In the JournalsPerspective

Mental health symptoms, vision impairment are bidirectional, researchers say

Researchers found a bidirectional association between self-reported vision impairment and symptoms of depression, but not between vision impairment and anxiety.

Anxiety symptoms may precede vision impairment, they said, but they found no evidence of the reverse.

A sample of 7,584 Medicare beneficiaries at least 65 years old who were part of the National Health and Aging Trends study 2011 to 2016 were included. Participants were considered to have vision impairment if they reported that they were blind, could not see across the street or read newspaper print, even with glasses. They were administered the Patient Health Questionnaire for Depression and Anxiety (PHQ-4), which screens for depression and anxiety symptoms, annually.

Researchers found that the weighted prevalence of depression and anxiety symptoms was more than double among those with self-reported vision impairment (31.2% and 27.2%, respectively) compared to those without (12.9% and 11.1%, respectively).

They said they established a bidirectional association between self-reported vision impairment and depression symptoms, but that anxiety symptoms may only precede vision impairment.

The reasoning for this bidirectional relationship is not clear, the authors stated. It could be that vision impairment causes difficulties in adapting to changes in daily activities, or those who initially have mental health symptoms are less likely to seek eye care. Additionally, perhaps those who have strong risk factors for vision loss or a diagnosis of chronic ocular disease could experience depression or anxiety before the vision impairment surfaces.

In light of these study results, the authors recommended that eye care providers screen older patients with vision loss for mental health issues, and that primary care physicians suggest vision screening in patients with mental health symptoms. – by Nancy Hemphill, ELS, FAAO

Disclosure: Frank reported no relevant financial disclosures. Please see full study for all other authors’ disclosures.

Researchers found a bidirectional association between self-reported vision impairment and symptoms of depression, but not between vision impairment and anxiety.

Anxiety symptoms may precede vision impairment, they said, but they found no evidence of the reverse.

A sample of 7,584 Medicare beneficiaries at least 65 years old who were part of the National Health and Aging Trends study 2011 to 2016 were included. Participants were considered to have vision impairment if they reported that they were blind, could not see across the street or read newspaper print, even with glasses. They were administered the Patient Health Questionnaire for Depression and Anxiety (PHQ-4), which screens for depression and anxiety symptoms, annually.

Researchers found that the weighted prevalence of depression and anxiety symptoms was more than double among those with self-reported vision impairment (31.2% and 27.2%, respectively) compared to those without (12.9% and 11.1%, respectively).

They said they established a bidirectional association between self-reported vision impairment and depression symptoms, but that anxiety symptoms may only precede vision impairment.

The reasoning for this bidirectional relationship is not clear, the authors stated. It could be that vision impairment causes difficulties in adapting to changes in daily activities, or those who initially have mental health symptoms are less likely to seek eye care. Additionally, perhaps those who have strong risk factors for vision loss or a diagnosis of chronic ocular disease could experience depression or anxiety before the vision impairment surfaces.

In light of these study results, the authors recommended that eye care providers screen older patients with vision loss for mental health issues, and that primary care physicians suggest vision screening in patients with mental health symptoms. – by Nancy Hemphill, ELS, FAAO

Disclosure: Frank reported no relevant financial disclosures. Please see full study for all other authors’ disclosures.

    Perspective
    Kuniyoshi Kanai

    Kuniyoshi Kanai

    Depression and anxiety may predict future vision impairment.

    Many studies have described the link between vision impairment and later mental health issues in older adults. This study also demonstrates that mental health issues can lead to impaired vision.

    This study's biggest limitation is that the nature of vision impairment was self-reported by patients or their family members, a common method used in studies of this type. However, the study was large, the authors used the same testing protocol each year, and they collected data from a panel that provided annual measures of self-reported vision impairment and mental health symptoms in older adults.

    As a result of their findings, the authors recommend that eye care providers consider incorporating mental health screening into their evaluation of older patients with vision loss and that primary care clinicians consider vision screening for patients with symptoms of depression and anxiety.

    • Kuniyoshi Kanai, OD, FAAO
    • Director of residencies, on-campus programs, University of California, School of Optometry

    Disclosures: Kanai reports he is a consultant for EyePACS LLC and Fuji Optical Co. Ltd.