title: Profound vision loss impairs psychological well-being in young and middle-aged individuals.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effects of profound vision loss on psychological well-being in adolescents, young adults, and middle-aged adults with regard to mood, interpersonal interactions, and career-related goals. In addition, we assessed the significance of the resources that may be used to enhance psychological well-being in cases of profound vision loss, and in particular, examined the utility of low vision aids and the role of the ophthalmologist as a provider of emotional support.
  
  
  METHODS
  A questionnaire was issued to individuals aged 13-65 years with profound vision loss resulting from Leber's hereditary optic neuropathy (LHON). Depression prevalence was evaluated with questions regarding major depressive disorder symptomatology. Participants appraised the effects of vision loss on their interpersonal interactions and career goals by providing an impact rating (IR) on a 21-point psychometric scale from -10 to +10. Social well-being index was defined as the average of interpersonal IR and career IR. Subjects were additionally asked about the use of low vision aids and sources of emotional support.
  
  
  RESULTS
  A total of 103 participants (mean age =26.4±11.2 years at LHON diagnosis; mean ± standard deviation) completed the questionnaire. Nearly half (49.5%) met the depression criteria after vision loss. Negative impacts on interpersonal interactions (median IR = -5) and career goals (median IR = -6) were observed; both ratings were worse (P<0.001) for depressed versus nondepressed subjects. Older age at diagnosis corresponded to higher depression prevalence and increased incidence of negative interpersonal IR and career IR. Sixty-eight percent of subjects used electronic vision aids; controlling for age, social well-being index was higher among these individuals than for those who did not use electronic aids (P=0.03). Over half of the participants (52.4%) asserted that they derived emotional support from their ophthalmologist.
  
  
  CONCLUSIONS
  Profound vision loss in adolescents, young adults, and middle-aged adults is associated with significant negative psychological and psychosocial effects, which are influenced by age and use of electronic vision aids. Ophthalmologists, in addition to managing vision loss, may serve an important role in the emotional adaptation of these patients.
authors.affiliation: Doheny Eye Institute, Los Angeles, CA, USA; University of California, Irvine School of Medicine, Irvine, CA, USA.
authors.forename: Giancarlo A
authors.initials: GA
authors.lastname: Garcia
authors.affiliation: Doheny Eye Institute, Los Angeles, CA, USA; Department of Ophthalmology, Temple University, Philadelphia, PA, USA.
authors.forename: Matin
authors.initials: M
authors.lastname: Khoshnevis
authors.affiliation: Doheny Eye Institute, Los Angeles, CA, USA; Wellington School of Medicine and Health Sciences, University of Otago, Wellington, NZ.
authors.forename: Jesse
authors.initials: J
authors.lastname: Gale
authors.affiliation: Doheny Eye Institute, Los Angeles, CA, USA; Department of Ophthalmology, New York Medical College, Valhalla, NY, USA.
authors.forename: Starleen E
authors.initials: SE
authors.lastname: Frousiakis
authors.affiliation: Doheny Eye Institute, Los Angeles, CA, USA; Department of Psychiatry & The Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Tiffany J
authors.initials: TJ
authors.lastname: Hwang
authors.affiliation: Doheny Eye Institute, Los Angeles, CA, USA.
authors.forename: Lissa
authors.initials: L
authors.lastname: Poincenot
authors.affiliation: Doheny Eye Institute, Los Angeles, CA, USA; Doheny Eye Centers, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles California, CA, USA; Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Health Research Institute, Ottawa, ON, Canada.
authors.forename: Rustum
authors.initials: R
authors.lastname: Karanjia
authors.affiliation: Department of Psychiatry & The Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Baron
authors.affiliation: Doheny Eye Institute, Los Angeles, CA, USA; Doheny Eye Centers, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles California, CA, USA.
authors.forename: Alfredo A
authors.initials: AA
authors.lastname: Sadun
keywords: Leber’s hereditary optic neuropathy; depression; low vision aids; psychological; quality of life; vision loss