Coping strategy in persons with low vision or blindness - an exploratory study

The association between visual impairment and mental disorders

To determine the association between visual impairment (VI) and some mental disorders using the general health questionnaire (GHQ) in individuals aged 60 years and above in Tehran, Iran. The present population-based cross-sectional study was conducted on people aged 60 and older in Tehran, Iran using multi-stage cluster sampling. After selecting the samples, examinations including visual acuity measurement, refraction, and slit-lamp biomicroscopy were performed for all participants. The GHQ was used to examine mental disorders. Simple and multiple linear regressions were used to investigate the association between VI and mental disorders. Of the 3740 invitees, 3310 participated in the study (response rate: 88.50%). After applying the exclusion criteria, 2789 individuals were analyzed for this report. Mean score of physical, anxiety, social and depression disorders in people with and without VI was 3.74 ± 2.03, 5.81 ± 2.79, 7.56 ± 1.91, 1.32 ± 1.90, and 3.14 ± 1.76, 4.93 ± 2.71, 8.09 ± 1.99, 0.91 ± 1.38, respectively. The total score of GHQ in participants with and without VI was 18.43 ± 4.75 and 17.07 ± 4.19, respectively. The association between GHQ subscales and total GHQ score with VI by multiple linear regression showed that VI had a statistically significant direct association with physical symptoms (β = 0.37; 95% CI 0.12 to 0.62) and anxiety (β = 0.48; 95% CI 0.16 to 0.81). Nevertheless, depression had a borderline association with VI (β = 0.21; 95% CI - 0.03 to 0.45) and social dysfunction did not have a statistically significant association with VI in the final linear regression model and did not remain in the model. Total GHQ score had a statistically significant association with VI (β = 1.02; 95% CI 0.39 to 1.64) in the presence of covariates. Regarding the association between VI and GHQ components, the physical symptoms had the highest R2 (R2 = 0.159). Patients with VI suffer more from anxiety, depression, and physical symptoms regardless of age, sex, education, and other effective variables. The coincidence of aging with VI and the association of VI with mental disorders emphasizes the importance of a broader view of the elderly and the aging process.

Magnitude of Maladaptive Coping Strategy and Its Associated Factors Among Adult Glaucoma Patients Attending Tertiary Eye Care Center in Ethiopia

Introduction

Coping strategy is the mechanism by which patients adjust to the condition they face. It can be adaptive or maladaptive. A maladaptive coping strategy is a harmful and ineffective way of dealing with stress or anxiety. It is common among patients with chronic illnesses. Despite Ethiopia having a greater glaucoma prevalence, there was no evidence of patients with glaucoma using maladaptive coping mechanisms.

Objective

The main goal of this study was to evaluate the magnitude of maladaptive coping strategy use and the factors that associate with it among adult glaucoma patients enrolled in the Tertiary Eye Care and Training Center at the University of Gondar in Northwest Ethiopia in 2022.

Methods and Materials

At the University of Gondar, Tertiary Eye Care and Training Center, a facility-based cross-sectional study was carried out on a sample of 423 glaucoma patients chosen by a systematic random sampling technique from May 15 to June 30, 2022. Optometrists conducted an interview with the study subject and reviewed the medical record, and administered a pretested, structured questionnaire of the brief cope inventory assessment. In the multivariable logistic regression, binary logistic regression was performed to identify the related factors, and significance was taken into account when the p-value was less than 0.05 at the 95% confidence interval.

Results

The study found that among study participants 50.1% (95% CI: 45.1-54.5%) had a maladaptive coping strategy. Female sex (AOR=2.031, 95% CI:1.185-3.480), chronic medical illness (AOR=1.760, 95% CI:1.036-2.989), bilateral glaucoma (AOR=2.321, 95% CI: 1.328-4.055), receiving both drug and surgery treatment (AOR=1.895, 95% CI: 1.002-3.585), severe visual impairment (AOR=2.758, 95% CI:1.110-6.852), absolute glaucoma (AOR=2.543, 95% CI:1.048-6.169), duration of diagnosis >12 months (AOR=3.886, 95% CI: 2.295-6.580) were significantly associated with a maladaptive coping strategy.

Conclusion and Recommendation

Half of the participants had a maladaptive coping strategy. It is better to set and plan strategies that enable the integration of coping strategy care into the current treatment of patients with glaucoma to encourage positive coping strategies instead of maladaptive ones.

Identifying psychosocial challenges and introducing coping strategies for people with albinism

Albinism refers to a group of genetic disorders that, following genetic mutations, lead to impaired melanin production, resulting in skin allergies and visual impairment in affected people. Visual impairment brings not only physical limitations and challenges but also many social problems, including psychosocial challenges, leading to different experiences in the lives of these people. To this end, using a qualitative content analysis approach, the present study aimed to identify psychosocial challenges and introduce coping strategies for people with albinism living in Tehran in 2021. The participants were people with albinism aged 20 to 40 years in Tehran. The participants were selected from among members of the Iranian Albinism Association (AMAL) using purposive sampling. The data were saturated through semi-structured interviews with 20 participants in the research sample. The collected data were analyzed using conventional content analysis. Analysis of the participants’ experiences revealed three main themes: (1) The challenges and difficulties of living with albinism, (2) welfare, specialized facilities, and support seeking, and (3) strategies for coping with psychosocial challenges. According to the findings, albinism, due to its limitations, brings many bitter and painful experiences in education, job finding, and marriage for affected patients. The condition is also associated with some limitations such as visual impairment affecting various aspects of the patient’s life and different developmental periods. Each person may have different interpretations of their challenges and thus seek unique strategies for coping with the challenges. The findings of this study can have some implications for mental health professionals and managers of relevant institutions and to become aware of the nature and complications of albinism, the challenges faced by people with albinism, and the special needs of these people. Findings from this study can be used to identify the relationship between albinism, the challenges of living with albinism, and the special needs of these individuals, by mental health professionals, related institutions, and psychosocial environments.

Simulating Macular Degeneration to Investigate Activities of Daily Living: A Systematic Review

Purpose: Investigating difficulties during activities of daily living is a fundamental first step for the development of vision-related intervention and rehabilitation strategies. One way to do this is through visual impairment simulations. The aim of this review is to synthesize and assess the types of simulation methods that have been used to simulate age-related macular degeneration (AMD) in normally sighted participants, during activities of daily living (e.g., reading, cleaning, and cooking).

Methods: We conducted a systematic literature search in five databases and a critical analysis of the advantages and disadvantages of various AMD simulation methods (following PRISMA guidelines). The review focuses on the suitability of each method for investigating activities of daily living, an assessment of clinical validation procedures, and an evaluation of the adaptation periods for participants.

Results: Nineteen studies met the criteria for inclusion. Contact lenses, computer manipulations, gaze contingent displays, and simulation glasses were the main forms of AMD simulation identified. The use of validation and adaptation procedures were reported in approximately two-thirds and half of studies, respectively.

Conclusions: Synthesis of the methodology demonstrated that the choice of simulation has been, and should continue to be, guided by the nature of the study. While simulations may never completely replicate vision loss experienced during AMD, consistency in simulation methodology is critical for generating realistic behavioral responses under vision impairment simulation and limiting the influence of confounding factors. Researchers could also come to a consensus regarding the length and form of adaptation by exploring what is an adequate amount of time and type of training required to acclimatize participants to vision impairment simulations.

Emotional valence and arousal induced by auditory stimuli among individuals with visual impairment

Despite significant vision loss, humans can still recognize various emotional stimuli via a sense of hearing and express diverse emotional responses, which can be sorted into two dimensions, arousal and valence. Yet, many research studies have been focusing on sighted people, leading to lack of knowledge about emotion perception mechanisms of people with visual impairment. This study aims at advancing knowledge of the degree to which people with visual impairment perceive various emotions – high/low arousal and positive/negative emotions. A total of 30 individuals with visual impairment participated in interviews where they listened to stories of people who became visually impaired, encountered and overcame various challenges, and they were instructed to share their emotions. Participants perceived different kinds and intensities of emotions, depending on their demographic variables such as living alone, loneliness, onset of visual impairment, visual acuity, race/ethnicity, and employment status. The advanced knowledge of emotion perceptions in people with visual impairment is anticipated to contribute toward better designing social supports that can adequately accommodate those with visual impairment.

The influence of coping types on post-traumatic growth in patients with primary breast cancer

Background

The physical and mental impacts of breast cancer diagnosis on women are substantial. Several studies have investigated the negative mental health effects of breast cancer. However, in recent years, there has also been growing interest in post-traumatic growth, a positive response to stressful events. Considering positive psychology focuses on such virtues, proactive coping theory was chosen as a theoretical guide. This study investigates how breast cancer patients’ post-traumatic growth is associated with proactive coping and mental well-being.

Methods

A self-administered questionnaire survey was conducted with 80 breast cancer patients aged 20–70 years attending an outpatient clinic. The survey was conducted using the Posttraumatic Growth Inventory-Japanese version (PTGI-J), Proactive Coping Inventory-Japanese version and the Japanese version of the General Health Questionnaire. Single regression and multiple regression analyses with PTGI-J as the dependent variable were performed.

Results

The multiple regression analysis extracted proactive coping (P = 0.006), emotional support seeking (P = 0.004) and avoidance coping (P = 0.001) as factors associated with post-traumatic growth in breast cancer patients.

Conclusions

These results suggest that using proactive coping for conflicts caused by a breast cancer diagnosis and temporary avoidant coping for daily stresses during the treatment process may enhance post-traumatic growth while preventing deterioration in mental well-being. Additionally, seeking emotional support is important for post-traumatic growth.

Long-term follow-up of antivascular endothelial growth factor treatment for diabetic macular oedema: a four-year real-world study

PURPOSE

To evaluate visual acuity (VA) and central retinal thickness (CRT) on optical coherence tomography during a 4-year period in patients treated for sight-threatening diabetic macular oedema (DMO) at two Swedish county hospitals. Additionally, to compare health-related quality of life and subjective visual functioning before and after 4 years of treatment.

METHODS

Fifty-eight patients with DMO were evaluated after 4 years of antivascular endothelial growth factor (VEGF) treatment. VA, CRT and clinical data were retrospectively reviewed. Health-related quality of life and subjective visual functioning were evaluated with Short Form Health Survey (SF-36) and National Eye Institute Vision Functioning Questionnaire 25 (VFQ-25). Comparisons between independent groups were performed using Pearson's χ² test, Fisher's exact test or Mann-Whitney U test. Spearman's ρ was used for correlation analyses. Wilcoxon signed-rank test was used for comparison between dependent groups. Logistic regression analysis was applied for analysis of VA and CRT over 4 years.

RESULTS

Follow-up data were obtained from 37 of 58 (63.8%) patients. Baseline characteristics were similar, regardless of follow-up. VA improvement at 1 year (mean + 4.4, SD 7.5; ETDRS letter score) was maintained over 3 years, then declined. CRT was reduced throughout the study. In the first treatment year, eyes received 5.1 (1.4) anti-VEGF injections, followed by approximately two injections yearly. Additional treatment included laser and dexamethasone implants. SF-36 showed no change at 4 years, compared with baseline. VFQ-25 demonstrated improvement in near vision activities (p = 0.036).

CONCLUSION

Significant long-term improvement in visual function was present in patients with anti-VEGF-treated DMO.

Treated PDR Reveals Age-Appropriate Vision Deterioration But Distorted Retinal Organization

Purpose

We determined the progression of visual function, macular structure, and quality of life in patients with regressed proliferative diabetic retinopathy (PDR) after panretinal photocoagulation (PRP).

Methods

In this prospective study, 22 patients who underwent PRP for PDR and 11 age-matched control participants underwent examinations at baseline and after 5 years. Visual acuity, contrast sensitivity, reading acuity, frequency doubling perimetry, Humphrey field analyzer, and dark adaptation were measured. The Low Luminance Questionnaire and National Eye Institute Vision Function Questionnaire-25 were administered. Macular spectral-domain optical coherence tomography was taken.

Results

After 5 years, patients who had previously undergone PRP for PDR (18.4 ± 7.9 years previously) showed significant deterioration in contrast sensitivity, reading acuity, frequency doubling perimetry 24-2 pattern standard deviation, and Humphrey field analyzer 10-2 foveal sensitivity, which were equivalent to age-related decreases in control participants. They revealed no further impairment in vision-related activities on questionnaires. In contrast with controls, their maculas showed pathologic disorganization of the retinal layers, especially the nerve fiber layer, which were thicker and constituted a greater proportion of the overall retinal thickness than the norm and associated with impaired vision.

Conclusions

Patients with treated PDR had age-related decreases in vision, but stable quality of life. Prior injuries from the diabetes and, possibly, laser treatment led to substantial disruption in the retinal structure, which may explain the loss of vision.

Translational Relevance

Despite PRP treatment, patients with regressed PDR had pathologic progression of the nerve fiber layer; further investigation may identify a new therapeutic target to reverse the visual deficits.