Original article
Depression and Visual Functioning in Patients With Ocular Inflammatory Disease

https://doi.org/10.1016/j.ajo.2011.06.028Get rights and content

Purpose

To characterize the level of depression in patients with ocular inflammatory disease and to determine predictors of depression in this population.

Design

Prospective cross-sectional survey and medical record review.

Methods

Participants were consecutive patients with noninfectious ocular inflammatory disease in a university-based tertiary referral center. Subjects were given the self-administered Beck Depression Inventory-II (BDI-II), National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25), and additional supplemental questions. Medical records were reviewed for clinical characteristics. Univariate analyses were conducted to compare clinical characteristics between patients with and without a positive screen for depression, and a multivariate regression model was performed to determine the most significant predictors of depression.

Results

Of the 104 participants, 26.9% screened positive for depression with the BDI-II. Of these subjects, only 39.3% had been previously diagnosed with depression. NEI VFQ-25 scores were significantly lower in depressed patients in all subscales except driving and color vision. Predictors of depression were inadequate emotional support, lower visual functioning (VFQ composite score), history of changing immunomodulatory treatment, and current oral corticosteroid use.

Conclusions

Depression may be a significant but underrecognized comorbid condition in patients with ocular inflammatory disease. Worse visual function was associated with depression. The authors recommend heightened awareness of potential depression in patients with ocular inflammatory disease.

Section snippets

Participants

Consecutive patients between March 29, 2010 and July 19, 2010 seen in the Uveitis and Ocular Inflammatory Disease Clinic at the Francis I. Proctor Foundation, a tertiary care referral center at the University of California, San Francisco, were included in the study. Eligible individuals included patients at least 18 years of age with a diagnosis of noninfectious ocular inflammatory disease, who were English-speaking and able to provide written informed consent. Patients seen at the Francis I.

Results

Of 151 eligible subjects for the study, 31 declined, 8 consented but did not mail in their questionnaires, and 8 consented but had incomplete questionnaires, resulting in 104 consecutive patients in the analysis. Twenty-eight subjects (26.9%) scored greater than 13 on the BDI-II (“depressed group”) and 76 subjects (73.1%) scored 13 or less (“not-depressed group”). There were no significant demographic differences between the depressed and not-depressed groups. Overall, 54.8% of participants

Discussion

Twenty-eight of 104 subjects with ocular inflammatory disease (26.9%) screened positive for depression by the BDI-II in our tertiary practice, which is much higher than 10% in the general population.20 This is in the same range as patients with chronic diseases such as rheumatoid arthritis,23 diabetes,24 cancer,25 and other chronic eye diseases such as retinitis pigmentosa6 and advanced macular degeneration.5 Less is known about depression in patients with ocular inflammatory disease. One

Nisha Acharya, MD, MS, is Director of the Uveitis Service at the F.I. Proctor Foundation and Associate Professor in the Department of Ophthalmology at the University of California, San Francisco. Her research interests include designing and implementing clinical trials and epidemiologic studies in the field of ocular infection and inflammation.

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    Nisha Acharya, MD, MS, is Director of the Uveitis Service at the F.I. Proctor Foundation and Associate Professor in the Department of Ophthalmology at the University of California, San Francisco. Her research interests include designing and implementing clinical trials and epidemiologic studies in the field of ocular infection and inflammation.

    Ying Qian, MD, received her medical degree from University of Pennsylvania School of Medicine in Philadelphia and completed her ophthalmology residency at Cole Eye Institute at Cleveland Clinic in Ohio. She completed a uveitis fellowship at the Francis I. Proctor Foundation at University of California San Francisco and will pursue a cornea fellowship at Proctor/UCSF. Her research interests include epidemiological studies in uveitis, corneal infections, and tele-ophthalmology.

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