Remaining Visual Field and Preserved Subjective Visual Functioning Prevent Mental Distress in Patients with Visual Field Defects

Abstract

Background: Patients with visual field defects after visual pathway lesion may experience reduced vision-related quality of life (vrQoL). It has not been clarified how vrQoL impairments contribute to vision-related mental distress.Methods: One hundred and eight subjects with visual field defects caused by optic neuropathies (age M = 57.6; SD = 13.7 years) answered the National Eye Institute Visual-Functioning Questionnaire 39 (NEI-VFQ) for vrQoL and the SF-12 Short Form Health Survey for health-related quality of life. A 10 item composite of NEI-VFQ “visual functioning” and 5 items of “mental-health symptoms due to vision problems” were subjected to Rasch analysis. The test battery comprised static and High Resolution Perimetry (HRP). Regression and path analysis were used to investigate associations between QoL, mental distress, and perimetry results.Results: A higher level of “visual functioning” was associated with monocular impairment and a larger remaining visual field compared to binocular impairment. Subjective “visual functioning” but not visual field parameters predicted “mental-health symptoms due to vision problems” which was the only variable associated with the SF-12 mental component score. The SF-12 physical component score was less strongly associated with “mental-health symptoms due to vision problems.” Here, reaction time in HRP and mean threshold in perimetry were additional significant variables. Path analysis revealed a significant path from remaining visual field via visual functioning on mental health.Conclusion: Subjective consequences of visual impairments in everyday life impact mental health rather than “objective” visual function loss as measured by perimetry. Since a higher extent of vrQoL was related to lower levels of mental distress, the maintenance of vrQoL could reduce and prevent mental distress due to vision problems. Patients with persisting visual field defects may benefit from neuropsychological rehabilitation and supportive therapies.

Retinal Origin of Electrically Evoked Potentials in Response to Transcorneal Alternating Current Stimulation in the Rat

“…[19][20][21]37 The postulated therapeutic mechanisms for this improvement are synchronization of activity in the visual pathway and interference with ongoing oscillatory brain activity, in addition to connectivity changes at higher stages of visual processing. 38,39 The complete abolition of EEPs following RGC activity blockage by TTX strongly supports the hypothesis that ACS enforces a wave of excitation flowing through the visual pathway with a retinal origin rather than directly activating neurons in downstream visual structures via passive conductance. This suggests that transorbital ACS renders its effect via synchronization of spike firing in the ascending retinogeniculate and extrageniculate pathways.…”

Inter-relationship between visual symptoms, activity limitation and psychological functioning in patients with diabetic retinopathy

“…CFI and TLI compare the fit of the specified model with that of the null model in which covariances among the observed variables are assumed to be zero. Generally, values>0.95 for CFI and TLI indicate a good-fitting model30 while values<0.90 suggest the model needs to be revised 29…”

“…SRMR is a standardised measure for the evaluation of the model residuals, which relate to the difference between sample covariance and the corresponding model estimated covariance. A good model should have RMSEA and SRMR values below 0.05 30. Values larger than 0.10 suggest model rejection 29…”

“…We carried out bootstrapping with 2000 samples to evaluate the significance of the indirect effects because the assumption of a normal distribution of indirect effects is often violated 30. Specifically, we computed 95% bias-corrected bootstrap confidence intervals (CI 95 ).…”

Psychiatric and Medical Comorbidity in the Primary Care Geriatric Patient—An Update

“…In patients with optic neuropathies, those with less subjective visual loss had less mental distress. If vision cannot be restored or maintained, coping strategies and supportive therapy should be offered [49]. In one study, a program of low vision rehabilitation combined with behavioral activation halved the incidence of depressive disorders compared to standard vision rehabilitation among outpatients with age-related macular degeneration [50•].…”