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Preventing Depression From Age-Related Vision Loss

An occupational therapist works with a patient who has low vision.Thomas Jefferson University

About 2 million Americans age 50 and older have low vision due to AMD, a leading cause of vision loss. Millions more have early-stage AMD. The condition damages the macula, a spot near the center of the retina. As the disease progresses, it can cause a growing blurred area near the center of vision.

AMD makes everyday activities—like driving, reading, watching television, and housework—more difficult. It interferes with activities that were once fun and fulfilling, and makes it hard to get out and see friends or meet new people. As a result, up to 25% of people with bilateral AMD (in both eyes) develop clinical depression.

To address this problem, Dr. Barry Rovner at Thomas Jefferson University in Philadelphia led a team testing an approach called behavior activation. The treatment helps people maximize their functional vision and engage in activities they enjoy, recognizing that loss of those activities can lead to depression. Maintaining an active social life is an important component of the approach.

The researchers recruited 188 participants with bilateral AMD. Participants were 84 years of age on average, and 70% were women. Half of the participants lived alone. All had a best-corrected vision of less than 20/70 (able to clearly see an object from 20 feet away that a person with normal vision sees at 70 feet away). Each had mild depressive symptoms and was considered at risk for developing clinical depression.

Optometrists first evaluated the participants and prescribed low-vision devices such as handheld magnifiers. Participants were then randomly split into 2 groups. One received behavior activation. Occupational therapists helped them use the low-vision devices, make changes around the home (such as using brighter lights and highlighting objects with high-contrast tape), increase social activities, and set and achieve personal goals by breaking them down into manageable steps. People in the second group met with a support therapist to talk about their vision loss and disability.

Both groups had 6 hour-long therapy sessions in their homes over a 2-month period. They were allowed to take antidepressants, but less than 10% did so. The study, which was funded by NIH’s National Eye Institute (NEI), appeared online on July 9, 2014, in Ophthalmology.

By 4 months, 18 in the control group (23.4%) and 11 in the behavior activation group (12.6%) developed clinical depression. Behavior activation had the most benefit for participants with the worst vision (less than 20/100), reducing the risk of depression by about 60% compared to controls. Overall, the researchers estimate that behavior activation reduced the risk of clinical depression by 50% compared to control treatment.

“Our results emphasize the high risk of depression from AMD, and the benefits of multi-disciplinary treatment that bridges primary eye care, psychiatry, psychology, and rehabilitation,” Rovner says. The study will continue to follow participants to assess the benefits of treatment out to one year.