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. 2024 Jul 24;19(7):e0302428. doi: 10.1371/journal.pone.0302428

Global burden of fall and associated factors among individual with low vision: A systematic-review and meta-analysis

Kingsley Ekemiri 1,*, Chioma Ekemiri 2, Ngozika Ezinne 1, Victor Virginia 3, Osaze Okoendo 4, Robin Seemongal-Dass 5, Diane Van Staden 6, Carl Abraham 7
Editor: Yuan-Pang Wang8
PMCID: PMC11268632  PMID: 39047020

Abstract

Introduction

Low vision has a significant global health problem that impacts the personal, economical, psychological, and social life of an individual. Each year around 684 000 individuals die from falls, 80% of these deaths occur are in low- and middle-income countries. The risk of falling significantly increases with visual impairment. This review aimed to determine the global pooled prevalence of fall and associated factors among individuals with low vision.

Methods and materials

Systematic search of published studies done on PubMed, EMBASE, MEDLINE, Cochrane, Scopus, Web of Science CINAHL and, Google Scholar. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to report the findings. Quality of studies was assessed using the modified Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using a random-effects method using the STATA™ Version 14 software.

Result

Thirty-five (35) studies from different regions involving 175,297 participants included in this meta-analysis. The overall pooled global prevalence fall among individual with low vision was17.7% (95% CI: 16.4–18.9) whereas the highest prevalence was 35.5%; (95% CI: 28.4–42.5) in Australia and the lowest was 19.7%; (95% CI: 7.6–31.8) seen in South America. Fear of falling (OR: 0.16(95%CI 0.09–0.30), and severity of visual impairment (OR: 0.27(95%CI (0.18–0.39) increases the odds of falling.

Conclusion

As one cause of accidental death, the prevalence of falls among individuals with low vision is high. Fear of falling and severity of falling increases the odds of falling. Different stakeholders should give due attention and plan effective strategies to reduce the fall among this population.

Introduction

Low vision is the existence of a visual impairment that results in a disability or a vision loss that can’t be corrected by medical or surgical treatments or conventional eyeglasses [1]. According to the World Health Organization (WHO), a person with low vision is a one who has impairment of visual functioning even after treatment and/or refractive correction, and has a visual acuity of less than 6/18 to light perception, or a visual field of less than 10° from the point of fixation, but who uses, or is potentially capable to use, vision for the planning and/or performing of activities [2].

According to different studies, the causes of low vision include: cataract, nystagmus, retinopathy, optic atrophy, glaucoma, refractive error, retinal disorders, albinism, and retinitis pigmentosa [3–5]. It has a significant global health problem that impacts the personal, economical, psychological, and social life of an individual [6, 7]. It also affects health -related quality of life [8–11],.reduces functioning [12], and generally it has a substantial impact on activities of daily living [13]. In addition, the low vision adversely affects balance ability; increase mortality risks, and results in deterioration in physical functioning [14–16].

Worldwide, falls are the next prominent causes of unintended injury deaths. Each year an approximately 684,000 individuals die from falls, of which over 80% are in Low- and Middle-Income Countries (LMIC) [17]. Studies indicated that the risk of falling is significantly correlated with vision related impairment [18, 19].

Besides globally, 1.1 billion people are known living with vision loss, from these 43 million people are blind, 295 million people have moderate to severe visual impairment, 258 million people have mild visual impairment, and 510 million people have near vision problems [20]. The number of blind persons increased from 34.4 million in 1990 to 49.1 million in 2020 [21]. As its prevalence increases, the occurrence of fall accident will be also expected to rise.

Even though of the increased burden of low vision in different parts of the world, there are a number of barriers to access the low vision services: which include lack of awareness of services by people with low vision, many people do not identify themselves as having low vision [22], mental health problems, denial of need for low-vision aid, poor physical health, lack of transportation, lack of referrals, communication failure, misconceptions of the service, negative societal views, influence of family and friends, insufficient visual impairment to warrant services, cost of the service, reduced perception of vision loss relative to other losses in life, and educational level [23, 24]. On the behalf of the health professionals, there is a lack of awareness about low vision services [25], and lack of awareness on referral criteria and available low vision care [26].

Vision loss and fall are interrelated, studies show that vision loss is high among those who fall, and vision loss may also be a contributing factor to falls [27, 28]. If an individual encounters a fall, it results poor health and well-being, decreased activity of daily living, and social participation, lower life satisfaction, and it affects the quality of life of the individuals [29–32]. Identifying the various factors that may contribute to falls in this population, especially those that may be modifiable will help in reducing the incidence of falling. So this systematic review and meta-analysis aimed to determine the global pooled prevalence of fall and associated factors among individuals with low vision.

Objectives of the review

  • ✓ To determine the pooled global prevalence of falls among individuals with low vision

  • ✓ To identify the associated factors falls among individuals with low vision

Methods and materials

Inclusion and exclusion criteria

  • ✓ The studies were included in the analysis if

  • ✓ The study participants were individuals with low vision (visual acuity >0.3 logmar (6/12 Snellen)

  • ✓ The prevalence of falls among individuals with low vision was reported.

  • ✓ It reported on fall related injury within the past two years

  • ✓ Reported fall were among adults.

  • ✓ Both published and unpublished studies till December 2023 will be included in this analysis. Studies were excluded if

  • ✓ Overall prevalence of fall in individual with low vision not report.

  • ✓ It had greater study duration either prospectively or retrospectively.

  • ✓ The prevalence of fall after corrective surgery.

Information sources, search strategy, and study selection

Primarily, electronic searches were used to extract studies. PubMed, Scopus, Web of Science, JStore, and African journal online databases were used. The Cochrane acronym POCC (population, Condition, and Context) related key terms were used to retrieve studies in PubMed. The key terms used were, “Low vision OR visual impairment OR vision loss OR Ophthalmic conditions OR Low vision status OR declining vision OR vision impairment OR vision loss OR Visual field loss OR poor vision OR lowered vision OR fall OR “injury”. Search limiters, such as study design and language of publication, were used. The identified articles were then exported into EndNote version 7.0 to remove duplicates. Also, manual and references searching was done to include studies not indexed in above mentioned sites. Finally the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement 2020 guidelines was used to report this study [33].

Data collection process

After agreement with the search strategy, data extraction was done by all authors independently by using a data extraction format prepared in a Microsoft Excel 2013 spreadsheet; containing author’s name, publication year, study design, sample size, setting, the prevalence of fall among individuals with low vision.and associated factors

Data items

The primary outcome of this review is the global pooled prevalence of fall among individuals with low vision and the secondary outcome is the factors affecting fall among individuals with low vision. All variables of low vision or the causes of low vision were independently searched as outcome variable.

Study risk of bias assessment /quality assessment of studies

The modified Newcastle-Ottawa Scale (NOS) for cross-sectional studies was used to assess the quality of studies, which has three components categorised as Selection, Comparatively, and outcome assessment methods, which scores out of 10. Studies that scored five or more on the NOS were included [34]. Any disagreement while assessing the quality of the study was resolved through careful examine of the studies together by all authors.

Effect measures

The prevalence fall among individuals with low vision proportion were taken to measure the effect; whereas for the associated factors odds ratio was taken.

Data analysis and synthesis methods

After the abstraction of all eligible studies; the data were exported to Stata software version 14 for analysis. For studies that reported the overall prevalence of fall in individuals with and without low vision, the proportion was calculated by considering of those individuals with low vision as denominator. A random-effects model was used considering the heterogeneity of studies. The study heterogeneity was assessed using Higgin’s I2 and Cochran’s Q method. I2 values of 25%, 50%, and 75% were considered low, moderate, and high heterogeneity, respectively. Subgroup analysis was also conducted by region. Also, funnel plot and Egger’s test were used to check publication bias. Sensitivity analyses were conducted to assess robustness of the synthesized results.

Results

Study selection and characteristics

The search strategy retrieved 4,986 published original articles. After the removal of duplicate articles, 3785 articles remained. Following further screening, 984 articles were assessed for eligibility, of which 949 articles were excluded because they did not report the outcome of interest and did not fulfill the inclusion criteria. Finally, 35 studies were included in the analysis (Fig 1).

Fig 1. PRISMA flow diagram of study selection for the global prevalence of fall among individual with low vision.

Fig 1

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The 1 included [35–69] studies had 175,297 study participants with 31employing a cross-sectional design, 3 cohort, and 1 case control study design. The final sample size ranged from 48 [69]– 94,311 [49]. Most studies were conducted in North America, and the prevalence of fall ranges from 0.0176 [38] - 74 [60] (Table 1).

Table 1. Characteristics of the studies included in the systematic review and meta-analysis.

Authors Name Publication Year Study area Study design sample Prevalence%(95%CI)
Gashaw M, et al 2020 Gondar Cross -sectional 328 26.8(22.0–31.5)
Mengste YL, et al 2023 Addis Ababa Cross-sectional 487 36.1(31.8–40.3)
Gashaw M, Adie Admass B. 2021 Gondar Cross -sectional 320 24.7(19.9–29.4)
KANG MJ, RIM TH, KIM SS. 2016 South Korea Cross -sectional 28899 0.0176(0.0023–0.032)
Lamoreux EL, et al 2008 Singapore Cross -sectional 1190 40.3(37.5–43.08)
Gupta P, et al 2023 Singapore Cross -sectional 1972 16.3(14.6–17.9)
Kuang TM, et al 2008 China Cross -sectional 1361 4.6(3.48–5.71)
Lamoureux E, et al 2010 Australia Cross -sectional 127 40(31.47–48.52)
Yip JL, et al 2014 UK Cross- sectional 8317 26.7(25.74–27.65)
Campagna G, et al 2018 USA Cross -sectional 809 7.4(5.59–9.20)
BOptom RQ, et al 1998 Australia Cross -sectional 3299 24.9(23.42–26.37)
Mehta J, et al 2021 UK Cross -sectional 585 16.4(13.39–19.40)
Freeman EE, et al 2007 USA Cross -sectional 2312 29(27.15–30.84)
Marmamula S, et al 2020 India Cross -sectional 1074 38(35.09–40.90)
Crews JE, et al 2016 USA Cross -sectional 94311 28.9(28.61–29.18)
Ouyang S, et al 2022 China Cross -sectional 251 56.9(50.77–63.02)
Kulmala J, et al 2008 Finland Cross -sectional 188 53.7(46.57–60.82)
Krishnaiah S, Ramanathan RV 2018 India Cross -sectional 382 13.8(10.34–17.25)
To KG, et al 2014 Vietnam Cross -sectional 413 13(9.75–16.24)
Coleman AL. et al 2007 USA Cross -sectional 4071 16(14.87–17.12)
Black AA, e al 2008 Australia Cross -sectional 65 35(23.40–46.59)
Bhorade AM, et al 2021 USA Cross -sectional 138 36(27.99–44.0)
Black AA, et al 2011 Australia Cross -sectional 71 44(32.45–55.54)
Baig S, et al 2016 USA Cross -sectional 116 25(17.11–32.88)
Patino CM, et al 2010 USA Cross- sectional 3203 19(17.64–20.35)
Wood JM, et al 2011 Australia Cross- sectional 76 74(64.13–83.86)
Moghadam AN, et al 2015 Iran Case-control 48 22.9(11.01–34.78)
Pattaramongkolrit S, et al 2013 Thailand Cross- sectional 278 37.8(32.10–43.49)
McCarty CA, et al 2002 Australia Cross- sectional 2343 20(18.38–21.61)
Kwan MM, et al 2012 Taiwan Cross- sectional 260 44.5(38.45–50.54)
Rosenblatt TR, et al 2023 USA Cohort 13385 0.063(0.020–0.105)
Glynn RJ, et al 1991 USA Cross- sectional 489 9.6(6.98–12.21)
Ehrlich JR, et al 2019 USA Cross- sectional 3933 27.6(26.20–28.99)
Lord SR, Dayhew J. 2001 Australia Cohort 148 21.7(15.05–28.34)
Haymes SA, et al 2007 Canada Cohort 48 35(21.50–48.49)
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Prevalence of fall among individuals with low vision

The overall pooled global prevalence fall among individuals with low vision was 24.1% (95% CI: 22.7, 25.5) with a heterogeneity index of 99.9% and P-value of < 0.001 (Fig 2) and because the Eggers test was found to be significant (P = 0.002), the final pooled prevalence was corrected for Duval and Tweedie’s trim and fill analysis and was found to be 17.7 (95% CI: 16.4–18.9).

Fig 2. Forest plot showing the pooled the global prevalence of fall among individual with low vision.

Fig 2

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Meta-regression

Meta-regression was conducted using the year of publication and sample size as a covariate to identify the source of heterogeneity. It was indicated that there is no effect of publication year and sample size on heterogeneity between studies (Table 2).

Table 2. Meta-regression analysis of factors affecting the between-study heterogeneity of depression.

Heterogeneity source Coefficients Std. Err. P-value
Publication year -0.2329166 0.2990457 0.442
Sample size -0.0003109 0.0001802 0.094
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Subgroup analysis

Subgroup analyses revealed a marked variation across continents, with the highest prevalence 35.5%; (95% CI: 28.4–42.5), I2 = 96.1%) in Australia and the lowest 19.7%; (95% CI: 7.6–31.8), I2 = 100%) seen in South America (Fig 3).

Fig 3. Subgroup analysis of the global prevalence of fall among individual with low vision.

Fig 3

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Publication bias

The publication bias was statistically tested by the Egger test (P = 0.002); which is significant. The funnel plot indicated publication bias as the graph appeared asymmetrical (Fig 4). After adjusting for publication bias by trim and fill analysis, the funnel plot appeared to be symmetrical (Fig 5).

Fig 4. Funnel plot to test publication bias in 35 studies with 95% confidence limits.

Fig 4

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Fig 5. Funnel plot after adjusting the trim and fill analysis.

Fig 5

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Sensitivity analysis

Additionally, in this systematic review and meta-analysis, sensitivity analysis was performed to determine how various sources of uncertainty contribute to the overall uncertainty among the studies, but the results indicated that uncertainty has an insignificant influence on pooled prevalence (Fig 6).

Fig 6. Sensitivity analysis of pooled studies.

Fig 6

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Sensitivity analysis of pooled the global prevalence of fall among individual with low vision for each study being removed one at a time.

Factor associated factors fall among individual with low vision

Five variables were extracted to identify factors associated with fall among individuals with low vision. Of those, two variables (Fear of falling and Severity of visual impairment) were identified as significant factors (Table 3).

Table 3. Factor associated with fall among individuals with low vision.

Determinants Comparison No of studies Sample size OR(95%CI) P–value I2 (%) Heterogeneity
test (p value)
Depression Yes vs No 2 648 0.98 (0.081–12.07) 0.992 95.8 < 0.001
Gender Men vs Women 4 4354 0.87 (0.51–1.48) 0.620 85.2 < 0.001
Taking of medication Yes vs No 2 648 0.991 (0.02–41.42) 0.996 98.9 < 0.001
Fear of falling Concerned vs Not concerned at all 2 818 0.16 (0.09–0.30) < 0.001 52.1 0.148
Severity of visual impairment Mild vs moderate and severe 2 807 0.27 (0.18–0.39) < 0.001 3.2 0.309
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Accordingly, individuals who were concerned about the fear of falling were 88.4% less likely to fall (OR: 0.16(95%CI 0.09–0.30), P<0.001, I2: 52.1%, the heterogeneity test (P = 0.148) than an those not concerned about the fear of falling

Individuals with mild vision impairment 73% less likely to fall (OR: 0.27(95%CI (0.18–0.39)), P<0.001, I2: 3.2%, the heterogeneity test (p = 0.309) than those with moderate and sever vision impairment.

Discussion

In this systematic review and meta- analysis, fall burden and associated factors was assessed among individuals with low vision. Different studies have shown that fall is a prevalent public health problem in the older population; in addition to advancement of their age, the presences of chronic diseases such as visual impairment worsens the problem in this group of individual [18, 70–74].

Globally, the estimated 10 million people who had visual impairment in 2015 are, estimated to be 55.7 million people by 2050 [75]; those patients with visual impairment at higher risk of falling [76].This shows that while the prevalence increases, those individuals are at high risk of health- related problems including falls.

According to our study, the overall pooled global prevalence falls among individuals with low vision was 17.7% (95% CI: 16.4–18.9); which is lower than pooled global prevalence of falls in the older adults 26.5% [77], this might be those individual with low vision take care to not fall knowing that they are at risk of falling compared to other individuals without visual impairment.

In addition, the subgroup analyses showed, the highest prevalence 35.5%; (95% CI: 28.4–42.5) in Australia and the lowest 19.7%; (95% CI: 7.6–31.8) seen in South America. This discrepancy might be due to evidence showing that the burden related to visual impairment and socioeconomic indicators were closely associated; as a result the occurrence of falls increased [78, 79].

In this study, falling was associated with fear of fall. Accordingly, those individuals who are concerned about fear of falling were 88.4% less likely to fall (OR: 0.16(95%CI 0.09–0.30), than those not concerned about the fear of falling. A different study also showed that fear of falling was associated with the occurrence of falls and that the occurrence of falls might contribute to the development of fear of falling [80, 81].

The degree of vision impairment is associated with fall occurrence. In this study, individuals with mild vision impairment 73% less likely to fall (OR: 0.27(95%CI (0.18–0.39) than those with moderate and sever vision impairment. Studies show that the occurrence of repeated falls depends on the level of visual impairment [19, 82, 83].

Conclusion

As one cause for accidental death, the prevalence of fall among individual with low vision is high. Fear of falling and severity of falling increases the odds of falling. Different stakeholders should give due attention and plan effective strategies to reduce the fall among this population.

Limitations of the study

This systematic review and meta-analysis presented the global prevalence of falls among individuals with low vision; however it might have faced the following limitations. First, the lack of studies from South America and Antarctica, may affect the generalizability of the findings to the world. Secondly, due to presence of significant heterogeneity and publication bias, the result should be interpreted cautiously. Finally, we faced difficulties in in comparing our findings due to the lack of regional and worldwide systematic reviews and meta-analysis.

Supporting information

S1 Checklist. PRISMA 2020 checklist.

(DOCX)

pone.0302428.s001.docx (36.2KB, docx)
S1 Data

(XLSX)

pone.0302428.s002.xlsx (23.3KB, xlsx)

Acknowledgments

We would like to thank all authors of studies included in this systematic review and meta-analysis.

Data Availability

All relevant data are within the manuscript and its Supporting Information files.

Funding Statement

The author(s) received no specific funding for this work.

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Decision Letter 0

Yuan-Pang Wang

7 Feb 2024

PONE-D-23-44176Global Burden of Fall Among Individual with Low Vision: A Systematic-Review and Meta-AnalysisPLOS ONE

Dear Dr. Ekemiri,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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https://www.emerald.com/insight/content/doi/10.1108/IJPCC-09-2015-0033/full/html

https://pubmed.ncbi.nlm.nih.gov/24314403/

https://www.tandfonline.com/doi/full/10.1080/23311932.2019.1642981

https://downloads.hindawi.com/journals/ijcd/2021/6708865.pdf

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Partly

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Reviewer #1: Yes

Reviewer #2: Yes

**********

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #2: Yes

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Reviewer #1: I have already commented it to rewrite it in standard English. I hope the authors will act accordingly. the manuscript technically sounded, the statistical analysis performed appropriately and rigorously.

Reviewer #2: it is an important work but needs revision

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Reviewer #2: No

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Attachment

Submitted filename: comments to low vision.docx

pone.0302428.s003.docx (13.9KB, docx)
Attachment

Submitted filename: PLOS ONE.docx

pone.0302428.s004.docx (13.9KB, docx)
PLoS One. 2024 Jul 24;19(7):e0302428. doi: 10.1371/journal.pone.0302428.r002

Author response to Decision Letter 0

1 Mar 2024

Dear Editor,

A rebuttal letter was sent and attached as "Response to Reviewers."

A marked-up copy was sent and labelled as Revised Manuscript with Track Changes

An unmarked version of revised paper was sent and labelled as "Manuscript"

The overlap was revised especially the introduction and Method

Response for reviewer 1

Dear reviewer thank you for your constructive comments and suggestion, we tried to incorporate all issues raised by you.

Manuscript PONE-D-23-44176 Global Burden of Fall Among Individual with Low Vision: A Systematic-Review and Meta-Analysis

Comments

The tittle “Global Burden of Fall among Individual with Low Vision: A Systematic-Review and Meta-Analysis” is important because, the Vision loss and fall are interrelated, vision loss is high among those who fall, and vision loss may be a contributing factor to falls. Falling results poor health and well-being, decreased activity of daily living and social participation, lower life satisfaction, as well as it affects the quality of life of the individuals.

I like to give minor comments and questions for this review.

1. I need to see the searching terms that you use for each data bases with their results? How do you get an access for each data bases other than PubMed?

Response- as we mentioned in method part we used those search terms for all databases after we extracted MeSH for our study based on POCC.

• We got all most all studies from PubMed, from other sites we only get 2 studies ( 1 Scopus indexed, so we accessed through institutional login.) the other from Google scholar.

Regarding the access issue most of the health journals are indexed in PubMed in addition to that other sites, so we haven’t faced any challenges. But what we have done for those not indexed on those sited is we did manual searches.

2. The whole article has language and grammar problems.

Response- modified

3. In line 129 it says “the keywords used were, Low vision OR visual impairment OR…..” are this key words or search terms?

Response—corrected based on your suggestion

4. Check for the right citation: for example for citation 35………

Response—corrected

5. Make the PRISMA diagram aesthetic.

Response---corrected

6. Since you are using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)….. use its correct format. Like 1. Introduction, 2. Material and methods, 2.1. Study design and search strategy, 2.2. Study selection and eligibility criteria, 2.3. Study selection and quality appraisa, 2.4. Data extraction, 2.5. Measure, 2 .6. Statistical analysis, 2. 7. Publication bias, 3. Results………….. 4. Discussion, 4.1. Implications, 5. Conclusions, Financial disclosures, Declaration of Competing Interest, Acknowledgements, Appendix A. Supplementary data, References.

Response- we followed PRISMA 2020, so corrected based on your recommendation

7. In line 235 make it 88.4%, it says 884%.

Response – corrected

8. If the Egger’s test is found to be significant, it indicates the presence of publication bias in the meta-analysis. To correct the final pooled prevalence, one can use the trim-and-fill method1. This method involves trimming the studies that are causing funnel plot asymmetry and then filling the funnel plot with hypothetical studies to make it symmetrical. The final pooled prevalence is then calculated using the filled funnel plot.

Response – mentioned on line 183 and 184

Response for reviewer 2

Dear reviewer thank you for your comments, we response for all comments raised by you.

Global Burden of fall and Associated factors among Individual with Low 2 Vision: A Systematic-Review and Meta-Analysis; It is an important piece of work but needs minor revision

Comments to author

� The title on the system and word document is different , should be similar Global Burden of Fall Among Individual with Low Vision: A Systematic-Review and Meta-Analysis and Global Burden of Fall and associated factors Among Individual with Low Vision: A Systematic-Review and Meta-Analysis

Response – corrected

� On page 1 line number 5 , Kingsley Ekemiri 1* 3 ,Chioma Ekemiri², Ngozika

Ezinne¹,Victor Virginia³,Osaze 4 Okoendo⁴ , Robin Seemongal-Dass⁵ , Diane Van

Staden⁶ , Carl Halladay Abraham⁷ , Low Vision Study Group¹

“ Low Vision Study Group” should be removed because it not the name of author

Response – removed

� The Corresponding Author is already showed by astrix and the affiliation so don’t need to be restated in title page

Dr Kingsley Ekemiri(OD,MPH)

Department of Optometry, Faculty of Medical Sciences, The University of West indies, St Augustine Campus, Trinidad and Tobago

Response – removed

� Under inclusion criteria- why authors only included reported fall injury within past two years?

Response – the author included studies which reported within two years is in order to minimize recall bias.

� All included studies are published studies, why author dealt with unpublished study?

Response – corrected and we removed the word unpublished from main document, we don’t have unpublished studies

� Under conclusion- author recommended …to give attention, do you think there is no attention for those groups?

Response – the current facts says fall is not given attention for those with low vision rather most literature suggests attention for older age groups

� The contents of declaration letter is not correct, it is cover letter , please amend it

See plos one submission guideline at https://journals.plos.org/plosone/s/submission-guidelines

Response – corrected and removed from the manuscript

� All supporting information is not available

Response – we will make available/ attach as supporting information

Attachment

Submitted filename: response to reviewers (1).docx

pone.0302428.s005.docx (21.3KB, docx)

Decision Letter 1

Yuan-Pang Wang

4 Apr 2024

Global Burden of Fall Among Individual with Low Vision: A Systematic-Review and Meta-Analysis

PONE-D-23-44176R1

Dear Dr. Ekemiri,

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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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 #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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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 #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: 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 #1: Yes

Reviewer #2: Yes

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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 #1: The manuscript technically sound, statistical analysis been performed appropriately and rigorously and written in standard English. The authors well addressed the comments I send to them. So, I have no more comments.

Reviewer #2: the authors corrected all my comments and worthy if it is published by journal. I don't have additional comments

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Reviewer #1: Yes: Mistire Teshome Guta

Reviewer #2: No

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Acceptance letter

Yuan-Pang Wang

16 May 2024

PONE-D-23-44176R1

PLOS ONE

Dear Dr. Ekemiri,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team.

At this stage, our production department will prepare your paper for publication. This includes ensuring the following:

* All references, tables, and figures are properly cited

* All relevant supporting information is included in the manuscript submission,

* There are no issues that prevent the paper from being properly typeset

If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps.

Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

If we can help with anything else, please email us at customercare@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Yuan-Pang Wang

Academic Editor

PLOS ONE

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 Checklist. PRISMA 2020 checklist.

    (DOCX)

    pone.0302428.s001.docx (36.2KB, docx)
    S1 Data

    (XLSX)

    pone.0302428.s002.xlsx (23.3KB, xlsx)
    Attachment

    Submitted filename: comments to low vision.docx

    pone.0302428.s003.docx (13.9KB, docx)
    Attachment

    Submitted filename: PLOS ONE.docx

    pone.0302428.s004.docx (13.9KB, docx)
    Attachment

    Submitted filename: response to reviewers (1).docx

    pone.0302428.s005.docx (21.3KB, docx)

    Data Availability Statement

    All relevant data are within the manuscript and its Supporting Information files.

    Articles from PLOS ONE are provided here courtesy of PLOS

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