Abstract
Purpose :
Leber Hereditary Optic Neuropathy (LHON) is a mitochondrial optic neuropathy characterised by bilateral subacute central visual loss. The visual prognosis is poor. The majority of patients achieve visual acuities worse than 20/200. Anxiety and depression can compound the loss of visual function in LHON patients, exerting further detrimental effects on quality of life (QoL).
The aims of this study were to:
1. Assess vision-related QoL using the validated Visual Function Index-14 (VF-14) and National Eye Institute Visual Function Questionnaire-25 (VFQ-25).
2. Screen for anxiety and depression using the Hospital Anxiety and Depression Scale (HADS).
Methods :
A standardised telephone interview, which included the VF14, VFQ25 and HADS, was conducted on 50 affected LHON patients and 28 unaffected LHON carriers.
Results :
The mean VF-14 and VFQ-25 scores (± standard deviation (SD)) were significantly lower in affected patients compared with unaffected carriers (VF-14: 29.4 ± 24.0 vs 98.6 ± 2.51, p < 0.001; VFQ-25: 48.3 ± 19.8 vs 92.9 ± 4.23, p < 0.001). 54% of LHON patients were found to be anxious based on the HADS-Anxiety (HADS-A) score and 28% of LHON patients were depressed based on the HADS-Depression (HADS-D) score. The mean HADS-A (7.48 ± 3.9) and HADS-D (5.72 ± 4.13) scores for LHON patients were greater than the general population scores of 6.14 ± 3.76 and 3.68 ± 3.07, respectively. The mean HADS-D score for LHON patients was significantly greater compared with unaffected carriers (3.68 ± 3.06, p= 0.024). In affected patients, the duration of disease correlated moderately with VF-14 and VFQ-25 scores (both r = 0.49, p < 0.001), as well as the HADS-D score (r= -0.41, p = 0.003).
Conclusions :
Vision-related QoL is significantly reduced in LHON patients who also have higher levels of depressive symptoms compared to unaffected carriers. Vision-related QoL and depressive symptoms correlate with disease duration, suggesting that both may improve as patients adapt to chronic disability. HADS-A and HADS-D scores of LHON patients are higher compared to the general population, highlighting their increased risk of anxiety and depression. Addressing mental health concerns and promoting enabling skills and strategies that overcome role limitations may improve QoL and mood in LHON patients.
This is a 2021 ARVO Annual Meeting abstract.