Age-related macular degeneration (AMD) is a major cause of disability in the elderly, substantially degrades the quality of their lives, and is a risk factor for depression. Rates of depression in AMD are substantially greater than those found in the general population of older people, and are on par with those of other chronic and disabling diseases. This article discusses the effect of depression on vision-related disability in patients with AMD, suggests methods for screening for depression, and summarizes interventions for preventing depression in this high-risk group.
Introduction This study characterizes self-reported functional vision goals and the use of low vision resources (for example, services and devices) in ophthalmology clinic patients with age-related macular degeneration (AMD) and comorbid depressive symptoms. Methods From July 2009 to February 2013, we assessed 188 consecutive patients (age 65 +; mean 84.0 years; 70.2% female) with AMD (best corrected distance acuity 20/70 or worse) enrolled in a 12-month randomized clinical trial to test the efficacy of a multi-component intervention that combined low vision optometry and home-based occupational therapy to prevent depression (Low Vision Depression Prevention Trial [VITAL]). A geriatric nurse conducted in-home assessments to measure visual acuity and contrast sensitivity, self-reported functional vision, functional vision goals that were personally important yet difficult to achieve (targeted vision function goals), and the use of low vision resources (defined as services, devices and strategies utilized by low vision patients to compensate for visual deficits). This study reports on baseline data collected prior to randomization. Results Only 9.6% of the sample had received formal low vision services. The five most common goals were newspaper reading, leisure and entertainment, computer use, personal communication, and correspondence. Participants engaged in targeted vision function goals less frequently since being diagnosed with AMD, despite using low vision resources and reporting low to moderate difficulty in using them. Discussion Few patients with AMD seen in ophthalmology clinics received low vision rehabilitation. Patients who utilized resources engaged in goals less frequently since being diagnosed with AMD. Implications for practitioners Patients with AMD are underutilizing low vision rehabilitation resources. Strategies for increasing low vision referrals are suggested.
This study examined how depression impacts age-related macular degeneration (AMD) disability among 114 elderly AMD patients. Results indicated that 49 patients met DSM-IV criteria for syndromal depression, and that visual acuity was the only variable significantly associated with vision-specific function. For general function, health was significant, and the relationship between visual acuity and function was only significant for depressed patients. Given that AMD results in high rates of depression and that depression exacerbates physical disability in AMD, devising optimal ways to identify and treat depressed patients in ophthalmology clinics is clearly important.
Vision rehabilitation staff were trained to deliver problem-solving therapy for primary care (PST-PC) over the telephone to adults with depressive symptoms and low vision. Training was a 2-day workshop, completion of training cases, and assessment of treatment fidelity. Staff perspectives of training and challenges in PST-PC delivery were explored. Telephone-administered semi-structured interviews were conducted pre- and post-workshop and following PST-PC competency. In all, 14 staff (mean age = 47.64 years, SD = 12.68 years, 93% females) achieved competency and 6 withdrew. Results showed an increased understanding of PST-PC from pre- to post-workshop ( Z = −2.71, p = .007) and pre-workshop to post-competency ( Z = −3.09, p = .002). A high level of satisfaction with training was reported. Staff challenges included the clients' ability to define problems and brainstorm solutions. Training enabled staff to competently deliver PST-PC and may serve as a model for integrating depression care into vision rehabilitation services recommended by international guidelines.
Introduction The purpose of the study was to determine whether personality traits influence self-reported functional vision in patients with age-related macular degeneration (AMD). Methods This is a prospective cross-sectional analysis of baseline data from the Low Vision Depression Prevention Trial. Participants ( N = 182) over age 65 with bilateral AMD, visual acuity worse than 20/70 in the better-seeing eye, and subthreshold depression were recruited from the Wills Eye Hospital retina practice. Assessments included visual acuity, contrast sensitivity, National Eye Institute Visual Function Questionnaire–25 plus Supplement (NEI VFQ–25) near and distance subscales, depression, and personality testing. Structural equation models were used to investigate the relationship of the NEI VFQ near activities and distance activities with the various demographic, clinical, and psychological predictors. Results In the single-predictor model for near functional vision, visual acuity at logMAR ≤ 1 (estimate = −0.33 [95% confidence interval {CI} −0.46, −0.20]; p ≤ 0.001), neuroticism (estimate = −0.05 [95% CI −0.08, −0.01]; p = 0.01), and education (estimate = −0.08 [95% CI 0.01, 0.15]; p = 0.03) were statistically significant predictors. In the single-predictor model for distance functional vision, only visual acuity at logMAR ≤ 1 (estimate = −0.49 [95% CI −0.69, −0.29]; p ≤ 0.001) and neuroticism (estimate = −0.09 [95% CI −0.15, 0.02]; p = 0.008) were statistically significant predictors. Discussion: Self-reported functional vision depends on the severity of vision loss as well as the personality trait of neuroticism. Implications for practitioners Assessment of personality traits, particularly neuroticism, may increase the precision of rating scales of functional vision and suggest new rehabilitative interventions to improve the functional vision and quality of life of patients with AMD.
