Abstract
Purpose :
AMD has significant psychosocial impact, with increased emotional distress and depression and reduced quality of life. There is retrospective evidence that people with poor treatment outcomes have higher rates of depression (Casten et al, 2009). The purpose of this study was to examine determinants of perceived stress and depression after anti-VEGF treatment in people with AMD and assess differences between treatment and observation groups.
Methods :
Patients with AMD were recruited during visits for anti-VEGF treatment or evaluation. Visual acuity (VA) with habitual correction was assessed using an ETDRS chart at the start of treatment and 8-12 weeks later. The Perceived Stress Scale (PSS), short form Center for Epidemiological Studies Depression scale (CES-D), ENRICHD Social Support Inventory (ESSI), and Impact of Vision Impairment scale (IVI) were administered at each visit. Rasch analysis was used to score all surveys. Relationships among changes in VA, IVI, PSS, and CES-D were analyzed using linear regression, adjusting for age, gender, education, and comorbidities.
Results :
One hundred-fourteen participants (55 receiving anti-VEGF treatment and 59 being monitored but without active disease) were enrolled. Mean age ± SD was 82 ± 9 years, 54% were female. Median (IQR) better eye VA at baseline was 65 (29) (approximately 20/50). 25% of subjects gained >1 line of VA and 14.6% lost >1 line. IVI, PSS, and CES-D all increased slightly from baseline. Baseline depression was associated with self reported visual functioning (p=0.002). Negative changes in visual functioning were related to higher perceived stress at follow-up (P=0.007). Baseline social support was associated with change in depression with treatment (p=0.05). We found no relationship between visual acuity treatment outcome and stress or depression. There was no difference in depression or perceived stress score at baseline between treatment and observation groups.
Conclusions :
Greater social support at initiation of anti-VEGF treatment was associated with reduced depression at follow-up. Decrease in self-reported visual functioning was related to higher stress level at follow-up, while VA change was not. Our findings indicate the importance of assessing these factors during treatment and considering interventions to improve functioning and psychological outcomes.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.