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  • Integrated Therapies Halve AMD-Related Low Vision Depression

    Reviewed By Abdhish R Bhavsar MD
    Jul. 10, 2014

    Low vision is a visual impairment that interferes with a person's ability to perform everyday tasks and cannot be corrected with glasses, contact lenses, medicine or surgery. This can be caused by eye diseases, such as age-related macular degeneration (AMD), diabetic retinopathy or glaucoma.

    Vision Simulator: Age-related macular degeneration

    People with low vision may have trouble performing daily tasks such as grocery shopping, reading or watching TV. They are also more likely to develop depression, which is associated with higher levels of disability, medical costs and mortality.[1] Unfortunately, many people with depression forego treatment because they believe depression shows personal failure or believe it may be an expected part of aging. In addition, many individuals don't know where to turn for specialty care, or may have physicians who lack the resources to diagnose and treat depression.[2]

    Currently, the most common treatment for low vision due to AMD is low vision rehabilitation. This treatment involves the assessment of a patient's functional vision, recommendation of vision-assisting devices and instruction in the use of these devices, but it does not include any form of psychological support for the patient.

    Recently, researchers investigated the value of combining psychological therapy and low vision rehabilitation to lower the rate of depression in patients with AMD-related low vision. They studied 188 patients, averaging 84 years of age, with AMD in both eyes and early signs of depression. This was the first clinical trial to look at the value of integrated therapies for this population.

    As part of the study, each participant received two sessions of low vision rehabilitation in clinics. Then the patients were randomly assigned to two types of psychological therapy: behavior activation or supportive therapy, both of which included six one-hour sessions in the patient's home.

    Behavior activation promotes self-sufficiency and social connections to improve mood and counter withdrawal. In the context of low vision occupational therapy, this involves environmental modifications, such as marking specific temperatures on the thermostat with high-contrast markers, and aims to improve functional vision as well as help patients achieve valued personal and functional goals. Supportive therapy, on the other hand, facilitates personal expression about illness, disability and vision loss.

    After four months, the researchers found that the incidence of depression was half in the behavior activation group (at 12.6 percent) than it was in the supportive therapy group (at 23.7 percent). The rate of depression found in the supportive therapy group was similar to that reported in the absence of any treatment.

    The American Academy of Ophthalmology encourages ophthalmologists to provide information about rehabilitation resources to patients with vision loss and, when available, referral to multidisciplinary rehabilitation and group support that focuses on social activation, problem-solving and self-management skills.

    Learn more about this study in the Academy's newsroom.

    See also: Low vision resources


    [ii] Lebowitz B, Pearson J, Schneider L, et al. Diagnosis and treatment of depression in late life: consensus statement and update. JAMA 1997; 278: 1186 – 90.