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. 2022 Oct 2;22(1):391.
doi: 10.1186/s12886-022-02602-9.

Mental health and visual acuity in patients with age-related macular degeneration

Cheryl N Fonteh  1   2 , Marc T Mathias  3 , Naresh Mandava  3 , Niranjan Manoharan  3 , Anne M Lynch  3 , Roxanne Navo  3 , Jennifer L Patnaik  3 ; University of Colorado Retina Research Group
Collaborators, Affiliations

Mental health and visual acuity in patients with age-related macular degeneration

Cheryl N Fonteh et al. BMC Ophthalmol. .

Abstract

Background: Visual acuity (VA) loss has been associated with depression in patients with age-related macular degeneration (AMD). However, previous studies did not incorporate subgroups of AMD when correlating VA and mental health. The goal of this study was to describe the relationship between VA and mental health questions in patients with different classifications of AMD, and to identify associations of mental health subscale scores.

Methods: AMD patients classified by multi-modal imaging were recruited into an AMD registry. Habitual VA was obtained by ophthalmic technicians using the Snellen VA at distance. At enrollment, patients completed the NEI-VFQ-25, which includes 25 questions regarding the patient's visual functionality. Median with interquartile-range (IQR) scores on the mental health subscale of the VFQ were calculated by AMD classification and VA groups. Univariate and multivariable general linear models were used to estimate associations between mental health scores and variables of interest.

Results: Eight hundred seventy-five patients were included in the study. Patients with bilateral geographic atrophy (GA) or bilateral GA and neovascular (NV) AMD scored lowest on the mental health subscales with a median (IQR) of 58.2 (38-88) and 59.3 (38-88). When stratified by VA, patients with a habitual VA of 20/200 or worse scored the lowest on mental health subscales scores: median of 43.8 (IQR: 31-62). Patients with a VA of 20/20 scored the highest: 87.5 (IQR: 81-94). Habitual VA of the better- and worse-seeing eye and AMD classification were significantly associated with mental health subscale scores (all p < 0.0001 in both the univariate and multivariable analysis, except the VA of the worse-seeing eye in multivariable model p = 0.027). Patients enrolled during the COVID pandemic had mental health scores that were 2.7 points lower than prior to the pandemic, but this difference was not significant in univariate (p = 0.300) or multivariable analysis (p = 0.202).

Conclusion: There is a significant association between mental health questionnaire scores and AMD classification, as well as VA in both the better and worse-seeing eyes in patients with AMD. It is important for clinicians to recognize feelings of worry/ frustration in these patients, so they can be appropriately referred, screened, and treated for mental health problems.

Keywords: Age-related macular degeneration; Mental health; Retina; Vison function questionnaires.

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Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Box plots of mental health subscale scores by AMD classification. The line in each boxplot represents the median and the circle correpsond to the mean values. The boxplots extend to the 25th and 75th percentiles, and the whiskers extend to a maximum of 1.5 IQR. IQR = inter-quartile range
Fig. 2
Fig. 2
Box plots of mental health subscale scores by HVA in better-seing eye. The line in each boxplot represents the median and the circle correpsond to the mean values. The boxplots extend to the 25th and 75th percentiles, and the whiskers extend to a maximum of 1.5 IQR. IQR = inter-quartile range
Fig. 3
Fig. 3
Box plots of mental health subscale scores by BCVA in worse-seing eye. The line in each boxplot represents the median and the circle correpsond to the mean values. The boxplots extend to the 25th and 75th percentiles, and the whiskers extend to a maximum of 1.5 IQR. IQR = inter-quartile range
Fig. 4
Fig. 4
Individual mental health subscale question responses by visual acuity in the better-seeing eye
See this image and copyright information in PMC

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