In age-related macular degeneration, depression can directly impact patient care through loss to follow-up, cancellations, and lack of treatment adherence.
“Poor vision is a risk factor for anxiety, depression, and other mental health disorders, but the quantification of the impact, the number of patients affected, was not known,” Rishi Singh, MD, explains. “We aimed to assess the major causes of blindness and the risk for developing mental health conditions, such as anxiety and depression, and related behaviors, such as suicide, in association with ocular conditions and visual impairment. We also wanted to assess whether race or gender disparities put patients at an increased risk.”
Dr. Singh and colleagues conducted a cross-sectional study using a US database. They identified patients with various ophthalmic conditions, visual impairment, and a mental health condition using ICD-10 codes, and the team stratified prevalence odds by demographic characteristics, including sex and race. The results were presented at the 2023 annual meeting of the American Academy of Ophthalmology.
Disparities in Depression Among Patients With AMD
The study included records for more than 87 million patients. Dr. Singh and colleagues found that prevalence ORs for every mental health condition were higher for patients with age-related macular degeneration (AMD) when compared with any other ocular condition among patients who had no visual impairment.
“In speaking to patients with AMD, as well as progressed stages of diabetic retinopathy and diabetic macular edema, the vast majority of patients had some depression related to their disease state, even if their vision was good,” Dr. Singh says. “This is because vision itself is not an indicator of visual or functional impairment. The burden of constant monitoring and procedures weighs on patients and can affect their independence and QOL.”
According to Dr. Singh, vision loss is associated with some of the most important qualities of life that impact a patient’s mental state; he equates its impact “to receiving news about a cancer diagnosis or heart attack.”
In their analysis, the researchers found that the incidence of mental health conditions varied across time points for patients with non-exudative AMD. The ORs for depression among these patients were 1.03 (95% CI, 1.00-1.06) at 1 year, 1.05 (95% CI, 1.03-1.08) at 3 years, and 1.07 (95% CI, 1.06-1.10) at 5 years.
“We observed a worsening of depression over time but did not find an appreciable increased odds for anxiety or suicide at different points,” Dr. Singh says. “When looking at depression in more detail, stratified by sex, ethnicity, and race, Black and Latino women experienced a higher prevalence of depression compared with White men.”
Specifically, the ORs for depression among Black women with exudative and non-exudative AMD were 1.54 (95% CI, 1.37-1.73) and 1.59 (95% CI, 1.42-1.78), respectively. Among Hispanic women, the ORs for depression with exudative and non-exudative AMD were 1.50 (95% CI, 1.31-1.73) and 1.57 (95% CI, 1.38-1.79), respectively.
Raising Awareness of Mental Health Conditions in AMD
Depression can have a direct impact on disease burden for patients with AMD, according to Dr. Singh.
“Depression can manifest in many ways in these patients, including loss to follow-up for maintenance visits, cancellations, and lack of treatment adherence. As a result, their visual outcomes may be impacted by the co-occurring conditions of AMD and depression.”
Future studies, with targeted interventions, may be helpful in validating these findings, he continues.
“The role and the goal of this paper was to highlight the increased association between depression and these ocular conditions for optometrists and ophthalmologists alike in order to help them focus on how to support patients with these disorders as well as to refer them to outside mental health services if possible and necessary.”
