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Assessing the impact of stress in age-related macular degeneration

March 03, 2017

March 3, 2017 - Age-related macular degeneration (AMD), the leading cause of vision loss among older adults in the United States, is often associated with psychological stress. A simple stress rating scale (the Perceived Stress Scale) is a valid and useful way to evaluate the connection between stress and progressive vision loss from AMD, according to a study in the March issue of Optometry and Vision Science, the official journal of the American Academy of Optometry. The journal is published by Wolters Kluwer.

"Because AMD is an inflammatory disease, we are studying the link between inflammation, stress, and AMD treatment outcomes," reported Bradley E. Dougherty, OD, PhD, of The Ohio State University College of Optometry. "In the end, we hope to better understand how general well-being influences disease outcomes."

Measuring Stress May Aid in Assessing the Life Impact and Progression of AMD

Patients with vision loss in AMD experience high rates of stress, anxiety, and other problems, including depression. Less is known about the relationship between the stress that AMD patients experience and the severity of their disease--for example, whether stress can cause AMD to worsen or not.

The Perceived Stress Scale (PSS) is a well-established stress rating scale that can predict objective biological markers of stress, as well as the risk of stress-related diseases. In previous studies, the PSS has been shown to be predictive of general markers of inflammation, including C-reactive proteins. In the new study, Dr. Dougherty and colleagues extend the use of this survey to determine how well it measures perceived stress in patients with vision loss due to AMD.

One hundred thirty-seven patients with AMD, average age 82 years, completed the ten-question PSS. Using a technique called Rasch analysis, Dr. Dougherty and colleagues evaluated the PSS's performance as a stress measure in AMD. About half of the patients filled out the stress questionnaire on a day when they received injections of anti-VEGF antibodies--a relatively new treatment that can slow the progression of the "wet" form of AMD.

Nine of the ten questions normally used with the PSS performed well with the patient group studied. These nine items were also able to separate between patients with higher versus lower levels of perceived stress. For some PSS items, responses differed according to patient age and visual acuity level.

However, the overall PSS score was not significantly related to the patients' visual acuity level. Average visual acuity in the better eye for this group of AMD patients was 20/50, with a range from near normal to very low vision.

"A psychometrically sound, easy-to-administer questionnaire such as the PSS is important for use with patients with AMD, given the evidence for increased rates of psychological symptoms in the population," Dr. Dougherty and coauthors write. They note that stress-reduction approaches--for example, "mindfulness" interventions--have led to improved outcomes in patients with various health conditions.

Dr. Dougherty and colleagues also note that stress may be associated with increased inflammation and that AMD is an inflammatory disease--raising the possibility that stress may contribute to disease progression. Future studies using repeated assessments with the PSS and measurement of inflammatory markers might provide evidence on how perceived stress levels affect the risk of AMD progression and worsening vision loss.
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Click here to read "Measurement of Perceived Stress in Age-Related Macular Degeneration."

Article: "Measurement of Perceived Stress in Age-Related Macular Degeneration" (doi: 10.1097/OPX.0000000000001055)

About Optometry and Vision Science

Optometry and Vision Science, official journal of the American Academy of Optometry, is the most authoritative source for current developments in optometry, physiological optics, and vision science. This frequently cited monthly scientific journal has served primary eye care practitioners for more than 90 years, promoting vital interdisciplinary exchange among optometrists and vision scientists worldwide. Michael Twa, OD, PhD, FAAO, of University of Alabama-Birmingham School of Optometry is Editor-in-Chief of Optometry and Vision Science. The editorial office may be contacted at ovs@osu.edu

About the American Academy of Optometry

Founded in 1922, the American Academy of Optometry is committed to promoting the art and science of vision care through lifelong learning. All members of the Academy are dedicated to the highest standards of optometric practice through clinical care, education or research.

About Wolters Kluwer

Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.

Wolters Kluwer reported 2015 annual revenues of €4.2 billion. The group serves customers in over 180 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY).

Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization, visit http://www.wolterskluwer.com, follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.

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