DEPRESSION AND VISION LOSS

By: Merideth Smith, M.S., Psychology Intern and Laura J. Peters, Ph.D., Staff Psychologist

Photo: Silhouette of a person sitting in a chair with their head in their hands

With vision loss, it is normal to experience periods of sadness, stress, or grief; however, these feelings will often lessen over time. For some individuals, these feelings do not go away, and when this happens it is called depression. Depression is characterized by feelings of sadness, hopelessness, loss of pleasure in previously enjoyed activities, guilt, worthlessness, helplessness, fatigue, problems sleeping or oversleeping, isolation, irritability, or restlessness that last for most days for two weeks or longer. Unfortunately, people with vision loss are at higher risk of developing depression. Of the 5.7 million older adults in the United States with vision loss, 57.2% are at increased risk for mild to moderate depressive symptoms and 6.2% are at risk for severe depression. Those with mild to moderate depression are 4 to 6 times more likely to experience worse health as well as problems with functioning (e.g., walking, shopping, and socializing). Those with severe depression are 18 to 23 times more likely to have worse health and problems with functioning. This increased risk for depression and poorer functioning in older adults with vision impairment is a significant public health concern and can have a negative impact on an individual’s quality of life and physical health.


Although adults with vision impairment are at an increased risk for depression, there are steps that can help someone cope with the symptoms of depression. Engaging in vision loss rehabilitation can help individuals feel more capable and in control of their lives. Seeking out social support through family, friends, organizations, or support groups can be very effective in improving quality of life and can help with the adjustment to changes in health. Rehabilitation can also support people's ability to resume pleasurable activities that they have abandoned due to their sight loss. Engaging in pleasurable activities can improve a person’s mood. Exercising on a regular basis can also help with problems with sleeping or feelings of fatigue.

However, sometimes the depression is severe and significantly interferes with a person’s life. People with depression can even have thoughts of hurting or killing themselves. This is referred to as suicidal ideation. In fact, white males over the age of 85 have the highest rates of death by suicide, 45 deaths out of 100,000. Unfortunately, this population is also the least likely to seek help if they experience depression. A national hot line is available for individuals who have suicidal thoughts, or for family and friends who are concerned about a loved one. This hot line can be reached at 1-800-273-TALK (8255).

For additional information please see the website: http://www.suicidepreventionlifeline.org/.


When depression becomes this crippling, professional help may be needed. Currently there are effective forms of treatment for individuals who are experiencing depression and these treatments continue to improve with ongoing research. Treatment can take the form of psychotherapy, which can include talking about stressors, learning to use healthy coping strategies, improving relationships, or learning to incorporate pleasurable activities back into everyday life. Antidepressant medications can also be used to effectively treat depression. These medications do take time to work and the first medication you try may not be effective. There are several different types of antidepressant medications, so do not give up if the first medication is ineffective. It is important to communicate with your doctor if you experience side-effects or do not notice a change in mood after 3 to 4 weeks.

Depression can be physically and mentally debilitating and adults with vision impairment are at an increased risk. However, there are effective resources and treatments that can improve mood and give the person the skills necessary to successfully adapt to these significant life changes. If you notice you or someone you love have prolonged periods of sadness, loss of pleasure, or depression, do not hesitate to talk with your doctor.

WBRC TAKES A SWING AT BEEP BASEBALL

By: Daniel Penrod, WBRC Manual Skills Instructor

A WBRC student gets ready to swing at the beeping

baseball while learning to play the game with the

Stockton Stingray Beep Baseball team

A recent WBRC outing had veterans and staff swinging. They were learning to play the game of Beep Baseball with the Stockton Stingray Beep Baseball team. The team joined the WBRC to demonstrate and teach the game. Beep Baseball uses a standard softball bat, a modified softball with audible signals, and two upright bases with audible signals. All of the players except the pitcher wear blindfolds to occlude their vision and level the playing field. The pitcher announces to the batter when he pitches the ball and also when the ball is passing over the home plate. If the batter makes contact with the ball, one of the 2 audible bases is randomly turned on, and the batter must take off to locate the base. If the batter makes it to the base before the fielders locate the beeping ball they score a point.

After a demonstration game, veterans and staff had an opportunity to put on a blindfold and go up to bat. There were varying levels of success, but everyone was impressed with how far some batters could hit the ball and how quickly the players could field the ball or find the base. As someone who struggled at the plate, I can personally say that it was challenging, exciting, and educational to feel for a brief period what it was like to solely use hearing to locate a pitch, a ball, or a base. I have never felt a thrill from any other sport like that of trying to run without sight towards a base while the opposing team scrambles to find the ball and get you out.

To learn more about Beep Baseball CLICK HERE

or

To read an article or watch a news clip from the Wall Street Journal about Beep Baseball CLICK HERE

WBRC CNVR PROGRAM PROFILED ON NPR

WBRC Researcher, Dr. Greg Goodrich, pictured in the

WBRC Advanced Wood Shop

Monday November 8th, 2010: Bay Area NPR station KQED aired a radio story regarding the vision research and treatment for Veterans with Traumatic Brain Injury related vision loss occurring at the Palo Alto VA.

Article Excerpt:

"Often people don't realize they have the problem," says Greg Goodrich, a vision researcher at the VA Medical Center in Palo Alto.

In 2003, Goodrich and another doctor started noticing something surprising in the young vets they were treating. According to their charts, these men and women could see just fine. Goodrich says many of them had full 20/20 vision. And yet, he says, "they had this huge hemianopsia. Half their visual world was gone. And the most common visual tests used didn’t catch it."

Glenn Cockerham, chief of ophthalmology at the VA Palo Alto, says he and others took to calling these "occult" injuries, because of the way they seemed to escape detection.
"If you just ask [these soldiers] how they’re doing," he says, "they’ll say I’m doing fine. But if you ask specific questions, and you compare them to other people, they’re not doing so well.

For example, many of the veterans were having problems concentrating. They bumped into things. Goodrich says another red flag was when a soldier would say he or she had lost interest in reading. If asked whether that had been the case before the war, the vets would often say that it had not.

What's striking, say the doctors, is that these symptoms -- difficulty concentrating, clumsiness, inability to read well -- are precisely the kinds of problems soldiers might attribute to PTSD, or other combat injuries. Many soldiers assume they are just a fact of life after war.

Returning to civilian life, says Goodrich, is "a tremendous psychological readjustment to go through. And sorting out symptoms that can be subtle, or that you don’t recognize, is a real challenge." Cockerham and Goodrich find that hemianopsias and other vision injuries are far more common than anyone had expected. Goodrich estimates that at least six thousand vets have suffered visual damage as a result of brain injury. "Because some of these are very subtle," says Goodrich, "we don’t catch them as often as we would like to."

One reason that so many vision problems go undiagnosed is that soldiers often don't realize they've been injured at all. For example, just being near an IED blast can, in some case, be enough to sustain brain injury, including vision problems.

"Blasts have this huge pressure wave that comes from them," explains Goodrich, "and the pressure wave does some rather unique things."

In a human body, that sudden pressure wave is like a powerful punch to the chest and stomach. The impact moves throughout the body, including to the brain where it can stretch or tear actual brain tissue. Brain cells can start to die off. If this damage takes place in the visual parts of the brain, that can mean vision problems, including hemianopsias.

Nowadays, far more of these problems are being diagnosed. That’s because Goodrich and Cockerham have invented a new, advanced vision test. It’s now part of the routine screening that veterans receive when they come to the hospital with major injuries.

And that means more vets are getting treatment.

On the day I visited the VA in Palo Alto, Iraq vet Chris Rader was being treated for a hemianopsia he sustained in a motorcycle accident, after he returned from the war.
As he walked down a hallway at the VA, Rader methodically turned his head from left to right, as if watching a tennis match. He was looking for pink post-it notes, placed here and there by Rader’s vision therapist, John Kingston.

Learning how to scan a scene is one way that hemianopsia patients, like Rader, can learn to get around better...

Goodrich says that for many vets, what comes before treatment – the simple act of diagnosis -- is just as important. "Part of my motivation is, I’m a Vietnam vet," he says, "and for some of my comrades, diagnosing the problems that happened to them took 15 to 20 years."

Article Excerpt from kqed.org, 'VA Doctors Solve a Medical Mystery', Written by: Amy Standen

To Read the Full KQED NPR Article CLICK HERE

To listen to the Full KQED NPR Audio Story CLICK HERE