Balance Performance in People With Peripheral Visual Field Loss: A Systematic Review and Meta-Analysis

Although peripheral visual field loss (PVFL) affects balance, previous research has produced mixed results and has not clearly distinguished the independent roles of different systems in balance impairment. This systematic review with meta-analysis is the first to comprehensively evaluate the proportion and contribution of different systems to balance in adults with PVFL, providing new insights for rehabilitation strategies.

A systematic search was performed in five databases (PubMed, AMED, Scopus, CINAHL, and Web of Science) from 2003 to 2023, with a manual search covering 2024 to 2025. The review focused on observational studies in adults (≥18 years) with PVFL because of glaucoma or retinitis pigmentosa. Data were synthesized by summarizing the balance function into two aspects: sensory strategy and motor strategy. The sensory strategy was defined as the motor response to changes in altering visual, vestibular, or somatosensory inputs to maintain balance, whereas the motor strategy was defined as the response to other conditions besides visual, vestibular, or somatosensory conditions, such as response to external perturbation, muscle coordination, and reaction time. The meta-analysis was conducted where appropriate.

Seventeen studies comprising a total of 2456 participants were analyzed. The meta-analysis revealed that individuals with PVFL exhibited poorer balance than age-matched controls. Specifically, PVFL was associated with a reduced contribution from the visual system, an increased contribution from the somatosensory system, and poorer motor strategies in maintaining balance. Greater peripheral visual field loss correlated with poorer sensory strategy for balance, whereas the relationship between motor strategy and peripheral visual field loss remained inconclusive.

Adults with PVFL demonstrate significant balance impairments compared to healthy peers, relying more on somatosensory input to compensate for visual deficits. These findings underscore the need for comprehensive balance assessments and targeted rehabilitation strategies. Further research should focus on identifying the most predictive balance parameters and developing targeted, evidence-based rehabilitation strategies for this population.

By identifying the specific sensory-motor mechanisms of balance impairment in patients with PVFL, this study bridges the gap between clinical vision assessment and rehabilitation. The finding that these patients rely heavily on somatosensory compensation provides a strong clinical rationale to transition from generic balance exercises to personalized, targeted rehabilitation strategies (such as proprioceptive and motor-strategy training), ultimately reducing fall risks and improving mobility in patients with PVFL.