MIAMI — Patients with retinal disease often suffer from emotional distress. Risk factors for emotional distress in clude shorter duration of ocular disease, worse visual acuity, increased systemic co-morbidities and increased functional impairment.

To determine the prevalence of and risk factors for emotional distress among patients with retinal disease, Ingrid U. Scott, MD, MPH, and colleagues at the Bascom Palmer Eye Institute, Wilmer Eye Institute and New England Medical Center conducted a cross-sectional study.

“The goal of practicing physicians is to provide care that maximizes the quality of life of their patients,” said Dr. Scott, of Bascom Palmer Eye Institute here. “Ophthalmologists need to be aware that patients with visual impairment are at risk for significant levels of emotional distress.”

Study cases included 86 consecutive patients examined at the Wilmer Eye Institute Retinal Vascular Center during a 4-week period. Exclusion criteria included new patients, patients already participating in other clinical trials and patients whose appointments overlapped with those of subjects who were interviewed. Also included in the study were 51 controls. These controls were required to have no known ocular disease and to have a best-corrected visual acuity of 20/25 or better using a standard Snellen visual acuity chart. Cases and controls were matched by age, gender and race.

Study participants were interviewed using the Community Disability Scale, a functional status questionnaire and the General Health Questionnaire, which assesses emotional distress.

Visual impairment groups

Study cases were divided into three groups: 30 patients were in the mild visual impairment group, 28 were in the moderate visual impairment group and 28 were in the severe visual impairment group.

Among the groups, there were no statistically significant differences in terms of age, gender, race, systemic co-morbidity and months since diagnosis of ocular disease.

“There was a clinically meaningful linear trend in mean number of months since diagnosis of ocular disease across the visual impairment tertiles consistent with a progression of disease severity with time among patients with age-related macular degeneration and diabetic retinopathy,” Dr. Scott said.

Cases and controls had significantly different scores on the General Health Questionnaire. Scores were significantly associated with level of visual acuity.

“The prevalence of probable or definite emotional distress was 55.8% among the ophthalmic patients, as compared with 2.0% among controls,” she said.

Univariate analyses showed that, among the patients in this study, gender, race, ocular diagnosis and age were not significant predictors of emotional distress, as assessed by General Health Questionnaire score.

However, “shorter duration of ocular disease, worse visual acuity, increased systemic co-morbidities and increased functional impairment are significantly associated with increased emotional distress,” she added.

Multiple regression analysis demonstrated that after controlling for other variables, weighted bilateral average logMAR visual acuity, systemic comorbidities and months since ocular diagnosis each explain more than 10% of the variability in General Health Questionnaire scores.

“The fact that shorter duration of ocular disease is significantly associated with emotional distress suggests that patients may adapt to their vision loss in such a way that, over time, lessens the associated emotional distress,” she said.

Functional impairment

Because increased functional impairment is associated with increased emotional distress, interventions designed to maximize patients’ level of functioning may improve patients’ emotional distress.

According to Dr. Scott, this study had several limitations. For example, visual acuity was the only objective measure of vision used. In addition, the study was a clinic-based series and, as such, may have been susceptible to local referral biases.

“[Also], we did not have a group of patients with extreme bilateral visual impairment. However, our group of patients represents the type of patients likely to be recruited in clinical trials,” she said.