Cataracts, whether present or previously removed, were associated with increased risk of depressive symptoms in the elderly, in a 3-year prospective study in which there was no similar association with age related macular degeneration (AMD) or glaucoma.
Ellen Freeman, PhD, School of Epidemiology and Public Health, University of Ottawa, and colleagues pointed out that vision loss due to uncorrected refractive error and age-related eye disease like cataract, age-related macular degeneration (AMD), glaucoma and diabetic retinopathy is common in old age, but the relation to development of depressive symptoms is unclear.
"Some older adults are able to adapt well to vision loss, adopting a resilient attitude and positive coping skills," Freeman and colleagues observed. "However, other older adults struggle to accept and adapt to their vision loss and are at risk of depression."
Freeman commented to HCPLive on the importance of considering the presence of depressive symptoms in visits and general examinations.
"It would be wise for all healthcare professionals to be aware that their patients may be experiencing depression," Freeman said. "Some suggestions to elicit responses from patients is to simply ask them how they are doing, is there anything else that they would like to share, and to take the time to listen."
Freeman and colleagues noted that most studies of vision impairment or eye disease and depression have been cross-sectional, so lacking capacity to establish temporality of vision loss and onset of depressive symptoms. The few longitudinal studies have generally not examined the range of potential modifiers which might suggest whether some groups are at greater risk of depressive symptoms after losing vision.
To better elucidate the relation of visual impairment and eye disease with development of depressive symptoms, the investigators conducted a three-year prospective cohort study with follow-up visits from July 2015 and December 2018 with over 23,000 participants.The cohort was identified from over 30,000 individuals included in the Canadian Longitudinal Study on Aging ( CLSA ) between December 2011 - July 2015. Findings were analyzed for possible modifying effect from such factors as gender, level of education or presence of hearing loss.
Baseline visual acuity was established using an illuminated Early Treatment of Diabetic Retinopathy Study (ETDRS) letter chart and its standard protocol. Participants were asked if a doctor had told them that they have or had a cataract, AMD or glaucoma. The development of depressive symptoms was determined by a score of 10 or higher on the Center for Epidemiologic Studies Depression Scale (CES-D10), in participants with lower scores at baseline.
Freeman and colleagues acknowledged that relying on self-reporting of the conditions is a limitation of the study design, but noted that the previously reported prevalence of eye diseases from the CLSA is similar to that reported in the US.
The investigatorsfound depressive symptoms had developed in 7.7% of the cohort within the 3 years.Cataract was associated with incident depressive symptoms, with relative risk of 1.20 (95% CI, 1.05-1.37), after controlling for multiple demographic factors. There was no association found with visual impairment, AMD or glaucoma.
"Cataract-related factors besides visual acuity that might affect depressive symptoms include difficulty with glare sensitivity or contrast sensitivity, fear of cataract surgery, difficulty doing visual tasks, or complications with obtaining surgery such as long wait times or uncovered surgical costs," the investigators opind.
Freeman commented on finding that cataracts were associated with depressive symptoms whether or not corrective surgery was previously performed, noting another study with similar findings.
"Our study did not have adequate data on whether cataract patients were waiting for surgery or had already had surgery," Freeman said. "It's possible that the stress from cataract may serve as a tipping point for some people so that even when the cataracts are removed, the depression does not subside."
The study, "Visual Impairment, Eye Disease, and the 3-year Incidence of Depressive Symptoms: The Canadian Longitudinal Study on Aging," was published online in Ophthalmic Epidemiology.