Anxiety and depression in patients with advanced macular degeneration: current perspectives.

Age-related macular degeneration (AMD) - despite advances in prevention and medical treatment options - remains prevalent among older adults, often resulting in functional losses that negatively affect the mental health of older adults. In particular, the prevalence of both anxiety and depression in patients with AMD is high. Along with medical treatment options, low vision rehabilitation and AMD-specific behavioral and self-management programs have been developed and have demonstrated effectiveness in improving the mental health of AMD patients. This article reviews the prevalence of anxiety and depression in patients with advanced AMD, discusses potential mechanisms accounting for the development of depression and anxiety in AMD patients, presents the state-of the-art of available interventions for addressing anxiety and depression in AMD patients, and delineates recommendations for eye care professionals regarding how to screen for these two prevalent mental health problems and how to facilitate appropriate treatment for patients with AMD

Rehabilitation needs and activity limitations of adults with a visual impairment entering a low vision rehabilitation service in England

Purpose- To evaluate outcome measures of the Participation and Activity Inventory (PAI) in a sample of adults with acquired visual impairment entering vision rehabilitation. Both Priority Scores, indicating level of rehabilitative need, and Person Measures, indicating goal difficulty, were considered. Methods- Participants were newly registered adults with visual impairment within Leicestershire, United Kingdom. The importance and difficulty of 48 goals of the PAI were assessed, as were demographic factors, clinical visual function (visual acuity, contrast sensitivity, reading function) and psychosocial function (adjustment to visual loss, depression, anxiety and fear of falling). Priority scores were calculated as the product of importance and difficulty of each goal. All questionnaires were Rasch analysed, and person and item measures of perceived difficulty with goals were derived. Results- Sixty people (mean age ± S.D. = 75.8 ± 13.8 years) took part. PAI goals with greatest rehabilitative need were reading (6.82 ± 2.91), mobility outdoors (6.55 ± 3.92), mobility indoors within an unfamiliar environment (5.52 ± 3.93) and writing (5.27 ± 3.02). Greater rehabilitative need was associated with younger age (β = −0.46, p < 0.001), and with higher depressive symptomatology (β = 0.35, p < 0.01; model R2 34%). Goals with greatest difficulty were mending clothing (−1.95 ± 0.35 logits) and hobbies and crafts (−1.32 ± 0.23 logits). Greater difficulty was associated with higher depressive symptomatology (β = 0.39, p < 0.001), lower visual acuity (β = 0.42, p < 0.001) and lower adjustment of visual loss (β = 0.31, p < 0.01; model R2 53%). Conclusions- Key rehabilitation needs for adults at entry to services require both optical and non-optical interventions. As rehabilitative need was not associated with the level of visual impairment, eyecare professionals should not wait until the end of medical treatment before referral for support. Similarly, rehabilitative need was associated with younger age, indicating the importance to refer younger people with sight loss at an early stage. The use of structured assessment, such as the PAI, ensures goals that have an impact upon quality of life are specifically identified. Depression screening on entry to rehabilitation is relevant as it predicts both perceived difficulty and rehabilitative need

Coping strategies, vision-related quality of life, and emotional health in managing retinitis pigmentosa: a survey study.

Background Retinitis pigmentosa is a group of genetic progressive retinal dystrophies that may adversely affect daily life. Those with RP should develop adaptive coping strategies to manage their condition. This study investigates the relationship between engaging (ECS) and disengaging coping strategies (DCS), vision-related quality of life (VRQoL), and emotional health, in adults living at home with retinitis pigmentosa. Method One hundred and five participants (70 female; meanage of 46.98, SD age  = 13.77) completed a cross-sectional survey. The questionnaire booklet consisted of the Coping Strategies Inventory – Short Form (32 items), the National Eye Institute Visual Functioning Questionnaire 25 (25 items), Marylands Trait Depression Scale (18 items), the Warwick-Edinburgh Mental Well-being Scale (14 items), and the Subjective Happiness Scale (4 items). Results Data was analysed with a two-block hierarchical multiple regression, with the first block controlling for the demographic data (age, sex, years since retinitis pigmentosa diagnosis, number of comorbidities, participant-perceived retinitis pigmentosa severity, and knowing RP type) and the second block consisting of primary measures (type of coping strategy, VRQoL, and Emotional Health). Type of coping strategy was found to impact psychosocial variables of VRQoL, not overall VRQoL. These psychosocial VRQoL variables had a positive association with ECS and a negative association with DCS. Emotional Health increased with ECS and decreased with DCS. There was a larger impact of DCS on VRQoL and Emotional Health compared to ECS, that is, VRQoL and Emotional Health decreased more with increasing DCS than VRQoL, and Emotional Health increased with increasing ECS. Conclusion In concordance with previous research, ECS increased with increasing VRQoL and DCS decreased with increasing VRQoL. However, the findings also indicated that DCS had a greater impact than ECS on VRQoL and Emotional Health. This suggests that diminishing DCS should be prioritised over developing ECS to positively influence VRQoL and Emotional Health. Further research should investigate the impact of reducing DCS compared to increasing ECS, and how this may influence VRQoL and Emotional Health.N/

The impact of perceived overprotection on adjustment to age-related vision loss

The primary goal of the present study was to investigate the impact of perceived overprotection, a negative social network variable, and other social support variables, namely instrumental, affective, and negative support, on the adjustment to age-related vision loss in a sample of recently visually impaired elders 65 years of age and older (N = 400). Optimal adjustment was operationalized as having high environmental mastery and high scores on a vision-specific adaptation measure. Another goal of the present study was to test gender differences in the impact of overprotection on adjustment. Results gained from path analysis demonstrated that functional disability, stemming from vision loss and other co-morbid health conditions, significantly positively impacted social support variables (overprotection, affective support, and instrumental support) and significantly negatively impacted the two indicators of adjustment. In addition, higher levels of overprotection led to decreased mastery and lower scores on the vision specific adaptation measure. Higher overprotection was predicted by both higher levels of instrumental support and higher levels of negative support. All social support variables taken together mediated the impact of functional disability on the outcome variables, but individually they did not. Moreover, higher mastery was predicted by lower levels of both negative support and overprotection, but was unaffected by instrumental and affective support. In contrast, higher scores on the vision specific adaptational measure were predicted by lower levels of overprotection and affective support and by higher levels of instrumental support. Finally, results could not establish any gender differences in regard to the impact of overprotection on outcomes. The results from this research have practical implications for the development and design of vision rehabilitation services, which aim to teach visually impaired individuals to maximize their functional ability and to enable them to lead more independent lives despite a disability. Such social support interventions can address issues around overprotection as well as the potential risks surrounding this mode of social exchange

Sensory impairments and their associations with functional disability in a sample of the oldest-old

PURPOSE: Research focusing on the consequences of sensory impairments for the everyday competence of the oldest-old is emerging. The two main goals of this study were to document the prevalence of self-reported vision, hearing, and dual sensory impairment and to explore associations of these impairments with functional disability in near-centenarians and centenarians. METHODS: Centenarians and near-centenarians (N = 119; average age = 99) were recruited, with about 80% living in the community. In-person interviews included self-ratings of vision and hearing impairment and functional disability conceptualized as having difficulties performing personal and instrumental activities of daily livings (PADLs and IADLs). RESULTS: Based on self-report ratings, 17% of participants were classified as having a visual impairment only, 18% as having a hearing impairment only, and 38% with both a visual and hearing impairment (dual sensory impairment). Regression analyses demonstrated that having a vision impairment only and being dual sensory impaired were the strongest predictors of functional disability. They were associated with higher levels of functional disability over and above higher levels of depressive symptomatology, interference of health with desired activities, and living in a nursing home. CONCLUSIONS: Sensory impairments-especially dual sensory impairment-are prevalent in the oldest-old. Having dual sensory impairment or a single visual impairment among other factors are strongly associated with less-optimal everyday functioning in the oldest-old