Low Vision News

For low vision specialists and those who consult them

Monthly Archives: February 2010

More evidence of the association between depression and visual impairment

There is a new paper in Investigative Ophthalmology and Vision Science which assesses the incidence of depression amongst people with visual impairment.

The authors interviewed 143 adults with visual impairment (vision worse than 6/12 or 20/40). 15% of their sample were identified as having ‘moderate depression’ by use of a standard instrument (the PHQ-9). One person had severe depression, for which they were already taking antidepressant medication.

The authors also find that younger adults were more likely to have depression than the older people they assessed. They show that this is not confounded by the length of time people have had visual impairment, but is indeed to do with the age at which people develop poor vision. They speculate that this is due to the increased burden of work and family commitments of younger people, or the fact that they have developed less successful coping strategies than older people.

This type of research is difficult to perform, and it is particularly difficult to determine causality from a cross-sectional report like this: would some of the people with depression have been depressed if they didn’t have vision loss? Quite possibly, as depression is so common. I was struck by the presentation by Dr Schwartz at the AAO meeting, where he pointed out that optometrists will see more people with depression than with blepharitis (a very common inflammation of the eyelids) in the average day.

This paper adds to the volume of research showing that people with visual impairment are at increased risk of depression. I am aware that as clinicians working in low vision clinics we should be screening for depression in the people which we see, yet I still find it difficult to broach this subject in the consulting room. As I have previously discussed, I think further training for low vision professionals in communication skills and identifying mental health problems is long overdue.

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(Another) paper on visual impairment and falls

In the most recent edition of Ophthalmology, there is a paper by Patino and colleagues reporting the relationship between visual impairment and falls. This paper is part of the large LALES (Los Angeles Latino Eye Study), which is a population-based study of the Latin American population of Los Angeles.

They found that about one-fifth of their sample had fallen in the previous four years, and that about 10% of the sample had injured themselves when falling. Most of the injuries were relatively minor, although some people broke their wrist, rib or hip.

Visual impairment was associated with falling and with injury. Those with central visual field loss were 2.4 times more likely to report a fall, and 2.8 times more likely to fall and injure themselves, than people without central vision loss. Peripheral vision loss made people 1.4 times more likely to fall. There was also a ‘dose effect’ in that the worse the visual impairment, the greater the likelihood of falls. Visual impairment is likely to contribute to falls in at least two ways: the increased likelihood of tripping over an unseen object, and impaired balance as a consequence of poor vision.

The authors found that people with bifocal glasses were more likely to have fallen, but this factor was found to be attributable to the older age and greater comorbidity of people who were bifocal wearers.

This is by no means the first study to examine visual loss and falls, but it includes a wider range of ages than some of the other large studies (eg. the Salisbury Eye Evaluation).

Of course the obvious question is ‘what can we do to stop people falling?’ The most important strategy is to ensure that eye disease is identified early, to reduce the impact of diseases such as glaucoma on the visual field. For those with visual impairment, home adjustment (to remove trip hazards), orientation and mobility training, optimal refractive correction and a medication review are all useful techniques to reduce the likelihood of falls.

From the front line: Low vision care in rural Romania

For the past six years I have been involved with a small charity called Iasis, which amongst other things provides low vision care in a School for the Blind in a remote part of Romania.

It has been fascinating to see the changes in this part of Eastern Europe since 2004: since then Romania has joined the European Union, there is mobile phone coverage in the remote area where the school is, there are Best Western and Ramada hotels in Iasi (the nearest big town), and there are far fewer horses and carts on the roads. My friend and former colleague Marek Karas has been coming here since shortly after the fall of Communism and the changes he has seen in the last 15 years are even more marked.

From a low vision perspective, three optometrists (myself, Marek, and Liz Gould) see about 100 children for a low vision assessment each year. The school has some computers and donated electronic CCTV magnifiers, so our role is in refraction and providing optical magnifiers. Due to previous difficulties with the supply of batteries we generally use very ‘low tech’ devices: non illuminated hand and stand magnifiers, hyperoculars, and spectacles.

What is remarkable – and humbling – is how effective very simple magnifiers are and how well they are used. It is not uncommon for us to ask children what magnifiers they use and to be presented with a chipped, scratched lens which has fallen out of a hand magnifier months earlier – but which is clearly well loved and which is used dozens of times a day. As some of these devices cost only about £5/€5/$8 it is staggering what value for money they provide.

Without wanting to sound sentimental, it also reminds me why I love working in the field of low vision rehabilitation: the smile on the face of a child when you show them that with a spectacle correction they can see their friends’ faces across a room is about as life-affirming as you can get.