Vision Difficulties Linked With Anxiety, Depression

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Vision Difficulties Linked With Anxiety, Depression

A study published in the Canadian Journal of Ophthalmology sheds light on the connection between vision difficulties and mental health challenges, urging eye care professionals to adopt a more integrated approach to patient care.

Drawing from the 2022 National Health Interview Survey, the cross-sectional analysis examined 27,640 US adults, 5,210 of whom (19%) reported vision difficulties. After adjusting for factors such as age, gender, and socioeconomic status, the researchers found that individuals with vision difficulties were at least twice as likely to be diagnosed with anxiety disorders (odds ratio [OR], 2.00), severe anxiety symptoms per the GAD-7 scale (OR, 2.67), and depressive disorders (OR, 2.31) compared with those with normal vision.

Specifically, 16%, 7%, and 6% of those with vision issues reported mild, moderate, and severe anxiety, respectively, compared with 10%, 3%, and 2% of individuals without vision difficulties. For depression, rates were 21%, 9%, and 7% for mild, moderate, and severe depression, respectively, compared with 12%, 3%, and 2% in the unimpaired group.

The study underscores a bidirectional relationship where vision loss and mental health issues exacerbate each other across a lifetime, unaffected by corrective measures such as glasses or contacts, which surprisingly correlate with higher mental health concerns. Additionally, these patients are 71% more likely to seek mental health treatments, indicating a critical care gap. The authors advocate for stronger collaboration between eye care providers, mental health professionals, primary care physicians, and geriatricians to develop comprehensive interventions addressing both visual and psychological health.

My Two Cents

Well, this one is obvious to anyone who sees patients with extreme vision challenges, whether that’s a corneal disease, retinal disease, or anything in between. These patients tend to be unhappy not only with their eyes and vision, but also with many aspects of their lives. In a nutshell, this new study reveals a fantastic statistic: Patients with self-reported vision challenges are twice as likely to be diagnosed with anxiety or depression. Interestingly, corrective eyewear/contacts did not mitigate psychological effects, and affected individuals were 71% more likely to seek mental health treatment. This does make me wonder if the rates of depression would be higher in the more severe visually challenged patients as classified by an eye doctor.

OUTSIDE THE LANE

Reducing the Risk of Peanut Allergy

A decade after the groundbreaking Learning Early About Peanut Allergy (LEAP) trial demonstrated that introducing peanut products to infants could prevent life-threatening allergies, new research confirms a significant real-world effect. Published in the journalPediatrics, the study analyzed EHRs from pediatric practices and found that peanut allergy rates in children 0 to 3 years of age dropped by more than 27% following the 2015 guidelines for high-risk infants and by more than 40% after the 2017 expansion to all infants.

This shift, which recommends starting peanut exposure as early as 4 months of age, has prevented approximately 40,000 cases of peanut allergies since 2015, contributing to a broader avoidance of about 60,000 food allergies in total. David Hill, MD, PhD, FAAP, an allergist at Children’s Hospital of Philadelphia and study author, hailed this as a remarkable public health success, noting fewer children are diagnosed with food allergies today due to these efforts.

Peanut allergies occur when the immune system mistakenly attacks peanut proteins, triggering symptoms such as hives, respiratory issues, or anaphylaxis. For decades, medical advice delayed introducing allergens until 3 years of age. Still, the LEAP trial, led by Gideon Lack, MD, at King’s College London, showed a more than 80% risk reduction with early exposure, with protection lasting into adolescence for about 70% of participants. Despite updated guidelines, adoption has been gradual—surveys indicate only 29% of pediatricians and 65% of allergists fully follow them—due to confusion about safe implementation outside clinical settings.

The study’s data, from a subset of practices, may not fully represent the US population. Still, many experts, including Ruchi Gupta, MD, MPH, from Northwestern University, see it as promising evidence of increasing adoption. Advocates from Food Allergy Research & Education (FARE) emphasize the opportunity to reduce peanut allergy prevalence further, affecting more than 2% of children amid an 8% overall food allergy rate. Current 2021 guidance urges introducing peanuts and other allergens between 4 and 6 months of age without prior testing via small tastes such as peanut butter or nut-based yogurts.

My Two Cents

Call me completely clueless, but I had no idea that it was recommended that we introduce peanuts and other allergens to our kids between 4 and 6 months of age. I mean, I absolutely did have Brooks try peanut butter and other things, but I had no idea it was a recommendation! This makes perfect sense, and it seems that evidence-based medicine has proven this strategy to be successful. So, for any of your friends or family who may be expecting soon or have a youngster at home, you might want to impress them with this knowledge that I certainly didn’t know (and I read all the “New Dad” books!).

CAN YOU RELATE

It has been a wild few weeks in the eye care world, marked by two potential paradigm shifts. In a few weeks, one shift has the potential to change our approach to myopia while the other is massive news in the treatment of progressive corneal disease.

First, Essilor has officially announced the approval of the Stellest spectacle lens. This lens is the first FDA-approved spectacle lens for myopia management and could significantly change how we prescribe glasses for children with myopia. Hopefully, Essilor has a solid plan in place for educating eye care providers on this seemingly amazing technology. So far, we’ve heard crickets regarding what to expect, how to prescribe it, and whether there are any tricks to it. Still, Essilor is extremely adept at direct-to-consumer advertising. Let’s see how they plan the rollout of this seemingly huge “game-changer” that I am very excited about as a former high myope.

Second, the FDA recently approved Epioxa (Glaukos), an oxygen-enriched riboflavin for a new epi-on corneal collagen crosslinking (CXL) procedure to treat keratoconus. Unlike the standard CXL, which requires corneal epithelium removal (quite uncomfortable according to most of my patients), Epioxa uses two concentrations (0.239% and 0.177%) applied sequentially with oxygen-infused goggles, eliminating the need for invasive debridement. This is designed to enhance patient comfort and reduce recovery time. Currently, we handle numerous crosslinking cases and have achieved tremendous success with Glaukos’ epi-off system. It will be exciting to see how Glaukos embraces optometry in the months and years to come, particularly as the company spreads the word about the recent approval of epi-on CXL, which should be a key part of every optometrist’s practice. If you fit a lot of keratoconic patients with scleral contact lenses, you could consider yourself a one-stop shop now for mild to moderate keratoconus patients. After all, who better to care for those patients than you—the doctor who carefully fits them into their life-changing scleral contact lenses or corneal gas permeable lenses!

QUOTE OF THE WEEK

“Every once in a while, a new technology, an old problem, and a big idea turn into an innovation.”

- Dean Kamen