Assessing the Impact of Stress in Age-Related Macular Degeneration

Newswise, June 6, 2017– Age-related macular degeneration (AMD), the leading cause of vision loss among older adults in the United States, is often associated with psychological stress. 

A simple stress rating scale (the Perceived Stress Scale) is a valid and useful way to evaluate the connection between stress and progressive vision loss from AMD, according to a study in the March issue of Optometry and Vision Science, the official journal of the American Academy of Optometry. The journal is published by Wolters Kluwer.

"Because AMD is an inflammatory disease, we are studying the link between inflammation, stress, and AMD treatment outcomes," reported Bradley E. Dougherty, OD, PhD, of The Ohio State University College of Optometry. "In the end, we hope to better understand how general well-being influences disease outcomes."

Measuring Stress May Aid in Assessing the Life Impact and Progression of AMD--Patients with vision loss in AMD experience high rates of stress, anxiety, and other problems, including depression. Less is known about the relationship between the stress that AMD patients experience and the severity of their disease—for example, whether stress can cause AMD to worsen or not.

The Perceived Stress Scale (PSS) is a well-established stress rating scale that can predict objective biological markers of stress, as well as the risk of stress-related diseases. In previous studies, the PSS has been shown to be predictive of general markers of inflammation, including C-reactive proteins. In the new study, Dr. Dougherty and colleagues extend the use of this survey to determine how well it measures perceived stress in patients with vision loss due to AMD.

One hundred thirty-seven patients with AMD, average age 82 years, completed the ten-question PSS. Using a technique called Rasch analysis, Dr. Dougherty and colleagues evaluated the PSS's performance as a stress measure in AMD. About half of the patients filled out the stress questionnaire on a day when they received injections of anti-VEGF antibodies—a relatively new treatment that can slow the progression of the "wet" form of AMD.

Nine of the ten questions normally used with the PSS performed well with the patient group studied. These nine items were also able to separate between patients with higher versus lower levels of perceived stress. For some PSS items, responses differed according to patient age and visual acuity level.

However, the overall PSS score was not significantly related to the patients' visual acuity level. Average visual acuity in the better eye for this group of AMD patients was 20/50, with a range from near normal to very low vision.

"A psychometrically sound, easy-to-administer questionnaire such as the PSS is important for use with patients with AMD, given the evidence for increased rates of psychological symptoms in the population," Dr. Dougherty and coauthors write.

They note that stress-reduction approaches—for example, "mindfulness" interventions—have led to improved outcomes in patients with various health conditions.

Dr. Dougherty and colleagues also note that stress may be associated with increased inflammation and that AMD is an inflammatory disease—raising the possibility that stress may contribute to disease progression.

Future studies using repeated assessments with the PSS and measurement of inflammatory markers might provide evidence on how perceived stress levels affect the risk of AMD progression and worsening vision loss.

Click here to read “Measurement of Perceived Stress in Age-Related Macular Degeneration.”

How People who are Visually Impaired Can Walk the Monday Mile

Lighthouse Guild Doctor Offers Tips for National Walking Day

Newswise, April 3, 2017-- Nearly 14 million Americans - about one out of every 20 people - have low vision, according to The Centers for Disease Control and Prevention. Eye-care professionals use the term “low vision” to describe significant visual impairment that cannot be corrected with standard glasses, contact lenses, medicine or eye surgery.

According to the National Federation of The Blind, each year, 75,000 more people in the United States will become blind or visually impaired. Though the condition mainly afflicts the elderly, younger Americans are increasingly at risk of irreversible vision loss, particularly as cases of diabetes continue to rise.

Low vision means that even with regular glasses, contact lenses, medicine, or surgery, people find everyday tasks, such as reading, shopping, cooking, watching TV, writing, and exercising difficult to do.

Because of this difficulty, individuals with visual impairments often exhibit lower levels of fitness than their sighted peers, often due to fear and lack of confidence.

Walking, a simple form of exercise with many health benefits, is considered a good choice for people who are visually impaired, according to Laura Sperazza, OD, Director of Low Vision Services at Lighthouse Guild in New York City.

Dr. Sperazza encourages people with low vision, who have been hesitant to venture out and walk for fitness, to participate in the American Heart Association’s National Walking Day on April 5.

The day promotes all the benefits of walking, and people can keep the momentum going throughout the year by starting a Monday Mile in their community.

The Monday Mile is an initiative of The Monday Campaigns, the nonprofit public health organization, associated with Johns Hopkins, Columbia and Syracuse universities. The Monday Mile mission is to encourage people from all walks of life to walk for their health, by using Monday as the starting day.

Research by Johns Hopkins shows that people view Monday as a day for a fresh start and are more likely to begin new healthy behaviors on a Monday, and carry them out for the rest of the week.

What are the best ways for people who are visually impaired to walk the Monday Mile with confidence? Dr. Sperazza offers these tips:

• Walk during daylight hours in order to avoid obstacles.
• Walk with a normally sighted buddy to help avoid obstacles and unforeseen conditions.
• Don’t walk in bad weather.
• Wear proper shoes to avoid slipping.
• Walk in familiar areas so you can anticipate the path.
• Use a ‘sighted cane’ which notifies others that you have an impairment
• For people with a greater level of impairment, train in the use of a ‘sighted cane’ with a mobility specialist, which can help them adjust to different surfaces and unfamiliar areas

For more information on low vision services, visit lighthouseguild.org.

About Lighthouse Guild

Lighthouse Guild, headquartered in New York City, is the leading not-for-profit vision and healthcare organization with a long history of addressing the needs of people who are blind or visually impaired, including those with multiple disabilities or chronic medical conditions. 

With more than 200 years of experience and service, Lighthouse Guild brings a level of understanding to vision care that is unmatched. By integrating vision and healthcare services and expanding access through its programs and education and awareness, we help people lead productive, dignified and fulfilling lives. For more information, visit lighthouseguild.org.

About The Monday Mile
The Monday Mile is part of The Monday Campaigns, a nonprofit organization, which dedicates the first day of every week to health. The organization offers a free Monday Mile Starter Kit and resources for workplaces, campuses and community groups to start their own program. At Syracuse University, Monday Mile routes have been created with accessibility in mind, and are well-lit and feature many flat routes. This Monday Mile program can serve as a great example of how to create an accessible Monday Mile in your community.
Download the Monday Mile Starter Kit at: www.moveitmonday.org/mondaymile
For a Monday Mile infographic: h