1. In a large population-based cohort, age-related macular degeneration (AMD) diagnosis was associated with increased risk for depression onset.

2. Visual disability related to AMD was associated with a further significant increase in depression risk.

Evidence Rating Level: 2 (Good)

Study Rundown: Age-related macular degeneration (AMD) is one of the most common causes of visual disability and blindness in high-income countries. Thus, managing and living with AMD involves consideration not only of ophthalmic complications like neovascularization but also quality of life and mental health concerns. This prospective study aimed to use a Korean population cohort to quantify the relationship between AMD and depression risk. Among a cohort of about 4 million patients, AMD diagnosis was associated with a 15% increase in risk for incident depression compared to participants without AMD. The presence of significant visual disability associated with AMD was associated with more increased risk — 23% compared to the control group without AMD. This very large cohort study provides compelling evidence for a link between AMD and major depression; this is consistent with past, smaller studies suggesting higher rates of depression in AMD patients than in the overall elderly population. This association is intuitive given the toll sensory impairment often takes on quality of life. Further study is needed on whether and how assistive technology and support services can mitigate this mental health impact, particularly in high-resource settings such as the United States and South Korea.

Click to read the study in Ophthalmology

Relevant Reading: Age-related macular degeneration

In-Depth [prospective cohort]: Baseline data on AMD status and demographics for patients aged 50 and older were drawn from the Korean National Health Screening Program in 2009. Patients with depression at baseline were excluded. Incidence of major depressive disorder was determined based on new cases through 2019. Visual disability was classified as mild or severe based on ophthalmologist grading through the Korean national disability registry. Cox proportional hazard models adjusted for factors including age, sex, low income status, smoking status, activity level, comorbidities including hypertension, diabetes, and dyslipidemia were used to calculate hazard ratios. The hazard ratio for depression associated with AMD was 1.15 [95% confidence interval (CI) 1.13-1.17]. The presence of visual disability increased the hazard ratio to 1.23 (95% CI 1.16-1.30), with hazard ratios of 1.21 and 1.25 for mild and severe disability, respectively.

Image: PD

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