What is the link between age-related macular degeneration (AMD), patient stress and treatment outcomes? Researchers at The Ohio State University College of Optometry are currently conducting a study to examine the link between these three factors to improve management of the condition.
AMD is an inflammatory condition, and previous studies have indicated that a patient’s level of stress has been shown to be predictive of inflammation (Dougherty, et al., 2017). Patients with AMD experience high levels of stress and anxiety along with depression which affects their everyday lives beyond sight loss.
How can the Perceived Stress Scale assist patient evaluation?
In the first part of this study, 137 patients with an average age of 82 were asked ten questions to establish the Perceived Stress Scale (PSS) – an accepted method for measuring the biological markers of stress. Around half of the patients took the test on the day they had received anti-VEGF injections for AMD.
The purpose of this test was to see if PSS can be used to evaluate stress levels in AMD patients, the study found that nine of the ten questions were useful in this context. The test is easy to administer and described as ‘psychometrically sound’ by Dr Dougherty, who led the study.
So far the researchers have found that the level of stress a patient experiences does not necessarily correlate with their amount of vision loss they have. We can see here that some cope better than others. In fact, some patients using ‘mindfulness techniques’ had better outcomes compared with those who did not.
Dougherty, et al., 2017 conclude by saying that further research is needed to see what role stress plays, particularly in relation to inflammation, and whether it can speed up the progression of AMD. Future studies can use repeated assessments with the PSS alongside measurement of inflammatory markers.
Managing stress for AMD patients
The progression of AMD is slow and treatments can be painful so it is reasonable for a patient to experience symptoms of stress. The key is to manage and try to lower patient stress as much as possible in AMD patients, in order to improve their quality of life.
The prognosis for AMD may not be good but there are ways to manage patient expectations and reduce stress:
- Detect risk early – AMD risk can be detected early using the Macular Pigment Screener. There is a wealth of clinical data that suggests early detection, complemented by lifestyle changes and lutein/zeaxanthin supplementation, can mitigate the progression of AMD and even slow progression amongst those in the early stages of the condition. If there is a family history of AMD, encourage your patients to come in for regular checks once they pass the age of 50.
- Establish a plan – If a patient is diagnosed with AMD, wet or dry, then a robust and easy to understand treatment plan is essential. Stress is often caused by the unknown, how their vision will be affected or what treatment will entail, for example.
- Create a support network – Along with family and friends being on hand to help, charities like the Macular Society offer support for those diagnosed. They can help in many ways, from providing basic advice to helping patients adapt their homes or find specialist treatment. Having a support network is vital in preventing isolation, anxiety and stress.
Read more about reducing stress in this guide from Harvard Health.
Research like the Dougherty, et al., 2017 study is another piece of the puzzle to tackling AMD now and in the future. The more we understand about the condition the more we can help patients. There is further information about AMD, its risk factors and how it could the condition could be handled more proactively in our free whitepaper ‘The case for early screening’, downloadable here.