Association Between Visual Impairment and Depression in Patients Attending Eye Clinics: A Meta-analysis

Abstract

Importance: Given that depression is treatable and some ocular diseases that cause visual loss are reversible, early identification and treatment of patients with visual impairment who are most at risk of depression may have an important influence on the well-being of these patients.

Objective: To conduct a meta-analysis on the prevalence of depression in patients with visual impairment who regularly visit eye clinics and low vision rehabilitation services.

Data sources: MEDLINE (inception to June 7, 2020) and Embase (inception to June 7, 2020) were searched.

Study selection: Studies that obtained data on the association between acquired visual impairment and depression among individuals aged 18 years or older were identified and included in this review. Exclusion criteria comprised inherited or congenital eye diseases, review studies, unpublished articles, abstracts, theses, dissertations, and book chapters. Four independent reviewers analyzed the results of the search and performed the selection and data extraction to ensure accuracy.

Data extraction and synthesis: Meta-analyses of prevalence were conducted using random-intercept logistic regression models. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Main outcomes and measures: Proportion of depression.

Results: A total of 27 studies were included in this review, and all but 2 included patients older than 65 years. Among 6992 total patients (mean [SD] age, 76 [13.9] years; 4195 women [60%]) with visual impairment, in 1687 patients with depression, the median proportion of depression was 0.30 (range, 0.03-0.54). The random-effects pooled estimate was 0.25 (95% CI, 0.19-0.33) with high heterogeneity (95% predictive interval, 0.05-0.70). No patient characteristic, measured at the study level, influenced the prevalence of depression, except for the inclusion of patients with cognitive impairment (0.33; 95% CI, 0.28-0.38 in 14 studies vs 0.18; 95% CI, 0.11-0.30 in 13 studies that excluded this with major comorbidities; P = .008). The prevalence of depression was high both in clinic-based studies (in 6 studies, 0.34; 95% CI, 0.23-0.47) and in rehabilitation services (in 18 studies, 0.25; 95% CI, 0.18-0.33 vs other settings in 3 studies, 0.15; 95% CI, 0.05-0.38; P = .17), and did not vary by visual impairment severity of mild (in 8 studies, 0.24; 95% CI, 0.14-0.38), moderate (in 10 studies, 0.29; 95% CI, 0.21-0.39), and severe (in 5 studies, 0.29; 95% CI, 0.12-0.56; P = .51).

Conclusions and relevance: The results of this meta-analysis suggest that depression in patients with visual impairment is a common problem that should be recognized and addressed by the health care professionals treating these patients.

Figure 1.. Trial Flow Diagram Summarizing the Process for Selecting Original Articles for Review

Figure 2.. Forest Plot of Prevalence of Depression in All Studies

Studies are sorted according to their sample size. No meta-analysis weights are displayed because a logistic random-effects model was used and weights, being parameter estimations based on an iterative, likelihood-function procedure, are not available.