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In brief: Program helps relieve distress of age-related eye disease

In brief

Program helps relieve distress of age-related eye disease

Aging eyes are at increased risk for several problems, but probably none are as unsettling as age-related macular degeneration (AMD), the most common cause of severe vision loss for people age 55 and over. AMD affects the macula, the area of the eye that provides the sharp central vision we need for normal daily activities such as reading and driving. (Peripheral vision, though never as sharp as normal central vision, is relatively unaffected.) AMD interferes with independence and mobility and increases the risk for depression, falls, and fractures.

Physicians and researchers are working to identify problems that most distress people with AMD and find ways to counteract or prevent them. A program developed at the University of California–San Diego (UCSD) was put to the test in a randomized trial funded in part by the National Eye Institute. The results suggest that self-management programs involving both education and behavioral change can improve quality of life, reduce disability, and prevent depression for as long as several months.

The UCSD investigators randomly assigned 231 older women and men with AMD to one of three groups: self-management, taped lectures on health and aging, or a waiting list. All participants had vision so poor they could not drive and found it difficult to read or recognize faces. The researchers evaluated the subjects’ mood (about 25% were depressed) and their level of vision-related functioning. Participants rated their self-efficacy, that is, their confidence in handling day-to-day challenges.

The self-management group met two hours a week for six weeks in small sessions that incorporated cognitive and behavioral techniques. Problem-solving lessons showed them how to manage various AMD-related challenges. They were also taught about the biology and course of AMD, and they learned exercise techniques that didn’t require walking or good vision.

At the end of six weeks, subjects in the self-management group had less emotional distress, better visual functioning, and greater self-efficacy than those in the other two groups. These benefits held up in a six-month follow-up. Also, compared to the control group, the self-management group had only half as many new cases of depression. Self-confidence improved most in patients who were depressed at the start of the study. Although the research requires replication, the investigators are particularly encouraged by the reduced risk for depression in the self-management group. Results were published in the January 2005 Archives of Ophthalmology.

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Last updated:	August 21, 2006