John Shepherd, MD: Recognizing and Addressing Depression in Low Vision Patients

John Shepherd, MD, University of Nebraska Medical Center:

As ophthalmologists we often are more treating the and the disease, and when we do that, we often don't recognize that in patients with irreversible vision loss that there is the difficulty that those individuals have participating in daily activities, so what I would call the impairment — and in that sense ophthalmologists struggle with recognizing the impairment.

In terms of recognizing depression, the best thing that an ophthalmologist could do is in a person who has some degree of permanent vision loss, I would say a best corrected visual acuity of less than 20/40 or 20/50, and they have a chronic eye condition that is going to cause progressive vision loss, this isn't something that's going to be cured and is going to get better.

When they have a patient like that, then they should take the time to ask the patient if they are having any difficulty because of their vision loss participating in favored daily activities. The number one might be reading, or driving, it could be any activity that the patient can do. And if the patient is having difficulty in those activities, then the eye doctor really needs to get that person in the hands of someone who will address the impairment.

Individuals that dress the impairment would be low vision rehabilitation specialists. And the concentration there, is on getting an understanding of what functional difficulties the individual is having and then helping that individual to find ways to be able to better go about those daily activities, where you're minimizing the disability and making it as easy as possible to do those activities that they can no longer do because of their eye problem. The low vision specialist will also address how the individual is adjusting and adapting to the vision loss. This might be through doing a depression screening, there are depression scales like the Geriatric Depression Scale which is a 15 question test, there are much shorter ones, but what that does it helps us to identify the individual who is likely to be experiencing depression from the lack of ability of being able to do their favorite day to day activities.

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 help those people to equip them 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.

If a person has very good vision even 20/20 vision, but they have a pair of central scotoma right by the fovea, the center of vision, then that could cause them significant trouble reading work documents, communication, computer information, anything, and in that sense again, the greater the difficulty the person is having going about those daily activities, the greater the likelihood of depression.