Adding insult to injury?

Visually impaired people are continuing to suffer accidental injuries related to their impairment because epidemiological research of the subject lacks rigour and intervention studies are almost non-existent.

A recent review of published data calls for comprehensive studies to identify the causes of injury and evaluate preventive measures, and it recommends minimum standards for future studies. These include formal ophthalmological assessment of visual acuity and visual fields, measurement of injuries as outcomes, and adjustment for confounders.

Of 31 studies that conformed to the review's inclusion criteria, about two thirds concerned falls, eight traffic related injuries, and three occupational injuries. Other types of accidents were not covered. Most studies were inconclusive—through having insufficient power or no adjustment for confounders, or both.

Those few studies with meaningful results dealt with falls in older people. The risk of falls in visually impaired people aged >75 years was 1.7 times that of sighted people. Multiple falls were 1.2–2.1 times more likely, depending on the type of impairment. The risk of hip fracture was 1.3–1.9 times higher for people with lowered visual acuity.

Research studies published during 1980–2000 were identified by MeSH and free text searches of 10 bibliographic databases. Only those which satisfied two or more of the following criteria were included in the review: formal ophthalmic assessment; adjustment for confounders; large sample size, with numbers of visually impaired subjects; and clear definitions and outcomes.

Visually impaired people are at increased risk of injury and therefore an important consideration in any measures to reduce injuries in general.