First Author: E.Linton UK
Co Author(s): M. Khalil S. Mishra N. Husain G. Naylor A. Khalil
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AMD is the leading cause of blindness in the developed world. It has a potentially devastating impact on patients’ vision and thus their lives. Literature highlights links with reduced quality of life, depression and low mood but these findings have not yet influenced clinical practice. This study was designed as an initial step in exploring the triggers for anxiety and low mood in AMD patients, not only to increase knowledge and promote awareness of this growing issue but also to pave the way for more robust psychological support for patients in future.
The study targeted follow-up patients who attended a dedicated AMD clinic in a district general hospital in the North West of England.
We designed a questionnaire to be completed by patients when they attended the AMD specialist clinic for a follow-up appointment. Nursing staff recorded visual acuity and then offered the patient a questionnaire. Assistance was provided for patients who needed help reading the questions or writing responses. Questions included demographic information such as gender, time since diagnosis, driving status and employment status. The patient was then asked to rate their current level of vision on a scale and choose whether a number of statements relating to thoughts and feelings surrounding their vision applied to them or not. They were asked to circle activities on a chart that they found difficult due to their vision. Finally, patients were asked if they had received intravitreal injections and if so answered a series of questions about how they felt before and after the injections. The questionnaires were collected by the first author anonymously at the end of each clinic and results were input into a database for data analysis.
100 patients (64 females, 36 males) completed the questionnaires. 108 of the 200 eyes had vision 70 letters or worse. 4% of patients were employed and 37% were drivers. We asked patient’s to rate their current level of vision, 4% said it was excellent, 15% good, 44% satisfactory, 28% poor, 8% very poor and 1% declined to answer. The most common psychological concerns for patients was worrying how they would cope in the future should their vision deteriorate (67% patients) and worrying about going blind in the future (67% patients). 58% of patients felt frustrated by their vision and around a third of patients said they felt anxious or low because of their vision and enjoyed life less. 23% of patients felt a burden on friends and family. The activities AMD patients struggled with the most were; reading (58 patients), writing (39 patients), paperwork (39 patients), hobbies (36 patients), driving (30 patients), handling money (27 patients) and shopping (23 patients). 93% of patients had received intravitreal injections for AMD. The most common feeling prior to injections was nervousness/apprehension and concerns about whether it would be painful. Patients mostly reported relief following their first injection.
Our study demonstrates the potential impact of AMD not only on patients’ vision but on their everyday life and psychological well-being. Possibly the most alarming statistic was that a third of patients felt anxious or low because of their vision and enjoyed life less, suggesting links with potential depression and low mood in this group. These inferences support a need for more robust psychological and social support for patients with AMD and their families or carers. AMD specialist clinics may be more holistic in their approach to patients if ties are made with colleagues who can provide psychological/psychiatric care or support either in joint clinics or on an individual referral basis.