Comment on: ‘A proposed redesign of elective cataract services in Scotland—pilot project’

Clancy, Noah; Lim, Qi Xun; Bennett, Harry; Cackett, Peter

doi:10.1038/s41433-022-01973-z

Cited by 2 publications

(1 citation statement)

References 3 publications

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“…This often results in further deterioration of their vision, thereby worsening their mental health; a well-established correlation [ 13 ]. Furthermore, this reduced engagement has been exacerbated by the COVID-19 pandemic which has resulted in a significant decrease in outpatient and surgical ophthalmic services thereby lengthening waiting lists [ 14 , 15 ].…”

Section: Main Bodymentioning

confidence: 99%

Depression secondary to vision loss in old age and an effective rapid screening tool for undiagnosed cases

2022

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Background Zenebe et al. recently stated that despite depression being a common mental health problem in the elderly population, it is underdiagnosed in over half of the cases (Zenebe et al. in Ann Gen Psychiatry, 2021). They described an extensive list of risk factors associated with geriatric depression. However, we noted that they did not include ophthalmic conditions in this list which have previously been identified as an important risk factor for depression in the elderly. Main body To determine the extent of undiagnosed anxiety and depression in our elderly population with vision loss, we screened a cohort of our patients, over 60 years with vision loss secondary to macular disease for both conditions. Our cohort included 104 patients with mean best corrected visual acuity 0.58 LogMAR (Snellen equivalent 6/24). In this group, we identified 29.8% (31/104) and 28.8% (30/104) of patients with at least one depression or anxiety-related symptom, respectively, in the past 2 weeks. We identified 7.7% (8/104) and 3.8% (4/104) who had significant symptoms of depression and anxiety, respectively, that warranted further follow-up. Only two of these patients had previously been diagnosed with anxiety or depression with the majority having no previous history of either condition. Patients from our cohort who screened for depression or anxiety often cited frustration completing tasks and loss of independence secondary to declining vision. They also complained that the vision loss resulted in a lack of confidence which in turn resulted in social isolation and loneliness. Most of the patients welcomed referral to their GP for follow-up for input regarding their mental health and they also stated an interest in attending hospital optometry low vision services and counselling support. Conclusions With increasing time pressures on healthcare services and the rising use of virtual clinics especially during the COVID-19 pandemic, it is still essential to screen efficiently for depression in those elderly patients who are at significant risk. There is a considerable burden of major depressive disease in the geriatric population, and we would recommend that physicians (Geriatricians, GPs, Ophthalmologists etc.) screen elderly patients with vision loss for depression using the rapid screening tool which we suggest.

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Section: Main Bodymentioning

confidence: 99%

Depression secondary to vision loss in old age and an effective rapid screening tool for undiagnosed cases

2022

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Pushing the envelope: the feasibility of using a mailed contrast sensitivity test to prioritise cataract waiting lists

Bianchi,

Reddingius,

Rathore

et al. 2024

Eye

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Background Cataract waiting lists are growing globally. Pragmatic, cost-effective methods are required to prioritise the most urgent cases. Here we investigate the feasibility of using a third-party pen-and-paper contrast sensitivity, CS, test (SpotChecksTM), delivered by mail, and performed by patients at home unsupervised, to flag eyes requiring surgery. Methods Pen-and-paper CS tests were mailed to 233 people waiting for a cataract assessment, along with a prepaid return envelope (cross-sectional study). Response rates were tabulated (stratified by age, sex and socioeconomic status), and test scores analysed to see how well the home tests predicted which eyes were listed subsequently for surgery. A subset of patients (N = 39) also underwent in-person follow-up testing, to confirm the accuracy of the home data. Results Forty-six percent of patients responded (216 eyes). No gross differences were observed between respondents and non-respondents, either in terms of age, sex, socioeconomic status, or geographic location (all P > 0.05). The home-test CS scores predicted which eyes were subsequently listed for surgery, with an AUROC {±CI95%} of 0.69 {0.61–0.76}. Predictive performance was further-improved when machine learning was used to combine CS scores with letter acuity, extracted from patients’ medical records (AUROC {±CI95%} = 0.77 {0.70–0.83}). Among 39 patients who underwent follow-up testing, home CS scores were correlated with various measures made in clinic: biometry signal-to-noise (P = 0.032), LogMAR acuity, Pelli-Robson CS and SpotChecks CS (all P < 0.001). Conclusions Mailing patients pen-and-paper CS tests may be a feasible, 'low-tech' way of prioritising patients on cataract waiting lists.

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Comment on: ‘A proposed redesign of elective cataract services in Scotland—pilot project’

Cited by 2 publications

References 3 publications

Depression secondary to vision loss in old age and an effective rapid screening tool for undiagnosed cases

Depression secondary to vision loss in old age and an effective rapid screening tool for undiagnosed cases

Pushing the envelope: the feasibility of using a mailed contrast sensitivity test to prioritise cataract waiting lists

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