PURPOSE: To assess the relationships between rates of glaucomatous visual field (VF) progression, fear of falling, history of falls, and ancestry. DESIGN: Prospective, multi-center, longitudinal cohort. SUBJECTS: Patients followed in the multi-site African Descent and Glaucoma Evaluation Study (ADAGES) with primary open-angle glaucoma and who completed a validated fear of falling questionnaire along with self-reported history of falls in the past year were enrolled. METHODS: Baseline VF severity and VF progression rates were assessed using 24-2 VF mean deviation (MD). We used univariable and multivariable models adjusting for confounders (age, sex, ancestry, and baseline MD) using clustered robust logistic regression and linear regression. MAIN OUTCOME MEASURES: The primary outcome measure was the relationship between history of falls (yes vs. no) as dependent variable and MD slopes (dB/year). The secondary outcome measure was the relationship between fear of fall (FoF) scores (continuous) as dependent variable and MD slopes (dB/year). RESULTS: There were 4,453 patient encounters, including at least 5 VF tests per patient with a minimum of 2 years of follow-up in 277 eyes of 183 individuals. Faster MD slopes were significantly associated with history of falls in both univariable (OR: 2.68 per dB/year faster rates
95%CI: 1.35 to 5.33
P=0.005) and multivariable models (OR: 2.55
95%CI: 1.29 to 5.04
P=0.007). Rapid progressors (MD slope <
-0.5 dB/yr) were 2.45-fold more likely to have a positive history of falls (95% CI: 1.22 to 4.91, P=0.012). Faster MD slopes were significantly associated with worse FoF in both univariable (β: 2.97 per dB/year faster rates
95%CI: 0.41 to 5.54
P= 0.023) and multivariable models (β: 2.27
95%CI: 0.17 to 4.36
P=0.034). Patients of African descent (AD) were as likely to have history of falls and had similar FoF scores as those of European descent (ED) (all P>
0.40). CONCLUSION: A faster rate of MD progression is associated with a greater fear of falling and history of falls among AD and ED treated glaucoma patients. Rapid progressors were almost 3-fold more likely to have a history of falls. The two ancestry groups also experienced similar rates of falls and fear of fall scores.