Depression and experience of vision loss in group of adults in rehabilitation setting: Mixed-methods pilot study

Depression among attendants of the Sudanese National Association of the Blinds in Khartoum, Sudan

Background

Blindness has profound consequences for the victim, family, and society. The impact of vision loss on daily life activities could lead to psychological stress. Early treatment of depression may reduce the added disability that is associated with vision loss. This study aimed to assess the extent and associated factors with depression among the Sudanese blind people in Khartoum, Sudan. A cross-section facility-based study was conducted, in which depression among the participants was assessed using the Beck Depression Inventory Scale. A chi-square test was implemented to determine the relationship between categorical variables and the significance level for all analyses was set at p < 0.05.

Results

A total of 185 participants were included in the study. Out of them, 84.3% were male and near half of the participants (42.2%) were born blind. The prevalence of depression among the participants was 11.4%. There were significantly higher rates of depression in those who were illiterate (χ2 = 6.233, p = 0.044) and in those whose loss of vision was due to accidents or traumatic causes and loss of vision due to accidents or traumatic causes (χ2 = 12.840, p = 0.002). There was significantly lower rate of depression in those who were born with blindness compared to others (χ2 = 10.504, p = 0.005).

Conclusions

People who were born blind have a lower rate of depression and people who lost their sight due to trauma have a higher rate of depression, and therefore, requiring more psychiatric support. Despite the relatively low percentage of depression, establishing programs for early identification and combating depression among the blind population in our setting is highly recommended.

Neuroprotective strategies for retinal disease

Diseases that affect the eye, including photoreceptor degeneration, diabetic retinopathy, and glaucoma, affect 11.8 million people in the US, resulting in vision loss and blindness. Loss of sight affects patient quality of life and puts an economic burden both on individuals and the greater healthcare system. Despite the urgent need for treatments, few effective options currently exist in the clinic. Here, we review research on promising neuroprotective strategies that promote neuronal survival with the potential to protect against vision loss and retinal cell death. Due to the large number of neuroprotective strategies, we restricted our review to approaches that we had direct experience with in the laboratory. We focus on drugs that target survival pathways, including bile acids like UDCA and TUDCA, steroid hormones like progesterone, therapies that target retinal dopamine, and neurotrophic factors. In addition, we review rehabilitative methods that increase endogenous repair mechanisms, including exercise and electrical stimulation therapies. For each approach, we provide background on the neuroprotective strategy, including history of use in other diseases; describe potential mechanisms of action; review the body of research performed in the retina thus far, both in animals and in humans; and discuss considerations when translating each treatment to the clinic and to the retina, including which therapies show the most promise for each retinal disease. Despite the high incidence of retinal diseases and the complexity of mechanisms involved, several promising neuroprotective treatments provide hope to prevent blindness. We discuss attractive candidates here with the goal of furthering retinal research in critical areas to rapidly translate neuroprotective strategies into the clinic.

Experience of Anti-VEGF Treatment and Clinical Levels of Depression and Anxiety in Patients With Wet Age-Related Macular Degeneration

PURPOSE

To investigate detailed patient experiences specific to receiving vascular endothelial growth factor inhibitors (anti-VEGF) for wet age-related macular degeneration (wAMD), and to acquire a snapshot of the frequency of clinically significant levels of depression, anxiety, and posttraumatic stress among patients and levels of burden in patients' carers.

DESIGN

Observational cross-sectional mixed-methods study.

METHODS

Three hundred patients with wAMD receiving anti-VEGF treatment and 100 patient carers were recruited. Qualitative data on patients' experience of treatment were collected using a structured survey. Standardized validated questionnaires were used to quantify clinically significant levels of anxiety, depression, and posttraumatic stress, as well as cognitive function and carers' burden.

RESULTS

Qualitative data showed that 56% of patients (n = 132) reported anxiety related to anti-VEGF treatment. The main sources of anxiety were fear of going blind owing to intravitreal injections and concerns about treatment effectiveness, rather than around pain. From validated questionnaires, 17% of patients (n = 52) showed clinical levels of anxiety and 12% (n = 36) showed clinical levels of depression. Depression levels, but not anxiety, were significantly higher in patients who received up to 3 injections compared with patients who received from 4 to 12 injections (analysis of variance [ANOVA] P = .027) and compared with patients who received more than 12 injections (ANOVA P = .001).

CONCLUSIONS

Anti-VEGF treatment is often experienced with some anxiety related to treatment, regardless of the number of injections received. Clinical levels of depression seem to be more frequent in patients at early stages of anti-VEGF treatment. Strategies to improve patient experience of treatment and minimize morbidity are suggested.

Psychologic adjustment to irreversible vision loss in adults: a systematic review

PURPOSE

To summarize relevant evidence investigating the psychologic adjustment to irreversible vision loss (IVL) in adults.

DESIGN

Irreversible vision loss entails a challenging medical condition in which rehabilitation outcomes are strongly dependent on the patient's psychologic adjustment to illness and impairment. So far, no study has systematically reviewed the psychologic adjustment to IVL in adults.

METHODS

We reviewed all articles examining the psychologic adjustment to IVL in adults. We included articles published in English in peer-reviewed journals. We performed a keyword literature search using 4 databases (PubMed, EBSCO, Cochrane Library, and Science Direct) for all years through July 2014. We assessed risk of bias of selected studies using the RTI Item Bank for Assessing Risk of Bias and Confounding for Observational Studies of Interventions or Exposures and the Cochrane risk of bias tool for randomized controlled trials.

RESULTS

Of a total of 3948 citations retrieved, we selected 52 eligible studies published between 1946 and 2014. The majority of studies were observational and cross-sectional in nature. Our review suggests that high levels of depression occur during the adjustment to IVL. Better adjustment to IVL was associated with greater acceptance of vision loss and use of instrumental coping, good social support, positivity, and use of assistive aids.

CONCLUSIONS

The overall findings indicate that IVL often has negative effects on patients' quality of life and mental health and that such effects tend to remain over time. Specific factors and variables associated with the adjustment to IVL need to be clarified through further in-depth and longitudinal research.