The DR Barometer program, with support from Bayer, in their endeavour to increase patient awareness, facilitate knowledge exchange, and engage stakeholders hosted a session on neovascular age-related macular degeneration (nAMD) and its connection to mental health.

Rapid population ageing, the almost epidemic rise in neovascular age-related macular degeneration (nAMD), and the continued lack of government investment in health promotion and prevention strategies has the potential to result in unprecedented psychological toll on patients and their families. 

The central purpose of nAMD management is to minimize vision loss and related physical effects.  Yet increasingly retinal specialists are recognizing the mental health consequences impairment and vision-loss on the quality of life of their patients.  Deterioration in a person’s functional ability often leads to increased risk for clinical depression and anxiety.

A study conducted in 2020 found a high prevalence of depressive symptoms among nAMD patients presenting for treatment with poorer self-rated health, impaired activities of daily living, and reduced visual function.[i]  While most patients with nAMD have achieved positive outcomes from anti-VEGF treatment, approximately 10% of patients whose outcomes are not ideal are at risk for depression.[ii]  This reveals a necessity for psychiatric and rehabilitative interventions for some nAMD patients who are receiving treatment.

The evidence is overwhelming that nAMD is a critical public health issue and remains a significant threat to mental health.

 The future of nAMD management lies in a well-developed model that is patient-centred and harnesses the latest research in the field – improving the language used by healthcare professionals, testing the most effective examples of practice with feasibility studies at a country level, screening for psychological symptoms in routine eye care, ensuring referrals, and continuing to monitor mental status.[iii] 

On November 12, 2021, at the IFA 15^th Global Conference on Ageing, the panel of eminent speakers helped drive policy and practice dialogue from evidence to practice through three main goals:

1. Increase understanding on the multifaceted impact of retinal diseases and mental health
2. Create a conversation on incorporating mental health care into the management of eye diseases.
3. Contribute to the discourse on the nature of education for health care providers to equip them with the patient communication tools that alleviate concerns, deliver quality care, and strengthen patient satisfaction as part of comprehensive care.

   Key messages of the session included:

   1. Mental health screening at the time of the diagnosis, regular screening and appropriate referrals for psychological symptoms, and therapeutic interventions need to be incorporated into primary care.
   2. Current care practices must be redesigned to position the patient as the leader of their health care team.
   3. Rates of depression and anxiety in nAMD are high even among patients who received anti-VEGF treatment.
   4. Mental health and nAMD are inextricably linked.

      Panelists:

      Prof. Tariq Aslam, Consultant Ophthalmologist, Manchester Royal Eye Hospital; Vision Academy

      Prof. Alan Cruess, Professor of Ophthalmology, Dalhousie University

      Dr. Kiran Rabheru, Geriatric Psychiatrist, The Ottawa Hospital

      A recording of the session is available here.

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      [i] Vu, K.V., Mitchell, P., Dharamdasani Detaram, H., Burlutsky, G., Liew, G. and Gopinath, B. (2021), Prevalence and risk factors for depressive symptoms in patients with neovascular age-related macular degeneration who present for anti-VEGF therapy. Acta Ophthalmol. https://doi.org/10.1111/aos.14635

       

      [ii] Casten R, Rovner BW, Leiby BE, Tasman W. Depression Despite Anti–Vascular Endothelial Growth Factor Treatment of Age-Related Macular Degeneration. Arch Ophthalmol.2010;128(4):506–508. doi:10.1001/archophthalmol.2010.24

       

      [iii] Rovner BW, Casten RJ, Hegel MT, Leiby BE, Tasman WS. Preventing Depression in Age-Related Macular Degeneration. Arch Gen Psychiatry. 2007;64(8):886–892. doi:10.1001/archpsyc.64.8.886