PONE-D-23-39304Assessing fall risk and equilibrium function in patients with age-related macular degeneration and glaucoma: An observational studyPLOS ONE

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Additional Editor Comments:

Dear authors, The reviewers have reviewed the manuscript and the majority of them have decided that the manuscript has merit, however, it still needs adjustments before it can be considered for publication. Therefore, I decided to reconsider the manuscript after major revisions.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Fall risk

24, 30 What is self-efficacy?

62 “deficits in postural control”

63 Make the purpose of the paper clearer. Are you attempting to replicate results of [8]? You don’t give any information about why or what about it is deficient. Recommend removing everything from line 63 to end of paragraph, replacing with some sort of justification for the research. Please also include why AMD is being included, as it has not been previously mentioned in the introduction.

82 how did you know what their vestibular function was?

114 what was the optical surround during the test?

141-149 Remove this, as it is already demonstrated in the table.

153 Within six months previously?

152 define self-efficacy here, and in abstract

184 Not sure of the justification for using superior eye. What would the results be if you used the inferior performing eye, which after all will be providing peripheral vision in half the environment.

199 inferior? Maybe you mean less. I’m not sure why a comparison to vestibular-deficient patients is given here, as it isn’t a major point of the paper

200 dizziness/vertigo is not a sensitive or specific symptom for vestibular loss. Please clarify.

201 indicates not insinuates—different meaning

212 The change in ratio is entirely expected—the term “intriguing” would indicate the opposite

215 indicate that “visual acuity” will be a measure of central vision (some readers might not know)

220 did they test the other eye?

229 “cohort” or “population” as a group, not “participants,” served to “comprise” individuals.

235 “identified” not “earmarked”

259 In 231 you indicated “the influence of visual impairment on fall risk appeared minimal” but here it actually decreases the risk? Are you comparing to effect of vestibular loss?

Reviewer #2: In this study the parameters of fall and equilibre were determined in patients with AMD and glaucoma. The visual function parameters included only visual acuity and visual field. It is necessary to extend the correlations to additional parameters including for AMD low-luminance visual acuity and dark adaptation, and for glaucoma the peripheral visual field limits as determined by Humphrey suprathershold perimetry and Goldmann perimetry.

Reviewer #3: General Comments:

This is an interesting work and I thoroughly enjoyed reading the manuscript. The authors in their manuscript have explored equilibrium function and falls risk in cohorts of age-related macular degeneration (AMD) and glaucoma. I believe that the information gained from this paper would add to the literature and knowledge base regarding falls risk in this clinical population. However, there are some issues, particularly in Method sections that need to be sufficiently addressed to improve the manuscript.

Importantly, I note that the authors have used several complex and peculiar words throughout the manuscript, for example, orchestrated, amassed, afflicted, chronicled, unbeknownst, emanates etc. I think authors have used ChatGPT, which they have acknowledged. It would be better to use simple academic words that are used in scientific writing so that it is easier for all readers to understand the contents.

Specific Comments:

Abstract:

1.The age of patients with AMD and glaucoma is missing in the Abstract. Please add this detail here.

2.Line 23:

While authors have mentioned falls determinants tools but the list of equilibrium function tests are not mentioned.

3.The authors have described 4 falls determinants tools in method sections in the main text. However, Hospital Anxiety and Depression Scale is missed in the Abstract.

4.Line 31:

Do visual deficits include both visual acuity (VA) and visual fields? Please specify this for clarity.

Introduction:

5.The introduction section would benefit by adding some further information about a wide range of falls risk factors and then stating that impaired vision is one of the important falls risk factors. For example, visual risk factors for falls in community-dwelling older adults or fall hazards in the home environment such as inadequate lighting, slippery surfaces, worn carpets, staircases without railings etc. as older adults spent the majority of their time in their homes.

6.Line 43 to 44:

It seems jumping directly to AMD and glaucoma. It would be better if the authors, in the first stance, mention that AMD and glaucoma cause central vision impairment and peripheral field losses and then describe these two conditions.

7.Line 45:

Is AMD cause of blindness or cause of irreversible visual impairment? Please check this.

8.Line 54: What does visual deficits refer to? Is it reduced vision (VA, contrast sensitivity or visual field) in general or specifically reduced VA and loss of visual fields? Please clarify this.

Methods:

9.The authors have directly reported demographic findings in the Result section. It is better to include at least the number and age of participants in this section also.

10.Line 78:

Again, it would be nice if VA and visual fields are stated clearly.

11.Visual function test:

More detail is required about vision tests.

I.What chart was used to test VA and how the process was entailed? Was VA tested monocularly or binocularly and which eye VA was used for correlation analysis in Table 3, is it better eye? I note authors have reported RE and LE in Result section in Table 1 and mentioned in the result section that better eye was used.

II.The authors have mentioned that decimal VA was converted into logMAR. I am bit curious why VA was not directly measured and recorded in logMAR.

III.It is a bit strange that authors have not tested VA in patients with glaucoma. Please justify this.

IV.How were visual fields tested monocularly or binocularly and which eye MD was used for correlation analysis, is it again better eye? Please explain these details. The authors have reported MD value for RE only in Table 1.

V.The authors have described how MD values were transmuted to power value, which is new term. Please add references to support this.

12.Outcome measures

I.It would be better to explain equilibrium function test at first and then falls risk evaluation tools later. More detailed explanation is also required for a range of equilibrium function tests.

II.The tool used by authors contain a set of questionnaires. How were responses from participants obtained? Was it self-reported or face-to-face interview? These all details are required.

13.The authors have not mentioned anything about screening of cognitive function (E.g., Mini-mental state examination) in older adults. I assume some older adults may have cognitive impairments which is likely to have impact on subjective responses that were obtained from questionnaires of falls evaluation tool. Please explain this for further clarification.

Results:

14.Line 144 to145:

The authors have directly reported results of general health but have not described in method sections that how this information was obtained.

15.In Table 2, I would suggest combining 1, 2 and 3 falls because of the smaller number of participants in each category. There are only 2 participants in each group who had falls within last 6 months. Please run this analysis again.

16.Are values reported in the Table 3 Pearson correlations? The interpretation of findings is hard to follow here.

Discussion:

This section is well written. Study limitations are well described.

17.Line 199: Please replace word inferior by less for appropriate word.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Assessing fall risk and equilibrium function in patients with age-related macular degeneration and glaucoma: An observational study

PONE-D-23-39304R1

Dear Dr. Tokunaga,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Renato S. Melo, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

Reviewer #3: No

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: No further comments all points have been addressed in my previous review and comments I suggest acceptance

Reviewer #3: Dear authors,

Thank you for working and addressing the concerns raised in the last review. The authors have addressed comments satisfactorily. I have no specific comments but a few minor corrections are required:

1. Line 69 to 71:

The authors have added new sentences: ‘In this study, we included patients with age-related macular degeneration (AMD) and glaucoma with moderate or low severity to distinguish between visual acuity impairment and visual field impairment, and determine which of the two contributes to postural control.’ This sentence should go in the Method section rather than in the Introduction section.

2. For one of my previous comments, regarding the reasons for not testing VA in patients with glaucoma (Visual function test: Comment III), the authors have responded that they have now included this data in the revised version. I noted that they have included these data in Table 1, however, they still have not stated in the method section that they assessed visual acuity in patients with glaucoma. Please include this.

3. Line 104 to 106:

The authors have added new sentences: ‘Humans are semi-crossed binocular animals; therefore, they rely on information from the better eye to discriminate objects and control eye movements and postural reflexes derived from peripheral vision.’ Please add references to support this sentence.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

Reviewer #3: No

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