One-third of those with age-related macular degeneration experience depression or anxiety related to their condition. Losing vision, or even the prospect of it, can substantially decrease quality of life, and mental health is one of the key contributors to this.
Much of the intervention around eye diseases focuses on treatment and screening, and mental health can often be overlooked. From diagnosis through to ongoing management it is important to support all aspects of a patient’s health – mental health included.
Understanding mental health alongside AMD
Age-related macular degeneration (AMD) is a risk factor for depression and anxiety, and older people with AMD suffer more than other people of the same age with different chronic conditions. As we know, our ageing population means more people are at-risk of AMD and cases are increasing, so you can see that the picture for mental health looks bleak.
A 2008 study by the Farber Institute for Neurosciences of Thomas Jefferson University noted that the severity of depression was directly linked to a person’s visual acuity. Rates of depression ranged from 14.3% for those with minimal vision loss to 25% for those with severe vision loss.
When someone begins to experience vision loss they often feel a lack of control over their circumstances. They may worry about losing all of their sight, and how quickly this can happen. People may feel isolated if they need to give up work or driving, which impacts their social lives and mental wellbeing. The Thomas Pocklington Trust has recently published a report into social isolation related to vision loss. The report cites that difficulties with everyday activities and problems with communication can cause social isolation.
Around 1 in 10 people with AMD also experience Charles Bonnet Syndrome – hallucinations due to low vision- which also affect mental health. These hallucinations can be a few minutes to a few hours long and can be upsetting and disorientating. As well as causing distress, they can lead to feelings of anxiety about when the next episode will occur.
Supporting patients with AMD
What’s important when diagnosing AMD, or informing a patient that they may be at risk, is communication and access to support. Many feelings of hopelessness in patients stem from lack of information leading people to worry about their future – whether that’s about treatment, quality of life or their prognosis. Patients need to know where to turn when they are concerned about their eye health.
It is important to empower patients by providing them with the right information and access to the right support. They may lose their vision, but this can be made less distressing if they understand how they can access care, adapt their home or deal with treatment.
There are practical ways you can support those newly diagnosed or living with AMD long-term:
- Refer patients for free support. The Macular Society runs a free advice line for patients. If you’re in the USA, the American Macular Degeneration Foundation offers a variety of free guides, including a journal to monitor vision.
- Encourage regular screening. Those with AMD or those at high risk of it should be screened regularly to monitor their condition. Regular screening can reduce feelings of isolation and reassure a patient that they are being taken care of. During screening a patient also has a chance to discuss any worries they may have, including any feelings of depression or anxiety.
- Understand the care pathways. For an optometrist or an ophthalmologist, caring for a patient with AMD doesn’t only involve screening and treatment. If someone has low vision then they will require social care from everything to sourcing low vision aids to arranging carers to ensure they can remain independent. Educate your team about the options available in your area and encourage them to pass that information on to patients.
For more information on AMD and mental health, read our related blog on stress. We’ve also recently covered how glaucoma affects mental health. For a full picture of the importance of MPOD screening in detecting AMD risk early, download our free whitepaper – age-related macular degeneration and the case for early screening.