January-February 2020

NEWS

Keeping an eye out for depression


by Liz Hillman Editorial Co-Director

Vision loss is among Americans’ greatest fears, compared to other disabling conditions or diseases.1 As such, it’s not surprising that vision loss has been associated with depression.
A number of studies have established this link. A study that looked at the association between depression and functional vision loss in the U.S., for example, found that self-reported vision loss (not necessarily loss of visual acuity) was significantly associated with depression.2
Vision loss is only a possible factor in some cases of depression with various other factors at play as well. But with this link to vision loss, what is the role of ophthalmologists in spotting depression in patients and how should suspected cases be handled?
Alan Morse, JD, PhD, thinks most in the ophthalmic community are at least aware of the association between vision loss and depression, but he doesn’t think medical professionals are taking the steps they should to get patients help.
While Dr. Morse doesn’t think ophthalmologists should necessarily get involved in addressing patients’ feelings, he does think simple screening and referrals are well within their purview.
“It’s important that eyecare professionals recognize depression in their patients. One of the ways they can do this very easily is to use something like the PHQ-2, which couldn’t be easier or simpler to do,” Dr. Morse said, noting that it could be done by the practitioner, at the front desk, or in the waiting room. “It’s only two questions, it scores instantly, and it would give them a very quick idea of whether that particular patient is feeling depressed.”
If the patient does score as having depressive symptoms, Dr. Morse said a referral to a behavioral practitioner should be made, while focusing on treating the patient’s visual issues.
“It’s important for practitioners to focus on the core of their practice. That said, it’s equally important for them to help their patients. You don’t want a patient coming in with a broken arm and you see the arm hanging by a thread and you say ‘Let’s talk about your eyes.’ They have a problem, you need to address it. In the case with a broken arm, clearly you’re going to make a referral to an orthopedist. In the case of a problem where a patient is depressed, a referral is equally appropriate,” Dr. Morse said.
If a patient asks why they are being referred to a psychologist or psychiatrist when they meet with an ophthalmologist about vision problems, Dr. Morse said to be honest with the patient about your concern about depression. Say that you will continue to see them to address vision issues, but that another professional could help with other aspects of their mood that might be affecting their quality of life, Dr. Morse explained.
Sometimes depressive symptoms associated with vision loss can be improved with treatment to improve vision. Addressing the patient’s vision issues could improve symptoms of depression but, Dr. Morse noted, it may not. In an invited commentary published in JAMA Ophthalmology, Dr. Morse offered a simple way to get at if a patient’s visual symptoms are affecting his or her quality of life and, thus, could be leading to depressive symptoms. “One easy way to help patients is to ask a simple question: Because of your eyesight, are you unable to do things you want to do?”3
“[Ophthalmologists] should address the components of a patient’s problem that they feel most equipped to deal with. Just as they would refer them if the patient needed surgery and it was not a kind of surgery they performed, they should understand that depression is something that there are people who are equipped to deal with. The assumption is they’re depressed because they have vision loss and once the vision loss is fixed, they won’t be depressed. That may be true, but it may not be,” Dr. Morse said. “Depression in patients with vision loss doesn’t necessary flow from their vision loss. Don’t make the assumption that you know what the cause of the depression is.”
Dr. Morse pointed to an editorial in the journal Ophthalmology that he wrote last year “What Can I Do to Help My Patient When I Think There Is Nothing Else I Can Do?” In this piece, Dr. Morse wrote about depression as a significant comorbidity of self-reported vision loss, emphasizing the importance of understanding and appreciating what the patient is experiencing to address their sense of vision loss. Dr. Morse wrote that eyecare providers should make sure discussions are had (either with them or with others, such as a social worker) about the patient’s “goals and the opportunities for vision rehabilitation.”

About the doctor

Alan Morse, JD, PhD
President and chief executive officer
Lighthouse Guild
Adjunct professor
Department of Ophthalmology
Columbia University
New York, New York

References

1. Alliance for Eye and Vision Research. New Public Opinion Poll Reveals a Significant Number of Americans Rate Losing Eyesight as Having Greatest Impact on their Lives Compared to Other Conditions. 2014.
2. Zhang X, et al. Association between depression and functional vision loss in persons 20 years of age or older in the United States, NHANES 2005–2008. JAMA Ophthalmol. 2013;131:573–81.
3. Morse A. Addressing the maze of vision loss and depression. JAMA Ophthalmol. 2019;137:832–833.
4. Morse A. What can I do to help my patient when I think there is nothing else I can do? Ophthalmology. 2018;125:959–61.

Relevant disclosures

Morse: None

Contact

Morse: armorse@lighthouseguild.org

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