Corporate Banner
Satellite Banner
Pharma Outsourcing
Scientific Community
 
Become a Member | Sign in
Home>News>This Article
  News
Return

Rehabilitation Helps Prevent Depression from Age-Related Vision Loss

Published: Friday, July 11, 2014
Last Updated: Thursday, July 10, 2014
Bookmark and Share
NIH-funded study brought together eye care and mental health professionals.

Depression is a common risk for people who have lost their vision from age-related macular degeneration (AMD), but a new study shows that a type of rehabilitation therapy can cut this risk in half. The study was funded by the National Eye Institute (NEI), part of the National Institutes of Health.

"Our results emphasize the high risk of depression from AMD, and the benefits of multi-disciplinary treatment that bridges primary eye care, psychiatry, psychology, and rehabilitation," said Barry Rovner, M.D., a professor of psychiatry and neurology at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia. Dr. Rovner and his colleagues published their findings in Ophthalmology.

AMD is a leading cause of vision loss in the United States. About 2 million Americans age 50 and over have vision loss from AMD, and about 8 million have an earlier stage of the disease, with or without vision loss. AMD causes damage to the macula, a spot near the center of the retina that is needed for sharp, straight-ahead vision. It can affect one eye or both, which is called bilateral AMD. As the disease progresses, it can cause a growing blurred area near the center of vision, and lead to difficulty with everyday activities, including the ability to drive, read, write, watch television, cook, and do housework.

Activities that used to be fun and fulfilling may begin to seem burdensome or even impossible. With loss of the ability to drive and navigate unfamiliar places, it becomes easier to stay at home than to see friends or meet new people. All of this can take a toll on mental health, and past studies have found that as many as one-third of people with bilateral AMD develop clinical depression.

"The depression is a response to disability, so we reasoned an effective treatment would be to reduce the disability through rehabilitation," Dr. Rovner said. In the Low Vision Depression Prevention Trial (VITAL), he led a team of psychologists, ophthalmologists, optometrists, and occupational therapists to test an approach called behavior activation.

"Behavior activation involves helping people to focus on activities they enjoy, to recognize that loss of those activities can lead to depression, and to re-engage in those activities," said Robin Casten, Ph.D., a co-author and an associate professor of psychiatry and human behavior at Jefferson. Helping people maintain an active social life is an important part of the approach, she said.

The trial recruited 188 participants with bilateral AMD from an ophthalmology practice affiliated with Wills Eye Hospital in Philadelphia. "We felt that this trial addressed an important need. Ophthalmologists have many tools at the ready for treating AMD, and we are continuing to forge links with other health care providers to effectively treat the whole patient," said Allen C. Ho, M.D., director of the Clinical Retina Research Unit at Wills Eye Hospital and professor of ophthalmology at Jefferson.

The participants were 84 years of age on average, 70 percent were women, and 50 percent lived alone. All had a best-corrected vision of less than 20/70. (A person with 20/70 vision sees an object from 20 feet away as clearly as a person with normal vision sees it at 70 feet away.) Each participant had mild depressive symptoms and was at risk for developing clinical depression, based on a nine-item depression subtest of the Patient Health Questionnaire, or PHQ-9.

During the trial, the participants had two visits with an optometrist, during which they were prescribed low-vision devices such as handheld magnifiers. After those initial visits, the participants were randomly split into two groups.

One group received behavior activation from an occupational therapist specially trained in the approach. The occupational therapist worked with participants to guide them on using the low-vision devices, to make changes around the home (such as using brighter lights and high-contrast tape), to increase their social activities, and to help them set personal goals and break these down into manageable steps.

"Blending the behavior activation with low-vision rehabilitation was straightforward and natural," said Mark Hegel, Ph.D., also a co-author and a professor of psychiatry at Dartmouth's Geisel School of Medicine in Hanover, New Hampshire. "Occupational therapy helps people regain valued activities in their daily lives, and behavior activation capitalizes on this through formal goal setting and reinforcement of progress."

The second group of participants served as a control group. They talked about their difficulties to a therapist, but did not receive behavior activation or low-vision occupational therapy. Both groups had six one-hour therapy sessions in their homes over a two-month period. All participants were allowed to take antidepressants, but less than 10 percent did so. All received medical management of AMD as prescribed by their primary eye care providers.

By four months, 12 participants in the control group and seven participants in the behavior activation group had withdrawn from the trial or passed away. Of the remaining 169 participants, 18 (23.4 percent) in the control group and 11 (12.6 percent) in the behavior activation group developed clinical depression, based on retesting with the PHQ-9. Behavior activation had the most benefit for participants with the worst vision (less than 20/100), reducing the risk of depression by about 60 percent compared to controls. When the data were adjusted for vision status, physical health and baseline PHQ-9 score, behavior activation reduced the risk of depression by 50 percent compared to the control treatment.

"AMD is typically diagnosed and treated in primary eye care settings, where there is no defined standard of care for depression. This study was a unique and compelling effort to address that issue by strengthening teamwork between eye care professionals and mental health professionals," said Eleanor Schron, Ph.D., group leader for clinical applications at NEI.

Dr. Rovner said he hopes the study will serve as a model for similar approaches to preventing and treating depression in AMD. When approved by a physician, occupational therapy is reimbursable through Medicare.

"Stronger links between primary eye care and mental health care workers would be needed to make behavior activation more widely available for AMD patients," Dr. Rovner said. Specialized instruction would also be needed for occupational therapists, who are not typically trained in behavior activation.

"We built this to be an affordable treatment. Now we would like to see it become accessible," he said. The study is continuing to follow participants to see if the benefits of treatment are maintained out to one year.


Further Information
Access to this exclusive content is for Technology Networks Premium members only.

Join Technology Networks Premium for free access to:

  • Exclusive articles
  • Presentations from international conferences
  • Over 2,400+ scientific posters on ePosters
  • More than 3,700+ scientific videos on LabTube
  • 35 community eNewsletters


Sign In



Forgotten your details? Click Here
If you are not a member you can join here

*Please note: By logging into TechnologyNetworks.com you agree to accept the use of cookies. To find out more about the cookies we use and how to delete them, see our privacy policy.

Related Content

Young South African Women can Adhere to Daily PrEP Regimen as HIV Prevention
NIH-funded study finds men in Bangkok, Harlem also successful in taking daily dose.
Saturday, July 25, 2015
Study Shows Promise of Precision Medicine for Most Common Type of Lymphoma
The study appeared online July 20, 2015, in Nature Medicine.
Tuesday, July 21, 2015
HIV Control Through Treatment Durably Prevents Heterosexual Transmission of Virus
NIH-funded trial proves suppressive antiretroviral therapy for HIV-infected people effective in protecting uninfected partners.
Tuesday, July 21, 2015
Early Antiretroviral Therapy Prevents Non-AIDS Outcomes in HIV-infected People
NIH-supported findings illustrate manifold benefit of therapy.
Tuesday, July 21, 2015
NIH-funded Vaccine for West Nile Virus Enters Human Clinical Trials
Enrollment is expected to be completed by December 2015.
Tuesday, July 07, 2015
In Blinding Eye Disease, Trash-Collecting Cells Go Awry, Accelerate Damage
NIH research points to microglia as potential therapeutic target in retinitis pigmentosa.
Friday, July 03, 2015
Boys More Likely to Have Antipsychotics Prescribed, Regardless of Age
NIH-funded study is the first look at antipsychotic prescriptions patterns in the U.S.
Thursday, July 02, 2015
New Medication for Alcohol Use Disorder
NIH begins clinical trial investigating a potential treatment for alcohol use disorder.
Friday, June 26, 2015
NIH Begins Clinical Trial of New Medication for Alcohol Use Disorder
Clinical trial will evaluate the safety and effectiveness of gabapentin enacarbil in treating alcohol use disorder.
Friday, June 26, 2015
Study of Ebola Survivors Opens in Liberia
Trial to examine long-term health effects of Ebola virus disease.
Friday, June 19, 2015
NIH Names Walter J. Koroshetz, M.D. Director of the NINDS
Dr. Collins recognized Dr. Koroshetz’ role in the creation of the StrokeNet.
Saturday, June 13, 2015
NCI-MATCH Trial will Link Targeted Cancer Drugs to Gene Abnormalities
Precision medicine trial will open to patient enrollment in July.
Tuesday, June 09, 2015
Linking Targeted Cancer Drugs to Gene Abnormalities
Investigators at the NIH have announced a series of clinical trials that will study drugs or drug combinations that target specific genetic mutations.
Wednesday, June 03, 2015
Starting Antiretroviral Treatment Early Improves Outcomes for HIV-infected Individuals
NIH-funded trial results likely will impact global treatment guidelines.
Thursday, May 28, 2015
Two Treatments Yield Similar Results for Children After Cardiac Arrest
NIH-funded research finds therapeutic hypothermia no more effective than normal temperature control.
Friday, May 08, 2015
Scientific News
Young South African Women can Adhere to Daily PrEP Regimen as HIV Prevention
NIH-funded study finds men in Bangkok, Harlem also successful in taking daily dose.
Researchers Find Key Player in Diabetic Kidney Disease Through Power of Metabolomics
Discovery could lead to new and better diagnostic marker for chronic kidney disease.
Immunotherapy Shows Promise for Myeloma
A strategy, which uses patients’ own immune cells, genetically engineered to target tumors, has shown significant success against multiple myeloma, a cancer of the plasma cells that is largely incurable.
Santhera Announces First Patient Dosing with Omigapil in CMD
Company announces full patient recruitment of CALLISTO study.
Study Shows Promise of Precision Medicine for Most Common Type of Lymphoma
The study appeared online July 20, 2015, in Nature Medicine.
HIV Control Through Treatment Durably Prevents Heterosexual Transmission of Virus
NIH-funded trial proves suppressive antiretroviral therapy for HIV-infected people effective in protecting uninfected partners.
Adaptimmune's Novel Cancer Therapeutics Show Positive Clinical Trial Results
The company has announced that positive data from its Phase I/II study of its affinity enhanced T-cell receptor (TCR) therapeutic targeting the NY-ESO-1 cancer antigen in patients with multiple myeloma has been published.
Early Antiretroviral Therapy Prevents Non-AIDS Outcomes in HIV-infected People
NIH-supported findings illustrate manifold benefit of therapy.
Adaptimmune’s NY-ESO-1 TCR-engineered T-Cells Demonstrate Durable Persistence
Study has been published in Nature Medicine.
First Made-in-Singapore Cancer Drug Enters Clinical Testing
The drug prevents cancer progression and paves the way for new advancements in cancer therapeutics.
Scroll Up
Scroll Down
SELECTBIO

Skyscraper Banner
Go to LabTube
Go to eposters
 
Access to the latest scientific news
Exclusive articles
Upload and share your posters on ePosters
Latest presentations and webinars
View a library of 1,800+ scientific and medical posters
2,400+ scientific and medical posters
A library of 2,500+ scientific videos on LabTube
3,700+ scientific videos
Close
Premium CrownJOIN TECHNOLOGY NETWORKS PREMIUM FREE!