JAGS 51:356–363, 2003 © 2003 by the American Geriatrics Society 0002-8614/03/$15.00 Visual Risk Factors for Hip Fracture in Older People Rebecca Q. Ivers, B Optom, MPH, PhD,* Robert G. Cumming, MBBS, MPH, PhD, † Paul Mitchell, MD, PhD, FRACO, ‡ Judy M. Simpson, PhD, CStat, † and Anthony J. Peduto, MB BS, FRANZCR § OBJECTIVES: To determine the association between poor vision and risk of hip fracture in the Blue Mountains Eye Study. DESIGN: Prospective population-based cohort study. SETTING: Two post code areas in the Blue Mountains, west of Sydney, Australia. PARTICIPANTS: Three thousand six hundred fifty-four community-dwelling Australians aged 49 and older. MEASUREMENTS: At baseline, subjects had an exten- sive eye examination, including refraction, contrast sensi- tivity and visual field testing, photographs of the lens and retina, and an interview. Hip fractures during the 5-year follow-up were identified by self-report and review of medical records and were radiologically confirmed. RESULTS: For 2-year follow-up (17 hip fractures), the adjusted hazard ratio (HR) for risk of hip fracture in those with corrected visual acuity worse than 20/60 was 8.4 (95% confidence interval (CI) = 1.5–48.5, popula- tion attributable risk (PAR) = 27%); for presence of posterior subcapsular cataract, the adjusted HR was 5.0 (95% CI = 1.1–23.0, PAR = 24%); and for visual field loss, the adjusted HR was 5.5 (95% CI = 1.0–29.8, PAR = 55%). In those aged 75 and older, visual acuity worse than 20/60 gave an adjusted HR of 40.6 (95% CI = 5.6–292.5, PAR = 49%). Visual impairment of any type did not predict risk of hip fracture after a 2- year follow-up. CONCLUSION: Visual impairment is strongly associated with risk of hip fracture in the next 2 years but not over a longer period of time. J Am Geriatr Soc 51:356–363, 2003. Key words: hip fracture; visual impairment; survival anal- ysis; cohort oor vision has long been recognized as a potential risk factor for hip fracture in older people. 1–7 Visual im- pairment occurs increasingly frequently as people age. 8,9 A high proportion may be reversible by improving spectacle correction 9 or by cataract surgery. Finding modifiable risk factors for hip fracture is important, because hip fracture incidence is increasing rapidly as the population ages. 10 The Blue Mountains Eye Study systematically mea- sured and graded visual function and eye disease in an older community-dwelling population. Subjects have now been followed for an average 5.1 years. This study pro- vides a good opportunity to carefully examine the associa- tions between poor vision and hip fracture in an older population. Because previous longitudinal studies have had conflicting results and different lengths of follow- up, 2,5,6 the aim of this study was to examine the associa- tions between visual impairment and hip fracture after dif- fering follow-up periods. METHODS Selection of Study Subjects The Blue Mountains Eye Study is a population-based survey of vision and common eye diseases in the Blue Mountains, Australia. Details of the survey methods and procedures have been described previously. 11–13 All noninstitutional- ized residents aged 49 and older were identified in a cen- sus. Of 4,433 eligible residents, 3,654 (82.4%) attended the eye examination. Baseline Assessment Visual acuity was recorded with current glasses and after subjective refraction using a LOGMAR chart. 9 Contrast sensitivity was measured after refraction for subjects in the first post code area using the Vectorvision CSV-1000 chart (Vectorvision, Inc., Dayton, OH). 14 Visual fields were as- sessed using the Humphrey 76 point 30° suprathreshold screening test (Humphrey Instruments, Inc., San Leandro, From the *Institute for International Health, † School of Public Health, ‡ Department of Ophthalmology, University of Sydney, Sydney, Australia; and § Department of Radiology, Westmead Hospital, Westmead, Australia. This study was supported by the Australian National Health and Medical Research Council (NHMRC) and the Save Sight Institute, University of Sydney. R. Q. Ivers was supported by a NHMRC (Public Health) Research Scholarship. Address correspondence to Dr. Rebecca Q. Ivers, Institute for International Health, University of Sydney, PO Box 576, Newtown NSW 2042, Australia. E-mail: rivers@iih.usyd.edu.au P