Preventing Depression from Age-related Vision Loss

Preventing Depression from Age-related Vision Loss Depression is a common risk for people who have lost their vision from age-related macular degeneration (AMD), but a study shows that a type of rehabilitation therapy can cut this risk in half.

The study was funded by the National Eye Institute (NEI), part of the National Institutes of Health. Activities that used to be fun and fulfilling may begin to seem burdensome or even impossible. With loss of the ability to drive and navigate unfamiliar places, it becomes easier to stay at home than to see friends or meet new people. All of this can take a toll on mental health, and past studies have found that as many as one-third of people with bilateral AMD develop clinical depression.

Barry Rovner, M.D., a professor of psychiatry and neurology at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia led the study. Behavior activation involves helping people to focus on activities they enjoy, to recognize that loss of those activities can lead to depression, and to re-engage in those activities,‰ said Robin Casten, Ph.D., a co-author and an associate professor of psychiatry and human behavior at Jefferson.

Helping people maintain an active social life is an important part of the approach, she said.

They studied 188 participants, 84 years of age on average, 70 percent women, of which 50 percent lived alone. Each participant had mild depressive symptoms and was at risk for developing clinical depression. During the trial, the participants had two visits with an optometrist, during which they were prescribed low-vision devices such as handheld magnifiers. After those initial visits, the participants were randomly split into two groups. One group received behavior activation from an occupational therapist specially trained in the approach. The occupational therapist worked with participants to guide them on using the low-vision devices, to make changes around the home (such as using brighter lights and high-contrast tape), to increase their social activities, and to help them set personal goals and break these down into manageable steps. The second group of participants served as a control group.

They talked about their difficulties to a therapist, but did not receive behavior activation or low-vision occupational therapy. By four months, 12 participants in the control group and seven participants in the behavior activation group had withdrawn from the trial or passed away. Of the remaining 169 participants, 18 (23.4 percent) in the control group and 11 (12.6 percent) in the behavior activation group developed clinical depression. Behavior activation had the most benefit for participants with the worst vision, reducing the risk of depression by about 60 percent compared to controls. Stronger links between primary eye care and mental health care workers would be needed to make behavior activation more widely available for AMD patients,‰Dr. Rovner said.