In older adults, age-related macular degeneration (AMD) is the most common cause of blindness. This disabling vision disorder impairs the ability to complete many important everyday tasks, such as housework, cooking, and travel.

Depression is common among individuals with AMD. According to Dr. Rovner, the incidence of depression over 6 months is 28% among these individuals. Patients with AMD and depression have higher levels of vision disability compared with non-depressed AMD patients.

Because depression can compound AMD disability, Dr. Rovner and colleagues have sought ways to reduce the burden of depression in this patient population. Accordingly, they undertook a randomized, controlled clinical trial of Problem-Solving Therapy (PST).

The theory behind PST is that depression can stem from inaccurate evaluation of problems, and difficulty finding solutions for those problems. Teaching depressed individuals to think through these problems and find solutions may ameliorate depression.

The study of PST included 118 older patients with AMD randomized to PST or a control arm of usual care only. All patients were over 65 and had AMD affecting both eyes. The AMD in the second eye had to be of recent onset. Nurses visited the homes of the subjects once weekly for 6 weeks to teach PST skills. Investigators evaluated depression in patients at baseline, 2 months and 6 months.

The study is still in progress. Here at IPA, Dr. Rovner presented data from the 2-month evaluation. In the control group, 14% had a diagnosis of depression at 2 months, versus no patients in the group that received PST. Scores on the Geriatric Depression Scale were more likely to improve in the PST group, and more likely to worsen in the usual care group.

The PST therapy also improved vision function for activities that AMD patients enjoyed, according to the investigators. Patients in the PST group were less likely to discontinue an activity due to poor vision function than controls (18% versus 30%). In addition, patients in the PST group were more likely to take advantage of large print materials, audio materials, handwriting aids, and other services or devices.

These preliminary results suggest that PST prevents depression and improves vision function for desired activities in AMD patients. Dr. Rovner said that PST training is not expensive but does require nurses conduct home visits. However, some of this cost might be offset if patients are less likely to become disabled, injured, or placed in a nursing home. If final results of this and other studies are positive, then psychogeriatrics experts might recommend PST as a routine part of ophthalmologic care.