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R.W. Bremer, T.R. Friberg, S. Mazumdar, N.L. Oden, AREDS Research Group; The Relation Between Depression and Visual Functioning. The AREDS Study . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1916.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To investigate the prevalence of depressive symptoms and the relation between depression and self–reported vision functioning as measured by the National Eye Institute Visual Functioning Questionnaire (NEI–VFQ) in patients with age–related macular degeneration (AMD). Methods: The NEI–VFQ was administered concurrently with a standardized set of cognitive function measures, as well as the Center for Epidemiological Studies Depression (CES–D) Scale to participants of the Age–Related Eye Disease Study (AREDS) after an average of 5 years of follow–up. A CES–D score > 16 was defined as a major depressive episode and participants with a CES–D score from 12–15 were considered to have significant symptoms of depression. Severity of AMD was categorized into three groups based on central grading of stereoscopic fundus photographs. Results: Of the 4757 AREDS participants, 970 completed the initial cognitive assessment battery, including the CES–D, concurrently with the NEI–VFQ and fundus photography. Overall, 11% of the study sample had a probable major depressive episode, while another 14% had significant symptoms of depression. A major depressive episode was more common in persons with more severe AMD (p<0.01). Among study participants with no evidence of AMD (few or no drusen) at the time of cognitive assessment, 9% had a probable major depressive episode, while for those with advanced AMD in one eye the rate was 13% and for those with advanced AMD in both eyes the rate was 17%. A significant association between a major depressive episode and overall VFQ score was found using a general linear model adjusted for worst eye visual acuity, macular degeneration severity, gender, and age (Mean Overall VFQ score=78.2 for CESD ≥ 16 versus Mean Overall VFQ score=86.2 for CES–D <16; p<0.001). Conclusions: Previous small studies have demonstrated high rates of depression in patients with visual impairment from macular degeneration. AREDS participants with advanced AMD also were more likely to have evidence of depression than those without evidence of AMD. Processes to screen for depression should be considered for patients with worsening AMD. Further, this study supports the hypothesis that depression is associated with poorer self–reported visual functioning.
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