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Blindness Can Bring Darkness to the Mind, Too

Depression hits hard as elderly start to lose their sight

THURSDAY, Nov. 1, 2001 (HealthDayNews) -- Blindness may not be deadly, but it can kill the human spirit nonetheless, reports a new study.

In fact, depression strikes elderly people who have lost some or all of their sight at double the rate it hits senior citizens who still can see, the researchers say.

As a result, they say eye doctors need to be more aware of the severe mental strain patients face as they cope with the disintegration of their sight.

"Many of these people have had cancer and terrible arthritis, but of all the bad things in aging, to them nothing is worse than loss of vision," says study co-author Dr. Stuart I. Brown, director of the Shiley Eye Center at the University of California, San Diego.

Researchers interviewed 151 men and women who were 60 or older and suffering from advanced macular degeneration, which causes loss of sight in the center of the field of vision as the retina deteriorates. People with the disease often retain some peripheral vision.

"They can say there's something on the floor, but if you pick it up and hand it to them, they can't see any detail," says Dr. Lylas Mogk, a Detroit ophthalmologist. "Often, people think they're faking."

Macular degeneration affects about one of every five white Americans over age 65, and one in three by age 75. Blacks are affected at a much lower rate.

The cause of macular degeneration is unknown, but researchers suspect molecules known as free radicals, whose numbers may be boosted by smoke, air pollution, light and pesticides.

While the levels of blindness differed among the seniors surveyed, the percentage of those who were depressed remained the same, about one-third, the study says.

"There are a lot of people who adjust, but we know that 30 percent can't. They become clinically depressed," Brown says. Details appear in the October issue of Ophthalmology, the clinical journal of the American Academy of Ophthalmology.

John Santos, a 77-year-old psychology professor emeritus at the University of Notre Dame, says blindness is one of several stressors that affect the elderly and rob them of stimulation.

"You find out that you're at risk of doing the wrong thing. You're afraid to go out, you're afraid you might fall. That becomes a really serious sort of stress. You've lost something very important," he says.

Adjusting to partial sight is very difficult, he says.

"Some can read, but always with tricks, either high magnification, special gadgets that enlarge pages or video cameras, all of which are onerous and difficult for people who are older to get used to and to put up with. It's very frustrating and costly," Brown says.

Still, Santos says some people are "tough old nuts" who can survive almost any adversity because of their personality and background. But for others, the stress of encroaching blindness "might tip them over and create incredible problems of hopelessness and helplessness that lead to depression," he says.

To treat depression, experts often suggest antidepressant medications and psychotherapy. Support groups have been shown to help, too, as can something called "visual rehabilitation," or learning new ways to handle old tasks.

People who are depressed also need to look inward and not focus entirely on their blindness, Santos says.

"I've been around for 77 years, and a psychologist for 55 years, and I've never seen something [psychological] that was just caused by one thing," he says. Depression is no different, he says.

"It's caused by a whole bunch of stuff. It's not just the blindness, but it's a whole bunch of things," Santos says.

What To Do

For more information about macular degeneration, check the Macular Degeneration Research Fund.

And to better understand what macular degeneration looks like from the perspective of a sufferer, visit the American Health Assistance Foundation online.

SOURCES: Interviews with Stuart I. Brown, M.D., chairman, department of ophthalmology, and director, Shiley Eye Center, University of California, San Diego; John Santos, Ph.D., professor emeritus of psychology, University of Notre Dame, South Bend, Ind.; Lylas Mogk, M.D., ophthalmologist, Detroit; October 2001 Ophthalmology
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