Curbing Depression in Vision-Loss Patients

For years, a local doctor has studied depression in patients with macular degeneration. Now he says he's found a way to stop it in its tracks.

It’s only natural for somebody who suddenly loses vision to become depressed, right? I mean, wouldn’t you?

Not if Barry Rovner, a geriatric psychiatrist at Wills Eye Hospital, has his way. “As you get older, you lose function of all sorts—your hearing, your sight, how fast you run, how strong you are,” he says. “These are natural changes, and they’re tolerated pretty well.” But with macular degeneration, a major cause of vision loss in older adults—it affects 10 percent of all those ages 66 to 74 and 30 percent of those 75 to 85—disability doesn’t come on gradually: “Suddenly—bam! You’re substantially visually impaired,” says Rovner. “You can’t read, you can’t drive, you can’t put on makeup, you can’t take care of your grandkids.” Your thinking becomes catastrophic; you’re convinced your life is over. And that sort of thinking, says Rovner, leads to depression.

With the help of $9 million in grants and collaborating with Wills Eye co-investigators Allen Ho and William Tasman, Rovner has spent years investigating how best to treat and prevent such depression. In one randomized study, he had sufferers meet soon after the disease’s onset with therapists who provided them with devices like magnifiers and helped them modify their homes to allow for easier navigation. “We showed we could halve the rate of people who became depressed,” he says. “But it’s like having a stroke—there’s a window in which you have to intervene.”

The problem was, once patients stopped meeting with the therapists, many went on to become depressed. Rovner wanted to tease out how much of the decrease in depression was simply due to having somebody pay attention to patients. So he designed another study in which they received either the specialized interventions or “placebo” psychological therapy, in which therapists talk about the impact of the visual impairment while reflecting patients’ observations back, without offering specific interventions. “That study showed the improved sense of self-efficacy came from the interventions,” Rovner says. “Patients got a better sense of their ability to exert control over their situation.”

If two patients have the same degree of macular degeneration but one is depressed, Rovner says, that patient is more likely to say, “I can’t do this.” Disability becomes a self-fulfilling prophecy: “When you’re depressed, you can do less and see less.” The studies are important because patients’ families—and even their physicians—often say, “Of course they’re depressed! They’ve lost their vision!” “They assume there’s nothing you can do,” Rovner says. “But that’s—well, short-sighted. Our research shows you can improve function and mood.” So if you—or your parent or grandparent—are struck with macular degeneration, don’t let that window close.