Optometrists Should Be Aware of Bidirectional Relationship Between Vision Loss, Distress

Posted by Healio

Key takeaways:

• Vision loss can cause psychological distress and psychological factors can affect vision loss.
• The number of Americans with uncorrectable vision loss is expected to double by 2050.

Targeted screening, integrated services and a biopsychosocial approach to care may help identify and manage anxiety and depression among people with vision loss, according to a perspective published in Psychodynamic Psychiatry.

“Studies conducted at Lighthouse Guild suggest that persons with eye conditions with poor prognosis, such as diabetic retinopathy and retinitis pigmentosa, endorse symptoms of depression more so than those with reversible or more treatable causes of low vision,” Edward Ross, LCSW, BCD, corresponding author and director of health and behavioral health services at Lighthouse Guild, told Healio. “Studies such as this should be replicated among diverse socioeconomic, ethnic and racial populations to better identify individuals at greater risk.”

Ross and César A. Alfonso, MD, chief psychiatrist at Lighthouse Guild and clinical professor of psychiatry at Columbia University, drew upon their clinical experience at Lighthouse Guild Behavioral Services Clinic in New York City to share insights about the relationship between visual impairment and mental health.

In their perspective, the authors wrote that the CDC reports 4.2 million Americans aged 40 years and older have uncorrectable vision impairment, which is expected to more than double by 2050.

“The CDC prediction that the number of Americans older than 40 with uncorrectable vision impairment will double by 2050, due to the aging population and increasing diabetes and other chronic conditions, is a bracing statistic that the health system is unprepared to address,” Ross told Healio.

People with vision impairment are more likely to struggle with daily activities, the authors wrote, and can often experience anxiety and dread associated with fear of blindness. They also are at greater risk for depression, cognitive decline and premature death.

Ross and Alfonso noted that the relationship between negative affective states and vision impairment may be bidirectional — vision loss can cause psychological distress and psychological factors can affect vision loss.

According to the authors, mental disorders often associated with vision loss share inflammatory and neuroendocrine pathogenic pathways. They cited studies that proposed how depression can worsen vision impairment through an increase in circulating cytokines and HPA-axis dysregulation, which can result in hypercortisolemia and insulin resistance.

“Optometrists should develop familiarity with the comorbidity of depression and anxiety disorders in vision-impaired populations and should learn about the bidirectionality between vision disorders and psychiatric conditions,” Ross told Healio. “They should administer the Patient Health Questionnaire 2 and 9 to their patients to help identify patients at risk, and they should develop relationships with behavioral health practitioners in their communities to refer individuals so identified.”