Psychologic adjustment to irreversible vision loss in adults: a systematic review.

PURPOSE: To summarize relevant evidence investigating the psychologic adjustment to irreversible vision loss (IVL) in adults. DESIGN: Irreversible vision loss entails a challenging medical condition in which rehabilitation outcomes are strongly dependent on the patient's psychologic adjustment to illness and impairment. So far, no study has systematically reviewed the psychologic adjustment to IVL in adults. METHODS: We reviewed all articles examining the psychologic adjustment to IVL in adults. We included articles published in English in peer-reviewed journals. We performed a keyword literature search using 4 databases (PubMed, EBSCO, Cochrane Library, and Science Direct) for all years through July 2014. We assessed risk of bias of selected studies using the RTI Item Bank for Assessing Risk of Bias and Confounding for Observational Studies of Interventions or Exposures and the Cochrane risk of bias tool for randomized controlled trials. RESULTS: Of a total of 3948 citations retrieved, we selected 52 eligible studies published between 1946 and 2014. The majority of studies were observational and cross-sectional in nature. Our review suggests that high levels of depression occur during the adjustment to IVL. Better adjustment to IVL was associated with greater acceptance of vision loss and use of instrumental coping, good social support, positivity, and use of assistive aids. CONCLUSIONS: The overall findings indicate that IVL often has negative effects on patients' quality of life and mental health and that such effects tend to remain over time. Specific factors and variables associated with the adjustment to IVL need to be clarified through further in-depth and longitudinal research.

Depression and experience of vision loss in group of adults in rehabilitation setting: mixed-methods pilot study.

There is a paucity of literature regarding the relationship between the experience of vision loss and depression. Therefore, the current pilot study aimed to explore whether significant differences existed in levels of depression between adults with different vision loss experiences. A group of adults aged between 20 and 65 yr old with irreversible vision loss in a rehabilitation setting was interviewed. Semistructured interviews were conducted in order to explore patients' experience of vision loss. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressive levels; 39.5% (n = 15) of patients met CES-D criteria for depression. In addition, higher levels of depression (p < 0.05) were identified in patients whose interviews revealed greater self-awareness of impairment, inadequate social support, and longer rehabilitation stay. Current findings draw attention to variables such as self-awareness of impairment and perceived social support and suggest that depression following vision loss may be related to patients' emotional experiences of impairment and adjustment processes.