Eyeworld

N EWS by Liz Hillman Editorial Co-Director "It's important that eyecare professionals recognize depression in their patients. One of the ways they can do this very easily is to use something like the PHQ-2, which couldn't be easier or simpler to do," Dr. Morse said, noting that it could be done by the practitioner, at the front desk, or in the waiting room. "It's only two questions, it scores instantly, and it would give them a very quick idea of whether that particular patient is feeling depressed." If the patient does score as having depres- sive symptoms, Dr. Morse said a referral to a behavioral practitioner should be made, while focusing on treating the patient's visual issues. "It's important for practitioners to focus on the core of their practice. That said, it's equally important for them to help their pa- tients. You don't want a patient coming in with a broken arm and you see the arm hanging by a thread and you say 'Let's talk about your eyes.' They have a problem, you need to address it. In the case with a broken arm, clearly you're going to make a referral to an orthopedist. In the case of a problem where a patient is depressed, a referral is equally appropriate," Dr. Morse said. If a patient asks why they are being referred to a psychologist or psychiatrist when they meet with an ophthalmologist about vision problems, V ision loss is among Americans' great- est fears, compared to other disabling conditions or diseases. 1 As such, it's not surprising that vision loss has been associated with depression. A number of studies have estab- lished this link. A study that looked at the association between depression and func- tional vision loss in the U.S., for example, found that self-reported vision loss (not necessarily loss of visual acuity) was significantly associated with depression. 2 Vision loss is only a possible factor in some cases of depression with various other factors at play as well. But with this link to vision loss, what is the role of ophthalmologists in spotting depression in patients and how should suspect- ed cases be handled? Alan Morse, JD, PhD, thinks most in the ophthalmic community are at least aware of the association between vision loss and depression, but he doesn't think medical professionals are taking the steps they should to get patients help. While Dr. Morse doesn't think ophthalmol- ogists should necessarily get involved in ad- dressing patients' feelings, he does think simple screening and referrals are well within their purview. Keeping an eye out for depression About the doctor Alan Morse, JD, PhD Adjunct professor Department of Ophthalmology Columbia University New York, New York References 1. Alliance for Eye and Vision Research. New Public Opinion Poll Reveals a Significant Number of Americans Rate Losing Eyesight as Having Greatest Impact on their Lives Compared to Other Conditions. 2014. 2. Zhang X, et al. Association be- tween depression and functional vision loss in persons 20 years of age or older in the United States, NHANES 2005–2008. JAMA Oph- thalmol. 2013;131:573–81. 3. Morse A. Addressing the maze of vision loss and depression. JAMA Ophthalmol. 2019;137:832–833. 4. Morse A. What can I do to help my patient when I think there is nothing else I can do? Ophthal- mology. 2018;125:959–61. Relevant disclosures Morse: None 32 | EYEWORLD | JANUARY/FEBRUARY 2020

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