By Eric B. Suhler, MD, MPH
This study investigated the level of depression among patients with ocular inflammatory disease and risk factors associated with depression in this population. The authors report in the February issue of the American Journal of Ophthalmology that 26.9 percent of patients included in the study screened positive for depression, of whom only 39 percent had been previously diagnosed. Additionally, worse visual function was associated with depression. They conclude that depression may be a significant but under-recognized and undertreated comorbidity in inflammatory eye disease.
They note that the percentage of patients screening positive for depression was higher than in the the general population (10 percent) but similar to reported rates for other chronic ocular diseases, such as AMD, retinitis pigmentosa and newly diagnosed glaucoma.
Uveitis is known to negatively impact both physical and mental health, while some of the treatments for inflammatory disease, such as corticosteroids, are known to exacerbate psychiatric disease, including depression and anxiety.
Subjects in the study were 104 consecutive noninfectious ocular inflammatory disease patients of a tertiary referral center. They completed tests to measure quality of life (National Eye Institute Visual Function Questionnaire-25, NEI-VFQ 25) and depression (Beck Depression Inventory II, BDI II) and answered supplemental questions.
NEI VFQ-25 scores were significantly lower in depressed patients for all subscales except driving and color vision. Depressed mood correlated with decreased visual quality of life as measured with the NEI VFQ-25. Risk factors predicting depression were inadequate emotional support, worse visual function, history of changing immunosuppressive therapy and current oral corticosteroid use. In addition, depression was more common among those with chronic or bilateral disease.
Self-reported visual function and clinically measured visual acuity were both associated with higher BDI-II scores, although composite NEI VFQ-25 score was identified as a better predictor by multivariate regression. These results support the authors' clinical impression that Snellen acuity does not fully characterize visual disability.
Nearly half of the patients felt that a uveitis support group would be beneficial, although only 15 percent were actually participating in one.
The authors recommend the consideration of depression screening and heightened awareness of potential depression in patients with ocular inflammatory disease. Patient support groups and Internet-based resources also may be helpful.