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N. Oestreicher, C. Stuen, M. Brennan; The Patient Impact of Age-Related Macular Degeneration: Focus on Mental Health. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4477.
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To evaluate the impact of age-related macular degeneration (AMD) on the mental health of patients over an 18-month period
The study population comprised 384 AMD vision rehabilitation patients ≥65 years at Lighthouse International from 1998-2004. We evaluated binocular Snellen best corrected distance acuity (BCVA) and functional vision (Functional Vision Questionnaire). For mental health outcomes, we summed 4 items from the National Eye Institute Visual Functioning Questionnaire-25 to create the VFQ-25 mental health score (VFQ-25 MS) and used the Center for Epidemiologic Studies Depression Scale (CES-D). Assessments were at baseline and 6, 12 and 18 months post-baseline.
Mean raw BCVA scores increased and functional vision decreased steadily over the study period. The mean VFQ-25 MS decreased from baseline (13.60 ± 3.79) to 6 months (immediately post-receipt of vision rehabilitation services) (13.24 ± 3.94) and to 12 months (13.21 ± 3.99), and returned to baseline levels at 18 months (13.61 ± 3.98). Depressive symptoms (CES-D) exhibited a similar pattern to the VFQ-25 MS over the study period. At individual assessment timepoints, there was a statistically significant association (p-value=0.0001) between impaired functional vision and poor VFQ-25 MS. AMD patients with a large discrepancy between BCVA and functional vision status experienced the highest levels of mental health problems and depression as measured by the VFQ-25 MS and CES-D, respectively. On individual items contributing to the VFQ-25 MS, patients with poorer functional vision experienced significantly greater feelings of frustration, loss of control, worry over potential embarrassment, and frequent worrying (each p-value<0.05) compared to those with better functional vision. Unlike the VFQ-25 MS, CES-D scores were not associated with BCVA or functional vision. BCVA and the VFQ-25 MS were also not associated.
Among AMD patients, decrements in functional vision over time may be paralleled by declines in mental health. The finding of the highest levels of mental health problems and depression experienced by those with the greatest discrepancy between BCVA and functional vision is novel and should be confirmed.
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