Recent findings from a study published in JAMA Ophthalmology analyzed the associations between vision impairment, depressive and anxiety symptoms, and social isolation in adults aged 65+ in the United States.
Give me some background.
Vision impairment, psychosocial function (i.e., symptoms of anxiety and depression), and social isolation are all major causes of morbidity in the U.S.
Consequently, a research team from Johns Hopkins University sought to provide evidence for prioritizing research that raises awareness on how to include and improve health outcomes in patients with vision impairment and psychosocial dysfunction.
Now talk about the study.
In this cross-sectional study, investigators analyzed participant data from the National Health and Aging Trends Study (NHATS)—a nationally representative sample of Medicare beneficiaries aged 65+—using information from round 9 (2019) and round 11 (2021).
To measure visual impairment, binocular distance visual acuity (BDVA), near visual acuity (VA), and contrast sensitivity were tested.
Talk about the cohort.
In total, 2,822 community-dwelling adults from a population of over 26 million people were included in the study.
Participants were included if they had objective measured or self-reported vision impairment and depression, anxiety, and social isolation symptoms.
The mean (standard deviation [SD]) age was 78.5 (5.6) years, and 1,605 participants (54.7%) were female.
How was vision impairment defined?
Objectively measured vision impairment was defined as having:
- Distance VA worse than 20/40
- Near VA worse than 20/40
- Contrast sensitivity worse than 1.55 logCS
Self-reported vision impairment was characterized based on the participants’ report on their vision status.
What about anxiety, depression, and social isolation?
Depressive and anxiety symptoms were evaluated using the Patient Health Questionnaire-2 (PHQ-2)—a screening tool used by the NHATS—while social isolation was defined based on living arrangement, communication frequency, and activity participation responses.
Findings?
Overall, 1,077 (32.3%) had objectively measured vision impairment and 203 (6.4%) had self-reported vision impairment.
In adjusted models, all outcomes were significantly associated with objectively measured vision impairment:
- Depressive symptoms (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.26-2.58)
- Anxiety symptoms (OR 1.74, 95% CI 1.13-2.67)
- Severe social isolation (OR 2.01, 95% CI 1.05-3.87)
Tell me more.
Additionally, depressive symptoms (OR 2.37, 95% CI 1.44-3.88) and anxiety symptoms (OR 2.10, 95% CI 1.09-4.05) were significantly associated with self-reported vision impairment.
Severe social isolation symptoms (OR 2.07, 95% CI 0.78-5.49) were not significantly associated with self-reported vision impairment.
Anything else?
Researchers compared the data of adults who self-reported vision impairment from 2019 and 2021 (i.e., to measure outcomes before and during the COVID-19 pandemic) and found that both depressive symptoms (14.3% vs. 23.5%) and anxiety symptoms (13.8% vs. 20.5%) increased following the pandemic.
Limitations?
The data collected on anxiety, depression, and social isolation symptoms were based on questionnaire responses instead of medical diagnoses—introducing the potential for inaccuracies and biases.
Further, the association between worsening psychosocial symptoms and vision impairment could result from patients not visiting or following up with doctors.
Finally, the study authors noted that hearing loss is often seen in patients with vision loss, and both conditions have been associated with worsening psychosocial symptoms—plus they did not account for the impact of hearing loss on vision loss in this study.
Take home.
These findings suggested that vision impairment was associated with multiple psychosocial outcomes, including symptoms of anxiety, depression, and social isolation.
The authors concluded that eyecare practitioners may benefit from assessing psychosocial function during examinations to implement treatments or refer patients for mental health services to provide comprehensive care for elderly patients.
Next steps?
Additional longitudinal studies are warranted to further understand the link between vision impairment, psychosocial symptoms, and social isolation.