The association between various visual function tests and low fragility hip fractures among the elderly: a Malaysian experience

BACKGROUND: hip fractures are an increasing source of morbidity and mortality in older people. The role of visual function tests such as visual impairment, stereopsis, contrast sensitivity and visual field defects in low fragility hip fractures in Asian populations is not well understood.
OBJECTIVE: to determine the association between various visual function tests and low fragility hip fractures in an Asian population.
DESIGN: case-control study.
SETTING: University Malaya Medical Centre, Kuala Lumpur, Malaysia.
SUBJECTS: 108 cases aged > or = 55 years admitted with low fragility fractures and 108 controls (matched for age, gender and race).
METHODS: both cases and controls underwent a detailed ophthalmological examination, which included visual acuity, stereopsis, contrast sensitivity and visual field testing.
RESULTS: poorer visual acuity (odds ratio, OR = 4.08; 95% confidence interval, CI: 1.44, 11.51), stereopsis (OR = 3.60, 95% CI: 1.55, 8.38), contrast sensitivity (OR = 3.34, 95% CI: 1.48, 7.57) and visual field defects (OR = 11.60, 95% CI: 5.21, 25.81) increased the risk of fracture. Increased falls were associated with poorer visual acuity (OR = 2.30, 95% CI: 1.04, 5.13), stereopsis (OR = 2.11, 95% CI: 1.03, 4.32), contrast sensitivity (OR = 2.12, 95% CI: 1.05, 4.30) and visual field defects (OR = 3.40, 95% CI: 1.69, 6.86).
CONCLUSION: impaired visual acuity, stereopsis, contrast sensitivity and visual field defects are associated with an increased risk of low fragility hip fractures. We recommend that all patients aged > or = 55 should have an annual ophthalmological examination that includes visual acuity, contrast sensitivity, stereopsis and visual field testing to assess the risks for falls and low fragility fractures.