People with diabetic retinopathy are more likely to fall than diabetics who have not developed vision problems, a study in Singapore suggests.

Among almost 9,500 middle aged and older adults, those with moderate diabetic retinopathy were almost twice as likely as individuals with diabetes but no eye damage to experience falls during the study.

Mild retinopathy, meanwhile, was associated with 81% greater odds of falling, researchers report online November 16 in JAMA Ophthalmology.

Compared to people without diabetes, patients with diabetic retinopathy were 31% more likely to fall, the study also found.

Approximately one in three elderly people living in the community fall each year, and roughly one in 10 falls result in traumatic injuries or fractures, the researchers note.

Falls can also result in reduced social interaction, less physical activity and declines in mobility and independence.

While previous research has linked diabetes to an increased risk of falls, many of these studies have focused on diabetic nerve damage that can reduce sensation in the feet and make it harder for people to sense where they’re stepping.

Some research has also tied falls to vision loss, but it’s been less clear how mild or moderate diabetic retinopathy might impact the odds of falling.

For the current study, researchers examined data on 9,481 Singapore residents of Malaysian, Chinese or Indian ethnicity who were taking part in a larger study. All had answered questionnaires that asked about any falls experienced in the prior year.

About half of participants were age 59 or older, and 6,612didn’t have diabetes. Among the 2,869 participants with diabetes, 857, or 30%, had diabetic retinopathy in at least one eye.

Overall, about 13% of people without diabetes had a history of falls, as did about 16% of diabetics who had no retinopathy.

Among patients with diabetic retinopathy, 14% of people with minimal cases had a history of falling, compared with 26% of mild cases, 27% of moderate cases and 20% of vision-threatening cases.

These results suggest that management of diabetes should include education on how to prevent falls, particularly for people with early stage diabetic retinopathy, the authors conclude.

The study wasn’t a controlled experiment designed to prove whether or how diabetic retinopathy directly causes falls.

Another limitation is that researchers relied on study participants to accurately recall and report on any previous falls, which might make the results less reliable than objective measurements of falls such as fall diaries.