Association Between Visual Impairment and Depression in Patients Attending Eye Clinics: A Meta-analysis

The lifestyle and nutritional factors for dry eye disease in depression population: a retrospective case-control study

Background

We aim to evaluate lifestyle and nutritional factors that lead to dry eye disease (DED) in a depressed population using data from the Taiwan BioBank (TWB).

Methods

A retrospective case-control study was conducted, and patients with depression based on a questionnaire were selected as the depression group. Each patient in the depression group was matched by age and sex to two individuals without depression, and a total of 3,754 and 7,508 patients constituted the depression and non-depression groups, respectively. Based on the questionnaire, the primary outcome was the presence of DED. Additionally, the chi-square test and interaction test were applied to survey the effect of lifestyle and nutritional factors on DED in the depression and non-depression groups.

Results

There were 822 (21.90%) and 958 (12.76%) DED patients in the depression and non-depression groups, respectively, and the incidence of DED was significantly higher in the depression group (p < 0.001). In terms of lifestyle and nutritional factors in the depression population, a higher rate of chronic pain and a sedentary lifestyle were observed than in the patients with depression without DED (both p < 0.05). According to the interaction test, the chronic pain (p = 0.0227) and sedentary lifestyle (p = 0.0002) were significant risk factors for DED presence in the depression group than in the non-depression group, while the persistent coffee consumption (p = 0.0005) and tea consumption (p = 0.0003) were significant protective factors for the DED exclusively for the depression group and not for the non-depression group.

Conclusion

The depression population could be significantly benefited from physical activity, coffee intake and tea intake regarding DED development compared to the general population.

Causal Relationships Between Retinal Diseases and Psychiatric Disorders Have Implications for Precision Psychiatry

Observational studies and clinical trials have reported potential associations between retinal diseases and psychiatric disorders. However, the causal associations between them have remained elusive. In this study, we used bi-directional two-sample Mendelian randomization (MR) analysis to explore unconfounded causal relationships between retinal diseases and psychiatric disorders using large-scale genome-wide association study (GWAS) summary statistics of over 500,000 participants of European ancestry from the FinnGen project, the Psychiatric Genomics Consortium, the European Bioinformatics Institute, and the UK Biobank. Our MR analysis revealed significant causal relationships between major retinal diseases and specific psychiatric disorders. Specifically, susceptibility to dry age-related macular degeneration was associated with a reduced risk of anorexia nervosa (OR = 0.970; 95% CI = 0.930 ~ 0.994; P = 0.025). Furthermore, we found some evidence that exposure to diabetic retinopathy was associated with an increased risk of schizophrenia (OR = 1.021; 95% CI 1.012 ~ 1.049; P = 0.001), and exposure to retinal detachments and breaks was associated with an increased risk of attention deficit hyperactivity disorder (OR = 1.190; 95% CI 1.063 ~ 1.333; P = 0.003). These causal relationships were not confounded by biases of pleiotropy and reverse causation. Our study highlights the importance of preventing and managing retinal disease as a potential avenue for improving the prevention, management and treatment of major psychiatric disorders.

Structural validity of the impact of vision impairment questionnaire among patients with visual impairment in Thailand

Background

The Impact of Vision Impairment (IVI) questionnaire is used to assess vision-related quality of life (VRQOL) among patients with visual impairment. This study aims to evaluate the factor structure of the IVI in the context of Thai culture to assess psychometric properties.

Methods

This cross-sectional study was conducted between February and July 2022. Purposive sampling was used to include 502 patients with visual impairment who received treatment at a tertiary eye center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. The data were collected using the interviewer-administered questionnaire. The participants were randomly divided into two groups: one employed for exploratory factor analysis (EFA; n = 251) and the other for confirmatory factor analysis (CFA; n = 251).

Results

EFA yielded 28 items that supported a four-factor structure: behaviors related to mobility and independence (8 items), reading (3 items), self-dependence (7 items), and emotional impact of vision loss (10 items), with a total variance of 64.9 %. The model fit was good: χ2/df = 1.66, CFI = 0.949, TLI = 0.940, RMSEA = 0.052, and SRMR = 0.041. The AIC and BIC for the bifactor four-factor model (17,484.86 and 17,879.41, respectively) were lower than those for the bifactor three-factor model (17,566.44 and 17,961.29, respectively), indicating that the former showed the best fit.

Conclusions

Given its good reliability and validity, the IVI scale has been extensively used to explore the impact of visual impairment on the VRQOL of patients in the clinical setting, thus greatly benefitting researchers, healthcare providers, and ophthalmologists.

The multiple mediating effects of vision-specific factors and depression on the association between visual impairment severity and fatigue: a path analysis study

BACKGROUND

Severe fatigue is a common symptom for people with visual impairment, with a detrimental effect on emotional functioning, cognition, work capacity and activities of daily living. A previous study found that depression was one of the most important determinants of fatigue, but less is known about disease-specific factors in this patient population. This study aimed to explore the association between visual impairment severity and fatigue in adults with low vision, both directly and indirectly, with vision-specific factors and depression as potential mediators.

METHODS

Cross-sectional data were collected from 220 Dutch low vision service patients by telephone interviews. Fatigue was defined as a latent variable by severity and impact on daily life. Potential mediators included vision-related symptoms, adaptation to vision loss and depression. Hypothesized structural equation models were constructed in Mplus to test (in)direct effects of visual impairment severity (mild/moderate, severe, blindness) on fatigue through above mentioned variables.

RESULTS

The final model explained 60% of fatigue variance and revealed a significant total effect of visual impairment severity on fatigue. Patients with severe visual impairment (reference group) had significantly higher fatigue symptoms compared to those with mild/moderate visual impairment (β = -0.50, 95% bias-corrected confidence interval [BC CI] [-0.86, -0.16]) and those with blindness (β = -0.44, 95% BC CI [-0.80, -0.07]). Eye strain & light disturbance, depression and vision-related mobility mediated the fatigue difference between the severe and mild/moderate visual impairment categories. The fatigue difference between the severe visual impairment and blindness categories was solely explained by eye strain & light disturbance. Moreover, depressive symptoms (β = 0.65, p < 0.001) and eye strain & light disturbance (β = 0.19, p = 0.023) were directly associated with fatigue independent of visual impairment severity.

CONCLUSIONS

Our findings indicate an inverted-U shaped relationship between visual impairment severity and fatigue in patients with low vision. The complexity of this relationship is likely explained by the consequences of visual impairment, in particular by strained eyes and depressive mood, rather than by severity of the disability itself.

Effect of visual impairment on depression and anxiety during the COVID-19 pandemic in the United States

OBJECTIVE

To evaluate associations between visual impairment, anxiety, and depression during the COVID-19 pandemic in the US.

DESIGN

Retrospective cross-sectional METHODS: This study included a cohort of US adults enrolled in the National Institute of Health All of Us Research Program. Individuals who were blind/visually impaired (BVI) were identified via SNONMED codes and compared to a control cohort. Prevalence of baseline, new, and worsened depression and anxiety, as defined by SNONMED codes and medication use were compared between the two groups. Anxiety and depression during the COVID-19 pandemic were evaluated using the Generalized Anxiety Disorder 7 and the Patient Health Questionnaire 9 survey, respectively.

RESULTS

324,915 participants, (7,526 BVI individuals and 317,389 controls) were included. BVI individuals had higher prevalence of baseline anxiety and depression (50.4% vs. 28.7%, p<0.001), new anxiety and depression (0.98% vs. 0.66%, p<0.001), and worsened anxiety and depression throughout the COVID-19 pandemic (0.19% vs. 0.07%, p<0.001) compared to controls. Being BVI was significantly associated with baseline and worsened anxiety and depression, after controlling for age, gender, race, ethnicity, and comorbidity (adjusted odds ratio (aOR)=1.61; 95% CI 1.46-1.78, aOR=2.07; 95% CI 1.03-4.13). Similarly, being BVI was associated with a 2.07-point increase on the GAD-7 survey (adjusted beta=2.07; 95% CI 1.32-3.27) and a 2.96-point increase on the PHQ-9 survey (adjusted beta=2.96; 95% CI 1.64-5.36).

CONCLUSIONS

These findings indicate that BVI individuals are disproportionately affected by anxiety and depression at baseline and throughout the pandemic, highlighting an important need to promote access to mental health services among this population.

Eye disorders associated with selective serotonin reuptake inhibitors: a real-world disproportionality analysis of FDA adverse event reporting system

BACKGROUND

Selective serotonin reuptake inhibitors (SSRIs) are widely used in depression and other psychiatric disorders. Despite their efficacy, there is a growing concern about the risk of eye disorders. This study aims to explore the potential correlation between eye disorders and SSRIs utilizing real-world data.

RESEARCH DESIGN AND METHODS

The data were extracted from the US FDA Adverse Event Reporting System database from 2004Q1 to 2023Q3. The analysis focused on the clinical characteristics, the ranking of adverse reactions, the time-to-onset, and the severity proportion of SSRI-related eye disorders.

RESULTS

Our analysis revealed that SSRIs were significantly associated with eye disorders, with a higher risk of vision blurred with escitalopram, angle closure glaucoma with citalopram, and photopsia with paroxetine. The most common eye disorders were vision blurred, visual impairment, mydriasis, etc. Most of these adverse events occurred within the first 30 days of treatment. The reported incidence of severe eye disorders was 38.6% for SSRIs, with fluoxetine exhibiting the highest rate at 45.9%.

CONCLUSION

Our study demonstrates a significant association between SSRIs and the risk of eye disorders. These findings provide crucial insights for clinicians when prescribing SSRIs and underscore the need to monitor eye health in patients receiving these medications.

Association of vision and hearing impairment and dietary diversity among the oldest old in China: findings from the Chinese longitudinal healthy longevity survey

BACKGROUND

The presence of sensory impairment among older age cohorts exerts a significant impact on both individuals and society generally. Although the impact of dietary patterns on health is vital across all stages of life, there still a paucity of comprehensive research on the association between dietary variety and sensory impairments.

OBJECTIVE

To investigate the potential relationship between dietary diversity and the prevalence of visual and hearing impairment or dual sensory impairments (visual and hearing impairment) among the oldest old population.

METHODS

This is a cross-sectional study relied on data obtained from the 2018 survey conducted by the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Subjects aged 80 and older with complete vision and hearing data were included in the study. Multivariate logistic regression models were developed to examine the association between dietary components and visual and hearing impairment while controlling for age, gender, socioeconomic demographic factors, living habits, other food habits, and general health status.

RESULTS

The study included 10,093 participants, with an average age of 92.29 ± 7.75 years. Vision and hearing function were assessed based on the ability to distinguish the direction of the break in the circle and the requirement for hearing aids, respectively. Upon controlling for confounding variables, individuals with a greater Dietary Diversity Score (DDS, the number of food groups, range: 1-11) had a reduced likelihood of experiencing visual impairment (odds ratio [OR] = 0.944, 95% confidence interval [CI], 0.915-0.974) and dual sensory impairment (OR = 0.930, 95% CI, 0.905-0.955). In comparison to the low dietary variety group (insufficient dietary diversity, DDS < 4), the high dietary diversity group (sufficient dietary diversity, DDS ≥ 4) exhibited a decreased risk of visual impairment (OR = 0.820, 95% CI, 0.713-0.944) and dual sensory impairment (OR = 0.751, 95% CI, 0.667-0.846). However, no statistically significant correlation was observed between dietary diversity and the presence of only hearing impairment (OR = 0.924, 95% CI, 0.815-1.047) (P < 0.05). CONCLUSIONS AND IMPLICATIONS: The synthesis of research findings suggests that following diverse dietary patterns and healthy nutritional practices may be an effective and affordable way to prevent age-related decline in visual impairment and dual sensory impairment.

Depression, loneliness, and lower social activity as partial mediators of the association between visual impairment and cognitive decline

OBJECTIVES

Sensory impairment is a hypothesized risk factor for cognitive decline; however, the psychosocial pathways are not well understood. We evaluated whether the association between visual impairment (VI) and cognitive decline was partially mediated via depressive symptoms, loneliness, or social activity.

METHODS

We used data from 2601 older adults enrolled in the Memory and Aging Project in 1997 and the Minority Aging Research Study in 2004 with neuropsychological tests across five domains measured annually for up to 16 years. VI was assessed with the Rosenbaum Pocket Vision Screener. Depressive symptoms, loneliness, and social activity were self-reported using validated scales. We used structural equation models to estimate the associations of VI with baseline and change in cognitive function, directly and indirectly through each mediator (depressive symptoms, loneliness, and social activity). We evaluated mediation via "psychological distress" using a latent variable combining depressive symptoms and loneliness.

RESULTS

The association between VI and global cognitive decline was mediated via lower social activity (indirect effect) [95% confidence interval (CI)] of linear slope: -0.025 (-0.048, -0.011), via loneliness (-0.011 [95% CI: -0.028, -0.002]), and via psychological distress (-0.017 [95% CI: -0.042, -0.003]). We did not find sufficient evidence for mediation via depressive symptoms alone.

CONCLUSIONS

The harmful effect of VI on cognitive decline may be partially mediated through loneliness and lower social activity.

Physical and Psychosocial Challenges as Predictors of Vision Difficulty in Children: A Nationally Representative Survey Analysis

PURPOSE

To elicit associations between vision difficulties and physical or psychosocial challenges in children in the United States.

METHODS

Children aged 2-17 years old from the 2021 National Health Interview Survey with data pertaining to vision difficulty were included in our retrospective, population-based analysis. Our primary aim was investigating physical and psychosocial challenges as predictors of vision difficulty. Logistic regression models were performed on Stata version 17.0 (StataCorp LLC, College Station, Texas). Analyses were accompanied by an odds ratio (OR) and 95% confidence interval (CI).

RESULTS

A total of 7,373 children had data pertaining to their level of vision difficulty and were included in our sample. In our multivariable analysis, children with a good/fair (OR = 1.84, 95% CI = [1.31, 2.60], p < 0.01), or poor (OR = 5.08, 95% CI = [1.61, 16.04], p < 0.01) general health status had higher odds of vision difficulty relative to children with an excellent/very good health status. Furthermore, children with difficulties hearing (OR = 8.67, 95% CI = [5.25, 14.31], p < 0.01), communicating (OR = 1.96, 95% CI = [1.18, 3.25], p < 0.01), learning (OR = 1.93, 95% CI = [1.27, 2.93], p < 0.01), and making friends (OR = 1.94, 95% CI = [1.12, 3.36], p = 0.02) had higher odds of vision difficulty. Nonetheless, the following factors were only predictors of vision difficulty in our univariable analysis: requiring equipment for mobility (p < 0.01), experiencing anxiety (p < 0.01), and experiencing depression (p < 0.01).

CONCLUSION

Several factors pertaining to physical and psychosocial challenges in children are associated with vision difficulty. Future research should further explore potential causal links between vision difficulty and physical or psychosocial factors to aid in coordinating public health efforts dedicated to vision health equity.

Clinical characteristics of recurrent non-arteritic retinal artery occlusion

OBJECTIVES

To investigate the recurrent non-arteritic retinal artery occlusion (RAO) in the same or opposite eye.

METHODS

We searched the RAO registry at Seoul National University Bundang Hospital and included patients with recurrent RAO in the present study. Ophthalmic and systemic features were analysed to identify risk factors and visual outcomes.

RESULTS

Of the 850 patients in the non-arteritic RAO cohort, 11 (1.3%) experienced a second RAO recurrence, either in the same (5 patients; 0.6%) or opposite (6 patients; 0.7%) eye. The same eye group experienced an earlier recurrence (1-2 months, median 1 month) than the opposite eye group, where the time to recurrence was notably longer (8-66 months, median 22 months). Best corrected visual acuity (BCVA) in the same eye group decreased after the recurrence of RAO. In the same eye group, initial BCVA ranged from 20/200 to counting fingers (CF), while BCVA during RAO recurrence ranged from CF to hand motion. When RAO recurred in the opposite eye, the reduction in visual acuity was less severe than the reduction of the initial episode: initial episode ranged from 20/400 to light perception and recurrent episode ranged from 20/25 to 20/400. Patients exhibited varying degrees of carotid (81.8%) and cerebral (9.1%) artery occlusions. Additionally, one patient in each group (total 2 patients, 18.2%) experienced a stroke 6 months after RAO recurrence.

CONCLUSIONS

Since the RAO recurrences could lead to devastating visual impairment, it is essential to emphasise the importance of risk factor screening to patients while collaborating with neurologists and cardiologists.

Depression and Eye Disease-A Narrative Review of Common Underlying Pathophysiological Mechanisms and their Potential Applications

Background: Depression has been shown to be associated with eye diseases, including dry eye disease (DED), cataracts, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR). This narrative review explores potential pathophysiological connections between depression and eye disease, as well as its potential correlations with ocular parameters. Methods: A literature search was conducted in August 2022 in PUBMED, EMBASE, and PsycINFO. Published articles related to the subject were consolidated and classified according to respective eye diseases and pathophysiological mechanisms. Results: The literature reviewed suggests that common pathophysiological states like inflammation and neurodegeneration may contribute to both depression and certain eye diseases, while somatic symptoms and altered physiology, such as disruptions in circadian rhythm due to eye diseases, can also influence patients' mood states. Grounded in the shared embryological, anatomical, and physiological features between the eye and the brain, depression is also correlated to changes observed in non-invasive ophthalmological imaging modalities, such as changes in the retinal nerve fibre layer and retinal microvasculature. Conclusions: There is substantial evidence of a close association between depression and eye diseases. Understanding the underlying concepts can inform further research on treatment options and monitoring of depression based on ocular parameters.

Technological Perception with Rural and Urban Differentiation and Its Influence on the Quality of Life of Older People with Age-Related Macular Degeneration

The past decade has seen a global increase in population age, especially in developed countries, where aging involves visual diseases such as age-related macular degeneration (AMD), which severely affect quality of life (QoL) and mental health, as well as increase isolation and care costs. This study investigated how persons with AMD perceive the impact of technology use on their QoL, focusing on potential disparities between urban and rural contexts in Spain. Using a cross-sectional observational design, data from the 2020 National Statistics Institute's Disability, Personal Autonomy, and Dependency Situations Survey were analyzed, focusing on QoL aspects based on the WHO items of the WHOQOL-100 scale. The results revealed a generally positive perception of technology among participants, with urban residents perceiving technology's positive impact more favorably. Sex discrepancies in technology perception were also observed, as women exhibited a more positive outlook on technology's influence on QoL. The analysis of QoL aspects, such as 'Visibility', 'Learning', 'Mobility', and 'Domestic life', highlighted distinct challenges faced by rural and urban populations, underscoring the importance of context-specific approaches in technology interventions. However, these perceptions were intertwined with comorbidities, which can exacerbate AMD-related issues. Furthermore, this study explored the role of technology in enhancing QoL among older adults with AMD, examining how it influences daily activities and independence, particularly in the context of AMD management. This study concluded that developing more-inclusive policies tailored to the specific needs of persons with AMD, with special attention to environmental and sex differences, is imperative to enhance the positive impact of technology on their QoL.

Association between visual impairment and suicide: A systematic review and meta-analysis

Visual impairment severely impacts the life of the patients. In this study, we systematically reviewed studies on the potential relationship between visual impairment and suicidal behaviour, and conducted meta-analyses on the risk estimates. We searched 11 literature databases on 20 October 2022 and identified a total of 10 eligible studies with 5.8 million participants. Suicide behaviour was investigated according to three domains: suicide ideation, suicide attempt and suicide death. In the 10 eligible studies, seven reported data on suicide ideation, five reported data on suicide attempt, and three reported data on suicide death. All summary estimates extracted for use in the meta-analyses were adjusted estimates of association since we acknowledged that depression as well as other confounding factors may play an important role. We found that visual impairment was a significant risk factor of suicide ideation (OR 1.83; 95% CI: 1.40-2.40; p = 0.000012), suicide attempt (OR 2.62; 95% CI: 1.29-5.31; p = 0.0077) and suicide death (OR 7.00; 95% CI: 2.30-21.4; p = 0.000063). These high increases in risk of suicide from visual impairment underscore the importance of eye health on the overall mental health, and the potential devastating consequences of insufficient access to eye care, lack of treatment possibilities for any reason or low political priority of eye care.

Trends in the Prevalence of Common Retinal and Optic Nerve Diseases in China: An Artificial Intelligence Based National Screening

Purpose

Retinal and optic nerve diseases have become the primary cause of irreversible vision loss and blindness. However, there is still a lack of thorough evaluation regarding their prevalence in China.

Methods

This artificial intelligence-based national screening study applied a previously developed deep learning algorithm, named the Retinal Artificial Intelligence Diagnosis System (RAIDS). De-identified personal medical records from January 2019 to December 2021 were extracted from 65 examination centers in 19 provinces of China. Crude prevalence and age-sex-adjusted prevalence were calculated by mapping to the standard population in the seventh national census.

Results

In 2021, adjusted referral possible glaucoma (63.29, 95% confidence interval [CI] = 57.12-68.90 cases per 1000), epiretinal macular membrane (21.84, 95% CI = 15.64-29.22), age-related macular degeneration (13.93, 95% CI = 11.09-17.17), and diabetic retinopathy (11.33, 95% CI = 8.89-13.77) ranked the highest among 10 diseases. Female participants had significantly higher adjusted prevalence of pathologic myopia, yet a lower adjusted prevalence of diabetic retinopathy, referral possible glaucoma, and hypertensive retinopathy than male participants. From 2019 to 2021, the adjusted prevalence of retinal vein occlusion (0.99, 95% CI = 0.73-1.26 to 1.88, 95% CI = 1.42-2.44), macular hole (0.59, 95% CI = 0.41-0.82 to 1.12, 95% CI = 0.76-1.51), and hypertensive retinopathy (0.53, 95% CI = 0.40-0.67 to 0.77, 95% CI = 0.60-0.95) significantly increased. The prevalence of diabetic retinopathy in participants under 50 years old significant increased.

Conclusions

Retinal and optic nerve diseases are an important public health concern in China. Further well-conceived epidemiological studies are required to validate the observed increased prevalence of diabetic retinopathy, hypertensive retinopathy, retinal vein occlusion, and macular hole nationwide.

Translational Relevance

This artificial intelligence system can be a potential tool to monitor the prevalence of major retinal and optic nerve diseases over a wide geographic area.

Visual Impairment and Suicide Risk: A Systematic Review and Meta-Analysis

Importance

Suicide is a substantial public health concern that involves various recognized contributing factors. Sensory impairments, specifically visual impairment, are deemed potential risk factors. Nonetheless, comprehensive information about associated risk levels and underlying determinants remains limited.

Objective

To investigate the association between visual impairment and different aspects of suicide, including the assessment of risk levels and exploration of potential contributing factors.

Data Sources

An electronic search was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases from their inception to February 8, 2024.

Study Selection

All published studies were considered without restrictions on study design, publication date, or language.

Data Extraction and Synthesis

Two independent reviewers extracted the published data using a standardized procedure in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Random-effects meta-analyses were used to estimate pooled effect sizes. Multiple meta-regression analyses were conducted to identify potential factors contributing to the association between visual impairment and the risk of suicide.

Main Outcomes and Measures

The primary outcome measure was the odds ratio (OR) of suicidal behavior (including suicide attempt and suicide death) for individuals with visual impairment compared with those without. The secondary outcome measures were the pooled ORs of suicidal ideation and suicide death, respectively.

Results

A total of 31 population-based studies with 5 692 769 unique individuals (mean [SD] age, 48.4 [8.5] years; 2 965 933 females [52%]) were included. For 17 studies (5 602 285 individuals) that evaluated suicidal behavior, the pooled OR was 2.49 (95% CI, 1.71-3.63). For 21 studies (611 899 individuals) that assessed suicidal ideation, the pooled OR was 2.01 (95% CI, 1.62-2.50). For 8 studies (5 067 113 individuals) investigating the association between visual impairment and suicide death, the pooled OR was 1.89 (95% CI, 1.32-2.71). The multiple meta-regression model identified age group as a predictive factor associated with suicidal behavior, with the studies included suggesting that adolescents were at the highest risk. While this analysis showed moderate heterogeneity for suicide death, high heterogeneity was observed for suicidal behavior and suicidal ideation.

Conclusions and Relevance

The findings of this systematic review and meta-analysis support the association between visual impairment and increased risk of suicidal tendencies. The risk differed by age group, with a pronounced risk observed among adolescents.

The Association of Retinal Disease with Vision Impairment and Functional Status in Medicare Patients

Background: The association of neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO) with functional status in the general Medicare population are not well established. Objectives: This study examined patient-reported survey data linked with Medicare claims to describe the burden of these vision-threatening retinal diseases (VTRDs) among Medicare beneficiaries. Methods: Medicare Current Beneficiary Survey data linked with Medicare Fee-for-Service claims data from 2006 to 2018 were used in a nationally representative retrospective pooled cross-sectional population-based comparison study. Outcomes between community-dwelling beneficiaries with nAMD (n = 1228), DME (n = 101), or RVO (n = 251) were compared with community-dwelling beneficiaries without any VTRDs (n = 104 088), controlling for baseline demographic and clinical differences. Beneficiaries with a diagnosis of nAMD, DME, or RVO during the data year were included; those with other VTRDs were excluded. Outcomes included vision function and loss, overall functioning as assessed by difficulties with activities of daily living (ADLs) and instrumental ADLs (iADLs), anxiety/depression, falls, and fractures. Results: In patient cohorts with nAMD, DME, and RVO, approximately one-third (34.2%-38.3%) reported "a little trouble seeing" (vs 28.3% for controls), and 26%, 17%, and 9%, respectively, reported "a lot of trouble seeing/blindness" (vs 5% of controls). Difficulty walking and doing heavy housework were the most reported ADLs and iADLs, respectively. Compared with those without VTRDs, beneficiaries with nAMD had higher odds of diagnosed vision loss (odds ratio [OR], 5.39; 95% confidence interval, 4.06-7.16; P < .001) and difficulties with iADLs (odds ratio, 1.41; 95% confidence interval, 1.11-1.80; P = .005); no differences were observed for DME or RVO vs control. After adjusting for age, sex, race/ethnicity, poverty status, comorbidities, and other relevant covariates, nAMD, DME, and RVO were not significantly associated with anxiety/depression, falls, or fractures. Discussion: Patients with nAMD or DME were more likely to report severe visual impairment than those without VTRDs, although only those with nAMD were more likely to be diagnosed with vision loss. Conclusions: Patients with nAMD continue to experience more vision impairment and worse functional status compared with a similar population of Medicare beneficiaries despite availability of therapies like antivascular endothelial growth factor to treat retinal disease.

A retrospective big data study using healthcare insurance claims to investigate the role of comorbidities in receiving low vision services

Introduction

The aim was to examine the association between physical and mental comorbidity with receiving low vision services (LVS).

Methods

A retrospective study based on Dutch claims data of health insurers was performed. We retrieved data (2015-2018) of patients (≥18 years) with eye diseases causing severe vision loss who received LVS at Dutch rehabilitation organizations in 2018 (target group) and patients who did not receive LVS, but who received ophthalmic medical specialist care for glaucoma, macular, diabetic retinal and/or retinal diseases in 2018 (reference group). For examining the association between the patients' comorbidities and receiving LVS, multivariable logistic regression was used. The relative quality of five different models was assessed with the Akaike Information Criterion (AIC).

Results

The study population consisted of 574,262 patients, of which 8,766 in the target group and 565,496 in the reference group. Physical comorbidity was found in 83% and 14% had mental comorbidity. After adjustment for all assumed confounders, both physical and mental comorbidity remained significantly associated with receiving LVS. In the adjusted model, which also included both comorbidity variables, the best relative quality was found to describe the association between mental and physical comorbidity and receiving LVS.

Conclusions

Mental comorbidity seemed to be independently associated with receiving LVS, implying that the odds for receiving a LVS referral are higher in patients who are vulnerable to mental comorbidity. Physical comorbidity was independently associated, however, the association with receiving LVS might not be that meaningful in terms of policy implications. Providing mental healthcare interventions for people with VI seems warranted.

Use of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires for clinical decision-making and psychological referral in ophthalmic care: a multicentre observational study

OBJECTIVES

The aim of this study was to evaluate the influence of anxiety and depression on clinician decision-making in patients suffering from chronic eye disease in ophthalmological clinical practice.

DESIGN AND SETTING

This multicentre observational study, in collaboration with the WHO, included ophthalmologists and their patients affected by chronic eye disease. States of anxiety and depression were screened with specific questionnaires, the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), self-administered by patients before the visit. In the present analysis, we report data from three major eye care centres in Italy between 2021 and 2022.

PRIMARY AND SECONDARY OUTCOMES

To assess self-reported changes in ophthalmologists' clinical approach (communication style and their clinical-therapeutic strategies) and decisions after knowing questionnaire scores (primary aim), and to analyse the PHQ-9 and GAD-7 scores in patients with chronic eye diseases (secondary aim).

RESULTS

41 ophthalmologists and 359 patients were included. The results from PHQ-9 and GAD-7 scores showed critical depression and anxiety status scores (PHQ-9 ≥5 and GAD-7 ≥10) in 258 patients. In 74% of cases, no actions were taken by the ophthalmologists based on these scores; in 26% of cases, they changed their clinical approach; and in 14% of cases, they referred the patients for psychological/psychiatric evaluation.

CONCLUSIONS

States of anxiety and depression affect many patients with chronic eye conditions and need to be detected and managed early to improve patients' well-being. Providing ophthalmologists with knowledge of their patients' psychological conditions can change the clinical management and attitude towards referral for a psychological evaluation. Further studies are needed to expand our knowledge of how to raise awareness among ophthalmologists regarding multimorbidity of patients suffering from chronic eye diseases in order to achieve better clinical outcomes.

Visual Impairment and Low Vision Aids-A Comparison between Children and Adults

(1) Background: This study aims to highlight differences in the etiology and fitting of low vision aids in visually impaired children and adolescents in comparison to adults. (2) Methods: A retrospective data collection from visually impaired patients presenting to obtain assistive devices from 1 January 2016 to 30 April 2020 was conducted. A total of 502 patients were included. Inclusion criteria were a minimum age of 4 years and the chart notation of a best-corrected distance visual acuity in the patient record prior to the fitting of magnifying visual aids. (3) Results: Of the 502 patients, 147 (29.3%) were children under the age of 18 years. The most common cause of visual impairment in children was albinism, and in adults, it was age-related macular degeneration (AMD). Children showed better distance visual acuity, with a median of 0.88 logMAR (Logarithm of the Minimum Angle of Resolution) compared to 1.0 in adults (p = 0.001). Near visual acuity was also significantly better, with a median of 0.54 logMAR in children compared to 0.9 in adults (p < 0.001). Near and distance visual acuity were significantly improved by fitting magnifying visual aids (p < 0.001). After fitting, near visual acuity averaged 0.3 logMAR, and distance visual acuity, 0.7. The most commonly prescribed aids were optical vision aids, which 68.5% of the patients received; 43.8% received electronic aids. In children, optical aids were more frequently prescribed, and in adults, electronic and acoustic aids (p < 0.001). (4) Conclusion: Visually impaired patients can regain the ability to read and improve distance vision by using individually adapted and tested magnifying vision aids, often with optical aids alone. Differences between children and adults could be discovered in the etiology and severity of visual impairment, as well as in the provision type of low vision aids.

Nationwide trends in the prevalence and incidence of depressive disorders and their correlates among adults with disabilities in Korea from 2006 to 2017

BACKGROUND

Evidence suggests that people with disabilities are more likely to suffer from depression. Previous studies have focused on depressive disorders in specific disability types or age groups using small-scale cross-sectional samples. We investigated longitudinal trends in the prevalence and incidence of depressive disorders according to disability types and severity levels in the entire Korean adult population.

METHODS

The age-standardised prevalence and incidence of depressive disorders were investigated using National Health Insurance claims data from 2006 to 2017. The odds of depressive disorders by type and severity were examined using logistic regression after adjusting for sociodemographic characteristics and comorbidities based on merged 2006 to 2017 data.

RESULTS

Both the incidence and prevalence of depressive disorders were higher among the disabled than the non-disabled, with the prevalence gap being larger than the incidence gap. In regression analyses, adjusting for sociodemographic characteristics and comorbidities considerably reduced the odds ratios, particularly for incidence. The severity of disabilities was inversely associated with the incidence of depressive disorders. Brain injury and disabilities in major internal organs were associated with lower odds of developing depressive disorders than in non-disabled individuals.

CONCLUSIONS

A significant proportion of depressive disorders in disabled individuals are caused by financial hardships or comorbidities rather than disabilities themselves. We must pay special attention to those who cannot access healthcare services due to severe disabilities and those whose depressive disorders are misdiagnosed as intellectual disabilities. More research is required to elucidate the causal mechanisms underlying depressive disorders in people with various types and severities of disabilities.

Prevalence of depression in visually impaired children and adolescents: A systematic review and meta-analysis

The prevalence of depression among visually impaired or blind children and adolescents has not been systematically reviewed. This study aims to provide the prevalence of depression among visually impaired or blind children and adolescents. This systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (PRISMA) (2020) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. A systematic search of various online databases was done to identify and include studies reporting the prevalence of depression among visually impaired or blind children and adolescents (aged up to 20 years). A random-effects meta-analysis was used to estimate the pooled prevalence of depression. Heterogeneity was assessed using I² to explain heterogeneity meta-regressive analysis and subgroup analyses were done. With the finally selected 13 studies consisting of 822 participants, the overall pooled prevalence of depression or dysthymia among visually impaired children or adolescents was 14% (137/822 individuals, 95% CI = 9% to 20%), with high heterogeneity between studies (I² = 80.11%; P < 0.001). Five studies that expressed gender distribution showed a cumulative prevalence of diagnosed depressive disorders was 6.85% and 18.96%, respectively, for male (n = 219, I² = 47.52) and female (n = 116, I² = 60.6%) participants. In this systematic review and meta-analysis, we selected and analyzed 13 studies and estimated pooled prevalence of depression was 14% (95% CI = 9% to 20%), among visually impaired or blind children and adolescents.

Beyond vision:Cataract and health status in old age, a narrative review

Cataract is a leading cause of visual impairment in old age. Lens opacification is notoriously associated with several geriatric conditions, including frailty, fall risk, depression and cognitive impairment. The association is largely attributable to visual impairment, while other mechanisms, associated with extraocular comorbidity and lifestyle, might partly explain this correlation. Available literature suggests that cataract surgery may be effective in decreasing fall risk, improving depressive symptoms and limiting the risk of cognitive impairment and dementia incidence, although intervention studies on these outcomes are still limited. In this review we also emphasize the need to move from the concept of visual acuity to functional vision, especially in the context of the geriatric patient. Research is needed regarding the effect on the cited outcomes of different cataract treatment strategies, such as systematic bilateral versus monolateral surgery and use of different intraocular lenses.

Potential Properties of Natural Nutraceuticals and Antioxidants in Age-Related Eye Disorders

Eye health is crucial, and the onset of diseases can reduce vision and affect the quality of life of patients. The main causes of progressive and irreversible vision loss include various pathologies, such as cataracts, ocular atrophy, corneal opacity, age-related macular degeneration, uncorrected refractive error, posterior capsular opacification, uveitis, glaucoma, diabetic retinopathy, retinal detachment, undetermined disease and other disorders involving oxidative stress and inflammation. The eyes are constantly exposed to the external environment and, for this reason, must be protected from damage from the outside. Many drugs, including cortisonics and antinflammatory drugs have widely been used to counteract eye disorders. However, recent advances have been obtained via supplementation with natural antioxidants and nutraceuticals for patients. In particular, evidence has accumulated that polyphenols (mostly deriving from Citrus Bergamia) represent a reliable source of antioxidants able to counteract oxidative stress accompanying early stages of eye diseases. Luteolin in particular has been found to protect photoreceptors, thereby improving vision in many disease states. Moreover, a consistent anti-inflammatory response was found to occur when curcumin is used alone or in combination with other nutraceuticals. Additionally, Coenzyme Q10 has been demonstrated to produce a consistent effect in reducing ocular pressure, thereby leading to protection in patients undergoing glaucoma. Finally, both grape seed extract, rich in anthocyanosides, and polynsatured fatty acids seem to contribute to the prevention of retinal disorders. Thus, a combination of nutraceuticals and antioxidants may represent the right solution for a multi-action activity in eye protection, in association with current drug therapies, and this will be of potential interest in early stages of eye disorders.

Self-reported visual impairment and depression of middle-aged and older adults: The chain-mediating effects of internet use and social participation

Background

Visual impairment (VI) is a strong predictor of depression in middle-aged and older adults. However, the underlying mechanisms and pathways have not been well characterized. The purpose of this study was to determine whether Internet use and social participation mediate the effects of self-reported VI on depression.

Methods

The study used the fourth wave of cross-sectional data from the China Health and Retirement Longitudinal Study, including 19,766 Chinese adults. Depression was assessed according to the CES-D 10 International Scale. Logistic regression models were used to examine the relationship between self-reported VI and depression. While adjusting for relevant covariates, the PROCESS macro (model nos. 6 and 91) was used to assess the chain-mediating effects of Internet use and social participation.

Results

A total of 17,433 respondents were included in this study. The CES-D 10 results showed that 7,327 middle-aged and older adults had depressive symptoms, of whom 39.5% were male and 10.2% were ≥75 years old. 32.1% of respondents self-reported VI. Regression analysis showed a positive association between VI and depression, while Internet use and social participation had a negative predictive effect on depression. In the mediation analysis, the social participation pathway contributed the most to the total effect, accounting for 52.69% of it. The proportion of Internet use is 37.72%. When these two mediators were considered together in the full model, they accounted for 9.58% of the total effect of VI on depression.

Conclusion

Internet use and social participation were important mediators that mitigated the effects of VI on depression. Combined with previous evidence, online activities such as e-health and m-health can effectively promote disease monitoring and diagnosis, and various offline social participation activities can also play a role in regulating emotions. Therefore, Internet use and social participation factors may serve as relevant entry points for the development of intervention programs that may further improve the mental health of the visually impaired.

Association of Visual Health With Depressive Symptoms and Brain Imaging Phenotypes Among Middle-Aged and Older Adults

IMPORTANCE

Vision loss and depression are common conditions with major health implications. However, mechanisms of the association of visual health (across the full acuity spectrum) with depression remain unclear.

OBJECTIVE

To characterize the association between visual health and depression and investigate the association between depression and brain microstructure and macrostructure in subgroups divided by visual acuity.

DESIGN, SETTING, AND PARTICIPANTS

In the UK Biobank Study cohort, 114 583 volunteers were included at baseline from March to June 2006 to July 2010. Habitual distance visual acuity was examined using the logarithm of the minimum angle of resolution (LogMAR) characters. Depression was identified based on Patient Health Questionnaire (PHQ) or through an interview-based psychiatric diagnosis. Subgroup participants completed multimodal magnetic resonance imaging (MRI) of the brain and PHQ evaluation during the imaging visit after 2014. Data were analyzed from May 5 to August 9, 2022.

MAIN OUTCOMES AND MEASURES

Depression, depressive symptoms, and imaging-derived phenotypes from T1-weighted and diffusion MRI.

RESULTS

Of the 114 583 participants from the UK Biobank Study, 62 401 (54.5%) were women, and the mean (SD) age was 56.8 (8.1) years (range, 39-72 years). A 1-line worse visual acuity (0.1 LogMAR increase) was associated with 5% higher odds of depression (odds ratio, 1.05 [95% CI, 1.04-1.07]) after adjustment for age, sex, race and ethnicity, Townsend index, educational qualifications, smoking, alcohol consumption, obesity, physical activity, history of hypertension, diabetes, hyperlipidemia, and family history of depression. Of the 7844 participants eligible for MRI analysis, there were linear associations between PHQ score and the left volume of gray matter in supracalcarine cortex (coefficient, 7.61 [95% CI, 3.90-11.31]) and mean isotropic volume fraction (ISOVF) in the right fornix (cres) and/or stria terminalis (coefficient, 0.003 [95% CI, 0.001-0.004]) after correction for multiple comparison. In addition, their association could be moderated by visual acuity, whereby increased PHQ score was associated with higher ISOVF levels only among those with poorer visual acuity (P = .02 for interaction).

CONCLUSIONS AND RELEVANCE

This study suggests an association between visual health and depression and that the diffusion characteristic of ISOVF in the fornix (cres) and/or stria terminalis is associated with depressive symptoms in participants with poorer visual acuity.

Impact of Vision Impairment and Ocular Morbidity and Their Treatment on Depression and Anxiety in Children: A Systematic Review

TOPIC

This systematic review and meta-analysis summarizes existing evidence to establish whether vision impairment, ocular morbidity, and their treatment are associated with depression and anxiety in children.

CLINICAL RELEVANCE

Understanding and quantifying these associations support early detection and management of mental health symptoms in children with vision impairment and ocular morbidity. Additionally, this review provides evidence in favor of insurance coverage for timely strabismus surgery.

METHODS

We searched 9 electronic databases from inception through February 18, 2021, including observational and interventional studies assessing whether vision impairment, ocular morbidity, or both and their treatment are associated with depression, anxiety, or both in children. We used narrative synthesis and meta-analysis with the residual maximum likelihood method. A protocol was registered and published on The International Prospective Register of Systematic Reviews (identifier: CRD42021233323).

RESULTS

Among 28 992 studies, 28 956 studies (99.9%) were excluded as duplicates or unrelated content. Among 36 remaining studies, 21 studies (58.3%) were observational studies concerning vision impairment, 8 studies (22.2%) were observational studies concerning strabismus, and 7 studies (19.4%) were interventional studies. Vision impaired children demonstrated significantly higher scores of depression (standard mean difference [SMD], 0.57; 95% confidence interval [CI], 0.26-0.89; 11 studies) and anxiety (SMD, 0.62; 95% CI, 0.40-0.83; 14 studies) than normally sighted children. In particular, children with myopia demonstrated higher scores of depression (SMD, 0.58; 95% CI, 0.36-0.81; 6 studies) than normally sighted children. Strabismus surgery significantly improved symptoms of depression (SMD, 0.59; 95% CI, 0.12-1.06; 3 studies) and anxiety (SMD, 0.69; 95% CI, 0.25-1.14; 4 studies) in children.

CONCLUSION

Among children, vision impairment is associated with greater symptoms of depression and anxiety. Surgical treatment of strabismus improved these symptoms. Further randomized controlled trials exploring the impact of public health measures for myopia correction on mental health in children are needed. Scaling up access to strabismus surgery could improve the mental health of affected children.

Increased probability of mood disorders after age-related macular degeneration: a population-based cohort study

We aim to investigate the association of mood disorders with age-related macular degeneration (AMD). This retrospective cohort study used data from 2000 and 2016 from National Health Insurance Research Database (NHIRD) in Taiwan. Patients with AMD diagnosis formed the exposed group, and an age- and sex-matched group without AMD served as the nonexposed group. Main outcomes were the incidence of mood disorders including psychological counseling, behavior therapy, sleep or anxiety-related disorders, and major depressive disorders (MDDs) in the exposed and non-exposed groups. The Cox proportional hazard regression analysis was used to evaluate the incidence and adjusted hazard ratio (aHR) of mood disorders. A total of 5916 and 11,832 individuals with and without AMD were enrolled into the exposed and nonexposed groups. There were 1017 (17.19%) and 1366 (11.54%) episodes of mood disorders occurred in the exposed and nonexposed groups, respectively. The aHRs of any psychological counseling, behavioral therapy, sleep or anxiety-related disorders, and MDD were significantly higher in patients with AMD than in those without AMD (all P < 0.05). Besides, patients with dry-AMD, participants aged 50-70 years, and women with AMD had a higher incidence of mood disorders (all P < 0.05) than did non-AMD individuals, patients > 70 years, and women without AMD. In conclusion, AMD occurrence leads to an increased rate of mood disorders, particularly among those with dry-AMD, middle aged participants (aged 50-70), and women.

Prevalence and Unmet Need for Mental Healthcare of Major Depressive Disorder in Community-Dwelling Chinese People Living With Vision Disability

Objective

Mental health services have been recognized as an essential part of the comprehensive eye care services, but data regarding the mental health of people living with vision disability (PLwVD) remain very limited. This study examined the epidemiology of major depressive disorder (MDD) among Chinese PLwVD, as well as their perceived needs for and utilization of mental health services.

Methods

By using stratified cluster sampling method, a total of 1,753 PLwVD were successfully recruited from 73 urban communities and 169 rural villages in Wuhan, China, and interviewed with the Mini-international Neuropsychiatric Interview 5.0. Standardized questions were used to measure perceived mental healthcare needs and use of mental health services of PLwVD with MDD.

Results

The one-month prevalence of MDD was 24.4%. Among the PLwVD with MDD, 26.0% perceived needs for mental healthcare and only 1.2% sought treatment from mental health specialists for their emotional problems. Factors associated with MDD were middle age [vs. young adulthood, odds ratio (OR) = 1.96, P < 0.001], older adulthood (vs. young adulthood, OR = 1.79, P = 0.004), being never-married (vs. married, remarried, and cohabiting, OR = 1.96, P < 0.001), being separated, divorced, and widowed (vs. married, remarried, and cohabiting, OR = 12.30, P < 0.001), a low level of objective social support (vs. high, OR = 1.83, P < 0.001), currently drinking (OR = 1.81, P < 0.001), having childhood-onset eye conditions (OR = 1.89, P = 0.005), and having difficulties in performing daily activities (OR = 2.78, P < 0.001).

Conclusions

Chinese PLwVD are at high risk for MDD and have a high level of unmet need for mental healthcare. Public strategies are warranted to improve the mental health literacy of PLwVD and make the mental health services available, accessible, and affordable for PLwVD.

The Association between Vision Impairment and Depression: A Systematic Review of Population-Based Studies

We conducted a systematic review and meta-analysis to investigate whether depression is associated with vision impairment (VI) in population-based studies in adults. MEDLINE and EMBASE were searched, from inception to June 2020. Studies were included if they provided two-by-two data for calculating the OR of association between VI and depression, or crude and/or an adjusted odds ratio (OR) with a corresponding 95% confidence interval (CI) were reported. The proportion of VI and depression was also extracted. ORs were pooled using random-effect models, proportions were pooled using random intercepts logistic regression models. Overall, 29 articles (31 studies) were included: of those, 18 studies used survey data (622,312 participants), 10 used clinical examination data (69,178 participants), and 3 used administrative databases (48,162,290 participants). The proportion of depression (95%CI) was 0.17 (0.13-0.22) overall and 0.27 (0.21-0.33) in VI subjects. The proportion of VI was 0.10 (0.07-0.16) overall and 0.20 (0.13-0.29) in depressed subjects. The association between VI and depression was direct: crude ORs were 1.89 (1.51-2.37) for survey data, 2.17 (1.76-2.67) for clinical examination data, and 3.34 (1.01-11.11) for administrative databases; adjusted ORs were 1.75 (1.34-2.30), 1.59 (1.22-1.96), and 2.47 (0.97-6.33), respectively. In conclusion, VI and depression are prevalent morbidities and should be actively sought when either is identified, especially in older adults.

Improved intention, self-efficacy and social influence in the workspace may help low vision service workers to discuss depression and anxiety with visually impaired and blind adults

Background

Depression and anxiety are common in visually impaired and blind adults, but often remain untreated in those who receive support from low vision service (LVS) organizations. This study aims to determine factors associated with discussing mental health by LVS workers.

Methods

A self-administered cross-sectional survey in one hundred LVS workers was performed. Data on current practice, symptom attribution, and determinants of the Integrated Change Model (i.e. predisposing and environmental factors, awareness, attitude, self-efficacy, social influence, confidence and barriers) were investigated. Multivariable logistic regression analysis was performed to determine predictors of discussing mental health problems in this population. Subsequently, internal validation was conducted using a bootstrapping method.

Results

Around 80% of the participants often discussed mental health with clients. Five factors were found to predict discussion of mental health: female gender (OR = 4.51; 95% confidence interval (CI) 0.98 to 21.61), higher education (OR = 3.39; CI 1.19 to 9.66), intention to discuss mental health problems (OR = 3.49; CI 1.20 to 10.15), higher self-efficacy (OR = 1.11; CI 1.02 to 1.20), and higher perceived social influence (OR = 1.15; CI 1.05 to 1.27). Good discrimination after internal validation was reflected by the area under the curve (0.850).

Conclusions

Previous studies indicate clients want healthcare providers to initiate discussions about mental health. However, still 20% of LVS workers do not discuss suspected depression or anxiety. In order to improve this, LVS organizations could address mental health as part of their care and provide training to ensure intention to discuss mental health problems, improve self-efficacy and create a supportive environment between colleagues.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07944-0.

Vision impairment and self-reported anxiety and depression in older adults in Nigeria: evidence from a cross-sectional survey in Kogi State

BACKGROUND

More than 2 billion people are thought to be living with some form of vision impairment worldwide. Yet relatively little is known about the wider impacts of vision loss on individual health and well-being, particularly in low- and middle-income countries (LMICs). This study estimated the associations between all-cause vision impairment and self-reported symptoms of anxiety and depression among older adults in Kogi State, Nigeria.

METHODS

Individual eyes were examined according to the standard Rapid Assessment of Avoidable Blindness methodology, and anxiety and depression were assessed using the Washington Group Short Set on Functioning-Enhanced. The associations were estimated using multivariable logistic regression models, adding two- and three-way interaction terms to test whether these differed for gender subgroups and with age.

RESULTS

Overall, symptoms of either anxiety or depression, or both, were worse among people with severe visual impairment or blindness compared with those with no impairment (OR=2.72, 95% CI 1.86 to 3.99). Higher levels of anxiety and/or depression were observed among men with severe visual impairment and blindness compared with women, and this gender gap appeared to widen as people got older.

CONCLUSIONS

These findings suggest a substantial mental health burden among people with vision impairment in LMICs, particularly older men, underscoring the importance of targeted policies and programmes addressing the preventable causes of vision impairment and blindness.

Psychological implications of vitreous opacities - A systematic review

QUESTION

Given that depression and anxiety can be comorbid to several treatable eye diseases, it is paramount to understand whether vitreous opacities are also associated with increased risk of well-being and mental health problems. The current systematic review summarises research examining psychological implications of vitreous opacities in adult patients.

STUDY SELECTION AND ANALYSIS

PubMed, Cochrane library, EMBASE, Global Health, Web of Science, EBSCO, and Science Direct were systematically searched for all articles published up to May 5th 2021. Inclusion criteria included studies that have assessed outcomes related to patients' mental health; well-being; quality of life; coping with the disease; studies exploring patients' experiences/perceptions/cognitions of illness and/or medical treatments related to vitreous opacities.

FINDINGS

5 studies were included in this review, with a total of 139 patients [278 eyes] assessed. Patients' age ranged from 32 to 78 years old. Compared with healthy controls, patients with vitreous opacities showed significantly higher levels of symptoms of depression, perceived stress, state anxiety, and trait anxiety. Studies also suggested that patients are more likely to show low vision-related quality of life, and social functioning. Studies also suggested a significant positive effect of medical treatments [e.g. pars plana victretomy] on patients' symptoms of depression and anxiety and on patients' vision-related quality of life.

CONCLUSIONS

The topic of psychological implications of vitreous opacities is still relatively new in the literature with very preliminary evidence of mental health problems and reduced quality of life associated with this condition.

Retinoblastoma: emerging concepts in genetics, global disease burden, chemotherapy outcomes, and psychological impact

In this review we discuss several recent concepts regarding retinoblastoma control and its impact. In a cohort of 482 patients with solitary unilateral retinoblastoma revealed germline mutation in 16% and the likelihood of germline retinoblastoma was greater for younger children (≤1 year versus (vs.) >1 year at presentation) with odds ratio (OR) 2.96 (p = 0.001), and greatest for the youngest infants (≤3 months vs. >3-12 months) (OR 5.52) (p = 0.002). Retinocytoma/retinoma, a benign variant of retinoblastoma, was studied in 78 tumours and demonstrated transformation into retinoblastoma in 9.2% by 5 years and 15.3% by 10 years and 20 years. An international global study on retinoblastoma over 1.5 years revealed 4351 new patients and 85% from low- and middle-income countries, notably with older age at detection and greater risk for metastasis. Management of retinoblastoma in 964 eyes using intravenous chemotherapy showed 20-year globe salvage at 96% in group A, 90% in group B, 90% in group C, 68% in group D, and 32% in group E eyes. The 5-year globe salvage with intra-arterial chemotherapy for 160 eyes (655 infusions) with retinoblastoma showed success in 100% for group B, 80% for group C, 78% for group D, and 55% for group E. The psychological impact of retinoblastoma on the parents revealed depression (73%), anxiety (64%), and/or stress (100%), and on the patient revealed deficits in quality of life issues. Retinoblastoma is a challenging disease and chemotherapy provides reliable tumour control and globe salvage. Continuing efforts to improve quality of life issues is important.

Anxiety levels moderate the association between visual acuity and health-related quality of life in chronic eye disease patients

The current study examines the potential moderating effect of depression and anxiety on the relationship between visual acuity and health-related quality of life in patients with chronic eye diseases. Of the 71 patients, 37 (52%) were female and 34 (48%) were male, age (mean ± SD) was 69 ± 12 years. A significant multivariate regression model was found for patients' health-related quality of life (EQ-5D-5L index) (R² = 0.43, p < 0.001), in which visual acuity (logMAR) (p < 0.001), anxiety (HADS-A) (p = 0.007), and age of diagnosis (p = 0.04)  were independently associated with health-related quality of life (EQ-5D-5L). The moderation model for anxiety (R² = 0.47, F = 5.91, p < 0.001) revealed a significant interaction of visual acuity and levels of anxiety in relation to health-related quality of life. Conditional effects analysis suggested that higher logMAR values (which indicate more vision loss) were associated with lower EQ-5D-5L index (indicating worse health-related quality of life), this relationship being stronger (even more negative), when levels of anxiety are high. Clinical and rehabilitation services providing care for chronic eye disease patients should include regular checks for patients' levels of anxiety, even in patients who still have preserved visual acuity, to help preventing a synergistic source of long-term poor quality of life and disability.