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Anxiety and Depression Prevalence Rates in Age-Related Macular Degeneration

¹From the Augenklinik, Karlsruhe, Germany; ²Hôpital des XV-XX, Paris, France; ³University of Udine, Udine, Italy; ⁴University Paris Descartes and Hôpital Sainte-Anne, Paris, France; ⁵Aremis Consultants, Neuilly-sur-Seine, France; ⁶PBE Consulting, Verona, Italy; ⁷Neos Health, Basel, Switzerland; ⁸Conservatoire National des Arts et Métiers, Paris, France; and ⁹Alcon France, Rueil-Malmaison, France.

PURPOSE. To estimate the prevalence rates of depression and anxiety in patients with wet age-related macular degeneration (AMD) and the relationship with visual acuity and to develop a simple algorithm for depression screening.

METHODS. This cross-sectional, prospective, observational, multicenter study was performed in France, Germany, and Italy. Retina specialists at 10 centers per country each enrolled 12 consecutive patients with wet ARMD. Patients were stratified into four severity groups by using best eye (BE) and worst eye (WE) visual acuity (VA) thresholds (BE:VA 20/40 and WE:VA 20/200). Patients rated themselves on the Hospital Anxiety and Depression Scale (HADS). Analysis of variance was performed to estimate the effect of VA severity levels on HADS scores adjusted on age, gender, and country.

RESULTS. Patients (females 60%) were recruited, with a mean age of 77 years and 2.3 years’ disease duration. Mean BE:VA at inclusion was 0.49 logMar (logarithm of the minimum angled of resolution) and WE:VA 1.0 logMar. The prevalence of severe depression increased from 0% (BE:VA 20/40+WE:VA 20/200) to 7.6% (BE:VA < 20/40+WE:VA < 20/200), whereas anxiety was unrelated to VA loss. Moreover, total depression scores were strongly associated with VA severity (P = 0.006), but not total anxiety scores (P = 0.840). Responses to two HADS items ("I still enjoy things I used to enjoy"; "I can enjoy a good book or radio or television program") identified 95% of severely to moderately depressed patients.

CONCLUSIONS. Self-rated depression in patients with AMD was associated with VA severity level. It should, therefore, be relatively easy for ophthalmologists to implement the screening procedure and refer identified patients to psychiatrists for proper assessment and treatment.