Self-Help for AMD

Summarized by Robert W. Griffith, MD
March 24, 2005

Introduction

Age-related macular degeneration (AMD) is a devastating disease that produces severe changes in patient's quality of life, and can, quite understandably, lead to moodiness and depression. All too often, patients are left on their own to cope with their loss of vision. Scientists at the University of California, San Diego, have studied the effects of a self-management program to help AMD patients handle their disability. The results of their study is reported in the Archives of Ophthalmology, and summarized here.

What they did

Over 250 older patients with advanced AMD - average age 81 - were randomly allocated to one of three groups: a 12-hour self-management program, a series of 12 hours of tape-recorded health lectures, or a place on a waiting list. The self-management program consisted of 12 hours of cognitive and behavioral instruction for 6 weeks in groups of 8-10, led by an experienced psychologist.¹

The main measure of effectiveness was a difference between the groups in the average score on an emotional distress scale. Other measures included visual functioning, self-confidence in handling day-to-day challenges, and the presence of depression.

What they found

After 6 months, 214 participants had completed their respective programs according to the study design. As the outcomes in the groups who received health lectures and those put on a waiting list were almost identical, their results were pooled together to allow better comparison with the self-management group.

Patients in the self-management program had significantly less likely emotional distress than those in the combined control groups; this was particularly the case in those subjects with some depression. They were better able to function from a visual point of view, and had greater self-confidence in handling AMD-specific challenges; this beneficial effect, too, was more obvious in patients who were depressed.

The number of patients who had depression that resolved during the 6-month study was the same in all three treatment groups. However, only 7% of the patients developed depression during the study in the self-management group, compared with 17% in the controls. At the end of the study 18% of the self-management group was depressed, compared with 31% of the controls.

What these findings mean

Loss of sight, whether total or partial, is inevitably accompanied by emotional distress, to a greater or lesser degree. Depression is also a likely accompaniment to poor visual function. In the absence of a curative treatment, patients have to come to terms with their inadequate eyesight. This study shows that so-called self-management therapy is able to improve significantly their emotional state, their self- confidence, and the management of the challenges presented by their disorder.

AMD is a growing problem for aging populations, and eye clinics would do well to provide such self-management programs. Anything that improves the lot of aged folk losing their vision should be readily available to those affected.

Source

• Self-management of age-related macular degeneration at the 6-month follow-up: a randomized controlled trial. BL. Brody, AC. Roch-Levecq, RG. Thomas,  et al., Arch Ophthalmol, 2005, vol. 123, pp. 46--53

Footnotes
1. Cognitive therapy helps the patient to recognize how some thinking patterns can cause symptoms, by giving a distorted picture of what's actually happening, producing anxiety, depression, or anger; the intent is to alter the patient's way of thinking. Behavior therapy is designed to break down the connections that have been built up between troublesome situations and habitual reactions to them.

Related Links
Age-Related Macular Degeneration (AMD) - An Overview
To Cut Your Risks of Age-Related Macular Degeneration (AMD), 'Go Fish'!
A Test of Risk for AMD?

Please take a moment to give us your comments. For questions about Health matters you may check our "Questions & Answers" Portal and Service.