Midlife Women With Declining Eyesight: Are They Also Looking at Future Depression?

Any degree of visual impairment seemed to be linked with future depression for midlife women, researchers reported.

In an analysis of 226 women, mild distance visual impairment — eyesight between 20/30 and 20/60 — was tied to a 78% higher odds of experiencing depressive symptoms compared with woman without visual impairment after adjustment for age and preexisting depressive symptoms (OR 1.78, 95% CI 1.04-3.05), reported Carrie Karvonen-Gutierrez, PhD, MPH, of the University of Michigan in Ann Arbor, and colleagues.

“This finding emphasizes the importance of considering and treating mild [visual impairment], which is often ignored but may considerably impact the quality of life,” the group wrote in Menopause, the journal of the North American Menopause Society (NAMS).

Worse vision only seemed to strengthen this relationship, as women who had moderate-to-severe distance visual impairment — eyesight of 20/70 or worse — had more than a two-fold higher odds of experiencing depressive symptoms (OR 2.71, 95% CI 1.28-5.73).

However, after the authors further adjusted for race, level of education, economic strain, BMI, and smoking status, only moderate-to-severe visual impairment stayed significantly linked with depressive symptoms (OR 2.55, 95% CI 1.13-5.75).

The researchers also adjusted for diabetes, hypertension, and osteoarthritis, and found that none of these relationships were statistically significant anymore, and pointed out that this finding may “reflect commonalities in the burden and pathophysiologic underpinnings between depression and other comorbid health conditions.” They added that prior research has found a link between depression, diabetes, and hypertension.

NAMS medical director Stephanie Faubion, MD, MBA, commented to MedPage Today that the “findings of this study are not surprising, but they do emphasize the additive effects of comorbidities as we age.”

“That the loss of an important sense — vision — is linked with future depressive symptoms speaks to the multiplying effect of medical comorbidities on healthy aging,” said Faubion, who is with Mayo Clinic Women’s Health in Rochester, Minnesota, and Jacksonville, Florida. “Healthcare providers should take every opportunity to screen for chronic disease and offer early intervention to preserve health later in life.”

Karvonen-Gutierrez’s recommended both early detection and timely correction of any degree of visual impairment in order to best protect women’s mental health. They added that although these issues can also extend to men, the combined presence of visual impairment and depressive symptoms seems to be more common in women.

For the analysis, the researchers drew upon a sample from the Study of Women’s Health Across the Nation (SWAN), and more specifically from participants at the Michigan site. The women had a mean age of 50, but ages ranged from 42 to 52. All women had to have an intact uterus and at least one menstrual period in the previous 3 months, and no use of hormone therapy in the previous 3 months for inclusion.

About 57% of the cohort was Black and 43% were white. The majority of the group were perimenopausal.

Of the 226 women included, 87 were free of visual impairment, 121 had mild visual impairment, and 18 had moderate-to-severe impairment. Distance visual acuity was assessed with the stereoscopic, occupational Titmus 2a vision screener, the authors noted.

They found that 56 women responded they experienced some degree of self-reported depressive symptoms at baseline according to the 20-item Center for Epidemiologic Studies Depression (CESD) scale. Scores could range from 0 to 60, while a score of 16 or higher was considered to be indicative of clinically relevant depressive symptoms. These symptoms were more prevalent among those who were smokers and had high levels of economic strain. Women who reported depressive symptoms had a significantly lower BMI than those without (31 versus 34).

Study limitations included the use of the vision screener versus “commonly used clinical methods to assess vision,” the authors stated. The study may also have been underpowered as only 18 women in the cohort had moderate-to-severe visual impairment.