Dr. Sikha Misra, M17861, Dr. Harshavardhan V K, Dr. Rakesh Betdur, Dr. Sumita Mohapatra
INTRODUCTION
There is a well-established link between poor eye health and mental health, and it is important that those involved with eye care be aware of this. Morbid ocular diseases come under a wide frame under which comes high refractive error, cataract, ARMD, end stage glaucoma, keratoconus, PDR with vitreous haemorrhage and retinal detachment, central retinal arterial occlusions, etc. Though all above conditions affects vision severely but refractive error and cataract can be managed successfully to great extent. It is the uncertainty of restoration of visual acuity which greatly affects mental status of patients.
A study looking at the high incidence of depression in people with ARMD was released by the National Institutes of Health (NIH) this past July, In addition to making it difficult to go places, vision impairment may make people hesitant to participate in social activities they once enjoyed. Not being able to recognize a familiar face across the room or even across the table can be very embarrassing. Depression can affect different people at different times. Many newly diagnosed people panic. The depression hits them later like a ton of bricks once the distraction of initial research and discovery is gone.
People who have dealt with Keratoconus (KC) for a really long time get tired and worn down. After the initial diagnosis, patients may feel stunned and fearful. Then, when that sinks in, and they realize this is a long-term condition with no quick fix, they get depressed, like those with ARMD, people with KC deal with limited vision, financial issues, and limitations on work and play. Plus, KC affects younger people, and it can affect every aspect of their lives, from career choices to family life.
Similarly Glaucoma is one of the leading cause of irreversible blindness worldwide. It is called the silent thief of sight because there is no warning.If it is not controlled early, blindness can result and it is irreversible and those patients suffer from depression. Diabetic retinopathy which occurs in chronic diabetics who are already struggling with other organ dysfunction losetheir mental balance due to vision loss as a result of proliferative diabetic retinopathy with vitreous haemorrhage and retinal detachment.
Depression is though a leading symptom among the group of mental illnesses, other symptoms are also seen like social withdrawal, panic attacks, anxiety and lastly can lead to suicidal tendencies and this becomes a point of no return. So our focus is to defocus the no return point with sufficient support to those patients in all points of their life with help from family or by creating support groups or through proper counselling from professionals.
AIM To study about various ocular diseases affecting mental health thereby taking proper measures to prevent it in these patients.
METHODS
It is a prospective observational study conducted in regional institute of ophthalmology from OCT 2014- DEC 2016.Total 44 patients were taken with various ocular morbidities with irreversible vision loss in both eyes out of which 12-END STAGE GLAUCOMA, 21- ARMD , 2 -KERATOCONUS, 6 had long standing PDR causing RD/V.H., 3- CRAO.
Visual acuity, slit-lamp examination, indirect ophthalmoscopy, visual field, Goldberg questionnaire (GAD score) tested in all the 44 patients.
Inclusion criteria
Only patients with irreversible vision loss taken who showed signs and symptoms of mental illness
Exclusion criteria
- High refractive error
- Only Cataract patients.
- Morbidly systemically ill patients
- Patient lost to follow-up
RESULTS -Of these 44 patients, 27(61.3%) patients had some features of mental illness
TABLE 1-MENTAL ILLNESS FEATURES IN MORBID OCULAR DISEASES
| FEATURE OF MENTAL ILLNESS | TOTAL AFFECTED(n=44) |
| DEPRESSION | 27(61.3%) |
| SOCIAL WITHDRAWAL | 14(31.8%) |
| ANXIETY | 6(13.6%) |
| SUICIDAL TENDENCIES | 2(0.5%) |
TABLE 2-GRADING OF DEPRESSION AND ITS RELATIONSHIP WITH GAD SCORE
| GRADING OF DEPRESSION | GAD SCORE | NO OF PTS(N-27) |
| GRADE 1- ON VERGE OF DEPRESSION | 18-21 | 12(44.4%) |
| GRADE 2- MINOR TO MODERATE | 22-35 | 10(37%) |
| GRADE 3- MODERATE TO SEVERE | 36-53 | 4(14.8%) |
| GRADE 4- SEVERE | 54+ | 1(3.7%) |
TABLE 3-IMPROVEMENT OF MENTAL STATUS WITH COUNSELLING AND SUPPORT
| TOTAL AFFECTED PATIENTS | TOTAL PATIENTS COND IMPROVED WITH COUNSELLING | NO IMPROVEMENT SEEN IN |
| 27 | 21(77.8%) | 6(22.2%) |
DISCUSSION: Of these 44 patients, 27(61.3%) patients had some or other features of mental illness like depression in all these 27 pts along with it around 14(31.8%) had social withdrawal and 6(13.6%)pts had anxiety disorders and 2(0.5%) pts had suicidal tendencies. Of the 27depression patients severity was graded with help of Goldberg questionnaire. Upon proper counselling with family support 21(77.8%) of the 27 pts showed improvement in their mental health. My study goes well with many studies which shows increased incidence of mental illness in morbid ocular diseases
CONCLUSION- Mental illness in these ocular morbid cases need utmost care with counselling from both ophthalmologist and proper family care or else it can be life threatening.
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