Age-related macular degeneration (AMD) and depression frequently occur in tandem. AMD is the leading cause of vision loss in older adults, and depression is a leading cause of disability. Up to 30 percent of people with AMD in both eyes, called bilateral AMD, become depressed as low vision interferes with activities they once found enjoyable. That’s twice as high as the rate of depression in older people with normal eyesight.
Researchers recently tested a new treatment model for AMD and depression, using a therapy called behavior activation. The study, funded by the National Institutes of Health and published in 2014 in Ophthalmology, aimed to prevent depressive disorders in people with AMD with early signs of depression.
Currently, the most common treatment for low vision resulting from AMD is low-vision rehabilitation. During this therapy, the patient’s functional vision is assessed, and he or she is instructed on using assistive devices, such as handheld magnifiers or telescopic glasses for TV viewing. This type of treatment doesn’t address the condition’s psychological and emotional impacts, though.
A different approach
Behavior activation, on the other hand, helps patients understand the link between action and mood. It promotes self-sufficiency and social connections as ways to improve mood and ability to function and helps counter the tendency to withdraw socially, all with the goal of fighting off depression.
This approach was used in a study of 188 patients with bilateral AMD (average age, 84) who experienced mild depression, which put them at risk of progressing to clinical depression. All of the participants were prescribed standard low-vision devices, such as hand-held magnifiers. In addition, an occupational therapist (OT) worked with half the patients, helping them focus on activities they enjoyed and ways to maintain an active social life.
To help improve the participants’ ability to function, the OT also helped them make changes around the home such as improved lighting, and helped them make an action plan based on self-defined goals. A second group talked to a therapist—though not an OT—about vision loss and disability but did not have behavior activation or additional supportive services.
After four months, the researchers found that using the multidisciplinary intervention halved the incidence of depressive disorders compared with only talking to a support therapist.
Coping with low vision
If you’ve recently been diagnosed with advanced AMD or low vision, it’s normal to feel anger, fear, or grief regarding your loss. Loss of vision can trigger emotions similar to losing a loved one. Thus it is important to acknowledge the emotions and go through the process of grieving. Sometimes a grief counselor can help move this process along. Otherwise, prolonged grieving may result in chronic anger, denial, and eventually depression.
Support from others going through the same experience may help; ask your doctor about local support groups.
Friends and family, too, can offer support and reassurance, as well as help you implement strategies for easing daily tasks and making your environment more conducive to your needs. Keep in mind that asking for help isn’t a sign of weakness—in fact, it’s a way to take control of your condition.
If lasting sadness has started to affect your day-to-day activities, you may have clinical depression. Medication or talk therapy or both may help you feel like yourself again and may even help with your visual functioning. Seek help from your doctor or a mental health professional.
Although the behavior activation therapy tested in the study isn’t readily available as a comprehensive approach, doctors can use the treatment as a model to help patients who appear to be depressed. Patients may be referred for depression screening and behavioral therapy, if needed, to improve mood, along with standard low-vision rehabilitation to improve function.
Living with vision loss
If you (or a loved one) are affected by low vision, these practical tips can help:
• Consider vision rehabilitation. This service attempts to enable independent living by teaching adaptive skills and use of assistive devices and suggesting adjustments for the home.
• Modify your home. Install brighter lightbulbs, use window blinds to reduce glare, and mark the edges of steps with brightly colored tape or paint to make them easier to see.
• Let friends and family know that you cannot see well, especially when you’re unable to recognize others. A common source of frustration, and eventually social isolation, among AMD patients with advanced vision loss is that they have great trouble recognizing people. Friends may take offense and shun the patient as a result.
If you’re experiencing this degree of vision loss, try to develop the habit of responding to a greeting by gently touching the person and saying, “Hello. I’m terribly sorry, but because of my poor eyesight, I am having trouble recognizing you. Please tell me your name.”
Find more tips at the American Foundation for the Blind website.