March 2008

 

OPHTHALMOLOGY NEWS

 

Better vision, better QoL for elderly patients


by Matt Young EyeWorld Contributing Editor

 

 

Refractive correction could reduce depression in nursing home patients

Even a one diopter correction of vision could help decrease depression in elderly patients, a new study suggests. The study, published in the November 2007 issue of Archives of Ophthalmology, found that in a nursing home population with an average uncorrected refractive error of +/–1.00 D for distance and + 1.25 D for near, corrected patients experienced better quality of life and even reduced depressive symptoms. “These results show that remediation of even modest to moderate levels of optical defocus can be helpful to the health and well-being of nursing home residents,” wrote lead study author Cynthia Owsley, Ph.D., department of ophthalmology, School of Medicine, University of Alabama at Birmingham. “This study implies that there are significant, short-term quality-of-life and psychological benefits to providing the most basic of eye care services—namely, spectacle correction—to older adults residing in nursing homes.”

Healthy sight

Despite the obvious benefits of refractive correction, it’s not so easy to obtain proper visual care in nursing homes. In as many as one-third of nursing home residents, visual handicaps could be eliminated with treatment of myopia, hyperopia and presbyopia, Dr. Owsley noted. But Dr. Owsley and colleagues went further, testing whether such visual correction could lead to improvement in quality of life and even reduction in depressive symptoms. They analyzed 151 patients, 81 of which received immediate refractive error correction with spectacles, and 70 of which received delayed treatment after a two-month follow-up visit. Participants were trimmed to 78 in the immediate group and 64 in the delayed group resulting from illness, death, moving out of the nursing home, or declining further participation. About one quarter were virtual emmetropes but had uncorrected presbyopia, half were modestly hyperopic or myopic, and one quarter were moderately to severely hyperopic or myopic.

After visual correction, at the two-month follow-up, the immediate refractive error correction group as compared with the delayed correction group had higher scores on the general vision, reading, and activities and hobbies subscales of the Nursing Home Vision-Targeted Health-Related Quality-Of-Life Questionnaire (NHVQoL) as well as on the VF-14. Other NHVQoL scores were not statistically significant. Further, the immediate group had lower Geriatric Depression Scale (GDS) scores than the delayed group. The median score was 4.9 for the delayed group at the two-month follow-up period versus 3.6 for the immediate group. “When comparisons were adjusted for the baseline value of the outcome measure under evaluation and baseline mental status, the immediate refractive error correction group had higher scores on the NHVQoL subscales of general vision, reading, psychological distress, activities and hobbies, and social interaction as well as on the VF-14, and they had lower scores on the GDS,” Dr. Owsley noted.

Practically speaking

Dr. Owsley found that in the studied population, seeing allowed patients to better perform daily tasks. With their new spectacles, participants could not only read better, they could write, use the telephone, watch TV, and play cards better. These improvements were reflected in the NHVQoL tests.

“After intervention, scores on some NHVQoL subscales increased dramatically—about 12 points—following refractive error correction (general vision, reading), with others exhibiting more modest increases, on average about 5 points (psychological distress, activities and hobbies, social interaction),” Dr. Owsley reported. The benefits of visual correction also led to fewer reports of psychological distress (such as worry, frustration and upset). New spectacles also increased social interaction such as visiting fellow residents in their rooms and participating in group activities. “Thus, optical correction of myopia, hyperopia, and/or presbyopia goes further than improving vision in that it can enhance the psychological well-being of nursing home residents,” Dr. Owsley reported. Beyond spectacles, cataract surgery also could enhance the psychological demeanor of elderly patients, said Mark Packer, M.D., clinical associate professor, Casey Eye Institute, Oregon Health & Science Univeristy, Portland.

“Cataracts reduce the amount of light coming in,” Dr. Packer said. “It’s just like a veil or cloud lifting [after cataracts are removed].” Further, he said, things like light, brightness, and color all have an impact on emotion and effect. Recent work has shown that there is a pathway through the retina to cells that release melatonin. The cortisol cycle also is controlled by melatonin release. Hence, Dr. Packer suggested, there is a link between light levels and mood. Of course, seeing better—even with simple refractive correction with spectacles—allows people to do things they want to do and enjoy life more, he said.

Editors’ note: Dr. Owsley has no financial interests related to this study. Dr. Packer has no financial interests related to his comments.

Contact Information

Owsley: owsley@uab.edu

Packer: 541-687-2110, mpacker@finemd.com

Better vision, better QoL for elderly patients Better vision, better QoL for elderly patients
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