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Vision Loss and Depression in the Elderly

Vision Loss and Depression in the Elderly

The emotional and functional consequences of sensory impairment in older persons have not been well studied despite the increasing prevalence of vision loss, in particular, and its substantial adverse effects. This review examines the impact of vision loss on psychological health, discusses factors that may reduce its negative effects, and describes new in terventions to help older people cope with eye diseases such as age-related macular degeneration (AMD).

AMD is the most common cause of legal blindness in the United States; it affects almost 10 million people.1,2 It is caused by deterioration of the macular region of the retina and can lead to various pigment changes, either as geo graphic atrophy (dry AMD) or choroidal neovascularization (neovascular or wet AMD). Although the dry form is more common (85% of AMD cases), many cases eventually transition to the wet form. Both types cause visual distortions that predominantly affect central vision and interfere with activities such as reading and driving. Risk factors for AMD include age over 60 years, smoking, obesity, white race, family his tory, and female sex.

One large-scale study suggests that a specific vitamin/mineral formulation (C, E, beta-carotene, zinc, and copper) can slow the progression to advanced AMD in high-risk patients.3 Although newer pharmalogic treatments (eg, ranibizumab) effectively halt vision loss in some patients and may improve vision slightly, none can restore vision to premorbid levels. For many patients, rehabilitation may be the most effective option for improving vision function, that is, the ability to perform necessary daily tasks even without improving visual acuity. Low vision rehabilitation encourages the use of assistive aids and devices (large clock, magnifiers), alternative reading materials (audio books), strategies for circumventing vision loss (using brightly colored tape to highlight dials on appliances), and environmental modifications (use of contrast).

Vision loss and disability
The effect of AMD on a patient's life can be devastating because vision loss is one of the major contributors to loss of independence and diminished quality of life in older persons. Williams and colleagues4 interviewed 86 patients with AMD and found that their overall ratings of quality of life were sub stantially lower than those of visually intact older persons, older persons with severe chronic obstructive pulmonary disease, or patients with AIDS. Compared with older persons who have intact vision, the patients with AMD were 8 times more likely to have trouble shopping, 13 times more likely to have difficulty in managing finances, 4 times more likely to have problems with meal preparation, 9 times more likely to report difficulty with light housework, and 12 times more likely to have trouble using a telephone.5

Another study found that persons with impaired vision were almost twice as likely as unimpaired persons to experience a fall or a broken hip. They were 3 times as likely to have difficulty in walking, 3.3 times more likely to have trouble getting outside, 3.1 times more likely to have difficulty in managing their medications, and 3.5 times more likely to have problems with meal preparation.6 Vision loss in the elderly is a significant contributor to functional lim itations and reduced quality of life.

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