At the Annual Meeting of the American Academy of Ophthalmology (AAO) in New Orleans, Louisiana, November 11-14, 2017, Dr. John D. Shepherd, Director of the Weigel Williamson Center for Visual Rehabilitation at the University of Nebraska Medical Center, delivered a powerful lecture on older adults, depression, and vision loss.
Dr. Shepherd discussed his own experience living with a chronic illness and pointed to the setbacks ophthalmologists face in diagnosing depression in their patients with incurable eye conditions and low vision. He cited a lack of skill in diagnosing psychological illness and/or the belief that depression is a normal part of aging. Said Dr. Shepherd, “I think we have to look at these reasons and not justify our behavior with [these patients]. I think we have to change our thinking to be able to address the needs of our patients.”
Depression and Low Vision
A number of recent studies support Dr. Shepherd’s observations regarding the links between low vision and depression—and the importance of physician communication and low vision rehabilitation services for patients with low vision:
- New Research: Emotional Support and Physician Communication Must Accompany Medical Treatment for Age-Related Macular Degeneration noted that “89% of patients with macular degeneration who showed anxiety and 91% who showed depression were not receiving appropriate emotional and psychological treatment from their physicians.”
- Integrated Low Vision and Mental Health Treatment Can Reduce or Prevent Depression demonstrated that a low vision rehabilitation program reduced the incidence of depression by half among older adults with low vision from macular degeneration.
- New Research Examines the Association Between Diabetic Eye Disease and Depression: Should Eye Doctors Be More Alert to Patients’ Mental Health? concluded that doctors who are treating adults with chronic disabling eye disease “should be alert and sensitive to potential indicators of depression such as sad mood, poor sleep and appetite, impaired concentration, and diminished self-esteem.”
Dr. Shepherd Discusses Depression and Vision Loss
Edited and excerpted from Addressing Depression in Vision Loss Patients and Recognizing and Addressing Depression in Low Vision Patients, via MD Magazine:
It took his own bout with a chronic condition for John D. Shepherd, M.D. to understand depression in patients.
He began the lecture with an anecdote. Shepherd developed severe back pain years ago, which was only worsened when he injured his right knee and thus altered his walking form. Over several years, he was treated by several doctors, received multiple treatment regimens, underwent two surgical operations, and took months of physical therapy.
All the while, Shepherd found that his doctors were “woefully insensitive” to patients living with chronic pain. He eventually attempted suicide, then was treated as a patient with major depression.
“I will tell you that nowhere along the line was there ever a physician or health care professional that talked to me about how I can live with this,” Shepherd said.
Shepherd came to the realization that his patients with age-related macular degeneration (AMD) were showing the same depressive symptoms he once did. Living with constant blurred vision and an impairment from normal lives, Shepherd’s patients never expressed their problems until he bothered to ask about them.
“I really didn’t do much better than the doctors did with me,” Shepherd said. “They don’t offer encouragement, they don’t offer hope.”
Shepherd pointed to particular setbacks ophthalmologists face in diagnosing depression, such as their lack of skill in diagnosing psychological illness, or the impression that depression is a “normal part of aging.”
“I think we have to look at these reasons and not justify our behavior with [patients],” Shepherd said. “I think we have to change our thinking to be able to address the needs of our patients.”
Treatments available for patients with depression include psychiatric medications, professional counseling, and low vision rehabilitation in susceptible patients. Low vision rehabilitation, however, is still used on a limited basis by clinicians, Shepherd said.
“We can also then address a variety of activities, we can provide magnifiers, we can provide non-optical devices, there is skill training, environmental adaptations — there’s a wealth of things that can then equip people to better go about those daily living activities.”
“It’s interesting because depression has been shown in research studies to correlate with the level of disability. Many ophthalmologists wait for a specific level of visual acuity to send a person for low vision services, and that’s probably the wrong thinking.”
He also advised an implementation of positive communication, pointing back to his difficulties with chronic pain physicians years ago. Ophthalmologists can stress what can be done for patients, as opposed to what cannot be done, and express language that focuses on quality-of-life improvement.
You can view a video of Dr. Shepherd’s talk at Recognizing and Addressing Depression in Low Vision Patients.
What Is Low Vision?
If your eye doctor tells you that your vision cannot be fully corrected with ordinary prescription glasses, medication, or surgery, but you find you still have some usable vision, you have what is called “low vision.”
Having low vision means that even with regular glasses, contact lenses, medication, or surgery, you can find it difficult to perform everyday tasks, such as reading your mail, shopping, preparing meals, and signing your name.
Low Vision Optical Devices
One way to address low vision is through the use of low vision optical devices, such as magnifiers and magnifying reading glasses and small telescopes, and electronic magnifiers and magnifying systems, including electronic desktop and portable digital magnifiers.
All of these low vision optical devices should be prescribed by an ophthalmologist or optometrist who specializes in low vision and performs a thorough and comprehensive low vision examination with you.
Low Vision Non-Optical Devices
Low vision non-optical devices can also be helpful for people who have low vision.
Low vision non-optical devices can include improved lighting and flexible-arm task lamps, reading stands, absorptive sunglasses, typoscopes, tactile locator dots, and colored acetate sheets.
These non-optical devices are often recommended as part of a comprehensive low vision examination, and you can use them in combination with magnifiers and other low vision optical devices.
Vision Rehabilitation Services for Low Vision
“Vision rehabilitation” includes a wide range of professional services that can restore functioning after vision loss, just as physical therapy restores function after a stroke or other injury. Vision rehabilitation services allow people who have recently lost vision, are blind, or have low vision to continue to live independently and maintain their accustomed quality of life.
Although your eye doctor is the professional you’ll likely turn to first when dealing with your own – or a family member’s – vision loss, it’s important to note that many different kinds of vision rehabilitation services are available in addition to the eye care provided by your family doctor, ophthalmologist, optometrist, or low vision specialist. In fact, your own doctor may not be aware of, or refer you to, these comprehensive vision rehabilitation services, which are often provided through a state or non-profit rehabilitation agency, at little or no out-of-pocket cost.
Who provides vision rehabilitation services?
Vision rehabilitation services for adults who have recently lost vision, are blind, or have low vision are provided by a team of specially trained professionals, which may include low vision therapists, vision rehabilitation therapists, and orientation and mobility specialists:
Low Vision Therapists
Certified Low Vision Therapists (CLVTs and SCLVs) instruct individuals in the efficient use of remaining vision with optical devices, non-optical devices, and assistive technology, and can help determine the need for environmental modifications in the home, workplace, or school. You can learn more about these professionals at the Low Vision Therapy website and the American Occupational Therapy Association – Low Vision website.
Vision Rehabilitation Therapists
Certified Vision Rehabilitation Therapists (CVRTs) teach adaptive independent living skills, enabling adults who are blind or have low vision to confidently carry out a range of daily activities. CVRTs work with individuals in their homes, rehabilitation facilities, and employment settings. You can learn more about these professionals at the Vision Rehabilitation Therapy website.
To learn more about what a Vision Rehabilitation Therapist does and how you could benefit, read What Is a Vision Rehabilitation Therapist?.
Orientation and Mobility Specialists
Certified Orientation and Mobility Specialists (COMS or O&Ms) teach the skills and concepts that people who are blind or have low vision need in order to travel independently and safely in the home and in the community.
O&Ms teach safe and independent indoor and outdoor travel skills, including the use of a long cane, electronic travel devices (such as GPS), public transportation, and sighted guide, human guide, and pre-cane skills. You can learn more about these professionals at the Orientation and Mobility website.
What You Can Learn with Vision Rehabilitation Lessons and Training
- Communication skills: reading and writing, braille, and assistive computer technology
- Counseling: to help you, your spouse, family members, and friends adjust to your vision loss
- Independent living and personal management skills: home modifications, home repairs, personal self-care, financial management, recreation and leisure activities, and using the telephone
- Independent movement and travel skills: moving about safely indoors, using transportation, and traveling safely outdoors with a long white cane or other device
- Low vision evaluations and training with low vision devices: the low vision examination, bioptics for driving, low vision optical devices, and non-optical devices that can make the best use of your remaining vision
- Vocational rehabilitation: Getting back to work after a vision loss, or breaking into the workplace as a job seeker with blindness or low vision, including vocational evaluation and training, job training, job modification and restructuring, and job placement.
Locating Vision Rehabilitation Services
Your state rehabilitation agency or an online searchable database can help you locate vision rehabilitation agencies in your area and find the type of services that are right for you. See State and Local Rehabilitation Agencies in the VisionAware Directory of Services to locate agencies in your area.