LEADING OFF: Recognize Depression in Low Vision Patients

Posted by Optometric Management, by Robert Stoneback

Learn the signs of depression to help patients who have vision loss

May is Mental Health Awareness Month in the United States; a time to recognize the difficulty posed by related conditions, such as depression. Studies show that individuals who have vision loss are two-to-three times more likely to be depressed than the general population, a trend seen regularly by clinicians at Lighthouse Guild. The non-profit organization, based in New York City, provides health care and support services for people with vision loss. Support services offered by Lighthouse Guild include training in assistive technology for people with vision loss, independent living skills for the visually impaired, and tele-support groups.

Here, staff from Lighthouse Guild offer the following advice for ODs to recognize depression in their patients. Additionally, they provide the next steps to follow, should a patient appear to have depression.

USE A SURVEY

Laura Sperazza, OD, director of low vision rehabilitation services for Lighthouse Guild, recommends a survey to screen for depression. At Lighthouse Guild, the staff uses a simple two-question survey to help screen for depression:

• “Over the past two weeks, have you had little interest or pleasure in doing things?”
  
• “Over the past two weeks, have you been feeling down or hopeless?”

Lighthouse Guild’s survey is based on the PHQ-2 depression screener. A more advanced version, the PHQ-9, is also available.2

BE ALERT FOR SYMPTOMS

Aside from the screener, César Alfonso, MD, chief psychiatrist of behavioral health services, of Lighthouse Guild, says an OD or staff member should be attentive to symptoms of depression, such as unprompted crying, or psychomotor retardation – “slow motion” moving, which is a diagnostic criterion for depression.

Other signs of depression include feelings of irritability, frustration, guilt, or helplessness; difficulty concentrating, remembering, or making decisions; difficulty sleeping; changes in appetite or unplanned weight loss; and physical aches.3

NEXT STEPS

If signs of depression are detected from screenings or in-person interactions, Dr. Alfonso recommends asking the patient for permission to get in touch with their primary care physician and family to make

them aware, then offering a referral to a mental health clinic. “With depression there’s always a higher suicide risk,” he says, which is why it’s important for the patient to begin mental health treatment right away.

Family support and knowing that specialized devices can help them see can be a great source of support for patients, says Edward Ross, LCSW, BCD, director of health services for Lighthouse Guild. “I think giving people hope is such an important thing to do.” OM

REFERENCES

1. Morse AR. Addressing the Maze of Vision Loss and Depression. JAMA Ophthalmol. 2019;137:832-833. doi: 10.1001/jamaophthalmol.2019.1234.

2. Patient Health Questionnaire (PHQ-9 & PHQ-2). American Psychological Association. bit.ly/APAPatientQuestionnaire . Published January 2011. Updated June 2020. Accessed April 10, 2023.

3. Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/depression . Updated April 2023. Accessed April 17, 2023.