Vision Impairment Associated with Development of Depression, Anxiety

MAY 16, 2019
Patrick Campbell
Eye examA recent study has found that older patients suffering from vision impairment (VI), were more than twice as likely to experience depression and anxiety symptoms than those without VI.

The study, conducted by investigators from the University of Michigan, also found that baseline depression and anxiety symptoms were both significantly associated with future reports of VI.

Investigators used data from the National Health and Aging Trends Study (NHATS) public-use data sets, which collected data from 2011 to 2016, to identify 7609 community-dwelling adults aged 65 or older. A total of 25 were excluded for missing information on VI, leaving the final analytical sample at 7584 Medicare beneficiaries. Vision status was determined through self-reporting and a participant was defined as having VI if they reported that they were blind or could not see across the street and/or read newspaper print, even with glasses.

At baseline in 2011, women made up 56.6% of the 7584 participants, 53% were between the ages of 65 and 74, and 8.9% had self-reported VI. Those with VI were more likely to be older, women, nonwhite, less educated, eligible for Medicaid, have dementia and more medical comorbidities. 

Authors reported that the weighted prevalence of depression and anxiety symptoms was more than twice as high in participants with self-reported VI. In those with VI, 31.2% reported depressive symptoms compared to just 12.9% of those without self-reported VI. Additionally, the weighted prevalence of anxiety symptoms was 27.2% in patients with VI and 11.1% in those without.  Authors noted that 41.3% of patients with VI had clinically significant depression or anxiety compared to 18.6% of participants without VI. 

The results of multivariable Cox proportional hazards showed that participants with self-reported VI at baseline had a significantly increased hazard of future clinically significant symptoms of depression (aHR, 1.33;95%CI, 1.15-1.55) but not anxiety (aHR, 1.06; 95% CI, 0.85-1.31). Authors noted that those who reported having symptoms of depression (aHR, 1.37;95%CI, 1.08-1.75) and anxiety (aHR, 1.55; 95% CI, 1.19-2.02) at baseline had a significantly increased hazard of reporting VI in the future. 

Authors noted several limitations within their study. Data was based on self-reporting which can be subject to multiple biases. Questions to assess VI within the NHATS relate to central vision and do not account for impact of peripheral field loss, which could have resulted in misclassification. Groups with and without VI at baseline were significantly different with respect to demographic, socioeconomic, and clinical factors. 

In their conclusion, authors suggest that eye care clinicians may want to consider incorporating mental health screenings into their assessments of older patients with vision loss. Conversely, primary care physicians could consider placing an emphasis on vision screenings for patients with mental health symptoms. Authors also noted that they were unable to determine the association between VI and actual depression and anxiety mental disorders.

In an invited commentary published in JAMA Ophthalmology, Cynthia Owsley, PhD, MSPH and Gerald McGwin Jr, MS, PhD, both of the Department of Ophthalmology and Visual Sciences at the University of Alabama School of Medicine, wrote that the study highlights the need for ophthalmologists and optometrists to be cognizant of the burdens experienced by patients with eye disease and VI.

“Regardless of the mechanism(s)underlying the increased risk for vision impairment among older adults with depression or anxiety, this study highlights the important need for ophthalmologists, optometrists, primary care physicians, and mental health professionals to recognize the role psychological health plays in visual prognosis and eye health in general,” they wrote. 

This study,  titled “Longitudinal Associations of Self-reported Vision Impairment With Symptoms of Anxiety and Depression Among Older Adults in the United States,” was published in JAMA Ophthalmology. 

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