Importance Gait dysfunction is common in older people with visual impairment and is a major cause of falls.

Objective To compare 3-year longitudinal changes in gait measures across the spectrum of baseline visual field (VF) damage in glaucoma.

Design, Setting, and Participants A post hoc analysis was designed on September 1, 2018, following a prospective cohort study, which enrolled older adults with glaucoma or suspected glaucoma from September 2013 to March 2015 and followed up for up to 3 years. Baseline VF damage was defined by integrated VF (IVF) sensitivity and categorized as normal/mild (IVF >28 dB), moderate (IVF, 23-28 dB), and severe (IVF, <23 dB). Each participant walked on an electronic walkway back and forth twice at normal pace each study year. Linear mixed-effects models evaluated longitudinal change in gait outcomes (1) stratified within each VF severity category and (2) across the range of IVF sensitivity. Analysis took place from October 2019 to October 2020.

Main Outcomes and Measures Three-year changes in 7 gait assessments under usual-pace walking, including base support and its coefficient of variation, stride length and its coefficient of variation, stride velocity and its coefficient of variation, and cadence.

Results Of 241 participants, the mean (SD) age was 70.8 (7.7) years, 116 (48.2%) were women, and 70 (29.0%) were African American. When comparing longitudinal gait changes over 3 years across the spectrum of IVF sensitivity, each 5-unit (dB) decrement was associated with more rapid declines in stride velocity (−0.05 z score unit/y; 95% CI, −0.09 to −0.01; P = .01) and cadence (−0.07 z score unit/y; 95% CI, −0.10 to −0.03; P < .001). When evaluating gait changes within each glaucoma severity group, shorter stride length was associated with persons with normal/mild (−0.06 z score unit/y; 95% CI, −0.10 to −0.03; P = .001), moderate (−0.08 z score unit/y; 95% CI, −0.12 to −0.04; P < .001), and severe VF damage (−0.16 z score unit/y; 95% CI, −0.24 to −0.07; P < .001), while stride velocity (−0.18 z score unit; 95% CI, −0.28 to −0.07; P = .002) and slower cadence (−0.15 z score unit; 95% CI, −0.25 to −0.04; P = .006) were associated with those with severe VF damage.

Conclusions and Relevance At worse levels of baseline VF damage, patients with glaucoma in this study demonstrated an exacerbated decline in walking speeds (ie, stride velocity and cadence), indicating that mobility speeds decrease faster over time in older adults with glaucoma.

重要性 步态功能障碍在视力受损的老年人中很常见，并且是跌倒的主要原因。

目的 比较青光眼基线视野 (VF) 损伤范围内步态测量的 3 年纵向变化。

设计、设置和参与者 在一项前瞻性队列研究之后，于 2018 年 9 月 1 日设计了事后分析，该研究招募了 2013 年 9 月至 2015 年 3 月患有青光眼或疑似青光眼的老年人，并随访长达 3 年。基线 VF 损伤由综合 VF (IVF) 灵敏度定义，分为正常/轻度 (IVF >28 dB)、中度 (IVF, 23-28 dB) 和重度 (IVF, <23 dB)。每个研究年度，每位参与者以正常速度在电子人行道上来回行走两次。线性混合效应模型评估步态结果的纵向变化 (1) 在每个 VF 严重程度类别内分层和 (2) 在 IVF 敏感性范围内。分析时间为 2019 年 10 月至 2020 年 10 月。

主要结果和测量 7 项正常步速步行步态评估的三年变化，包括基础支撑及其变异系数、步幅长度及其变异系数、步幅速度及其变异系数和步频。

结果 241 名参与者的平均 (SD) 年龄为 70.8 (7.7) 岁，116 名 (48.2%) 为女性，70 名 (29.0%) 为非裔美国人。在 IVF 敏感性范围内比较 3 年的纵向步态变化时，每 5 个单位 (dB) 的减量与步幅速度更快速的下降相关（-0.05 z评分单位/年；95% CI，-0.09 至 -0.01 ；P  = .01) 和节奏（−0.07 z分数单位/年；95% CI，−0.10 至 −0.03；P  < .001）。在评估每个青光眼严重程度组的步态变化时，较短的步幅与正常/轻度（-0.06 z评分单位/年；95% CI，-0.10 至 -0.03；P  = .001）、中度（-0.08 z分数单位/年；95% CI，-0.12 至 -0.04；P  < .001）和严重 VF 损伤（-0.16 z评分单位/年；95% CI，-0.24 至 -0.07；P  < .001），而步幅速度（-0.18 z评分单位；95% CI，- 0.28 至 -0.07；P  = .002）和较慢的节奏（-0.15 z评分单位；95% CI，-0.25 至 -0.04；P  = .006）与严重 VF 损伤的患者相关。

结论和相关性 在基线 VF 损伤水平较差的情况下，本研究中的青光眼患者表现出步行速度（即步幅速度和步频）下降加剧，表明老年青光眼患者的移动速度随着时间的推移下降得更快。