j.ophtha.2015.02.010.
Diniz-Filho A, Boer ER, Gracitelli CPB, Abe RY, van Driel N, Yang Z, Medeiros FA. Evaluation of Postural Control in Patients with Glaucoma Using a Virtual Reality Environment. Ophthalmology. 2015 Jun;122(6):1131–1138.
Journal cover image

Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

June 2015

Volume

122

Issue

6

Start / End Page

1131 / 1138

Location

United States

Related Subject Headings

  • Visual Fields
  • Visual Field Tests
  • Visual Acuity
  • User-Computer Interface
  • Surveys and Questionnaires
  • Prospective Studies
  • Posture
  • Postural Balance
  • Ophthalmology & Optometry
  • Middle Aged