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Byron L. Lam, MD, discusses the impact of depression in patients with IRD, and ophthalmology clinicians’ role in screening patients for depression.

Inherited retinal diseases that cause division loss are known to be linked with depression. One study of patients with retinitis pigmentosa found that 17.7% of patients with the disease had depression. Yet, some experts say that this complication is under-recognized—and that ophthalmology clinicians should take on a larger role in screening their patients for depression, as well as referring those patients for psychological care.

Physician’s Weekly (PW) spoke with Byron L. Lam, MD, author of an invited commentary published alongside the study, about the ophthalmologist’s role in detecting depression in patients who are losing their vision.

PW: Can you describe the original study you commented on?

Byron L. Lam, MD: Korea has a national health database, so its ability to do a population-based study is quite good. With this setup, researchers examined depressive symptoms in patients with retinitis pigmentosa (RP) before and after the diagnosis. It was clear that the diagnosis had a high impact.

What is the context of your op-ed piece?

The association between visual impairment and increased depression is well-recognized. In studies, the prevalence of depression associated with visual impairment is one in four or one in five.

What is the standard for depression in patients with vision loss?

The status quo is that it’s neglected, unintentionally neglected. I think everybody always wants to be the best doctor they can be, but it’s unintentionally neglected because traditional medical training does not work like that.

What barriers do patients with depression face in this setting?

First of all, sometimes the patient doesn’t realize they’re depressed. That is a common factor, but it’s also important for clinicians to help the patient realize they’re depressed. Another barrier is the fact that ophthalmologists are not trained to detect depression, know what to do with it, or feel that it’s their job to manage it. As I pointed out in my commentary, I think it is important for the ophthalmologist to realize that.

It’s important to note that ophthalmologists are busy. They have a lot of patients and not enough time. They may also expect that their patients should be depressed because they have poor vision, so it’s okay if they feel depressed. But I do not feel that is the proper approach.

I think the other point is that it’s critical to include at least some of the psychological implications of visual impairment in the training programs of ophthalmology residencies. Good ophthalmologists can detect eye diseases, know the latest treatment approaches, and are proficient surgeons—those things make you a good ophthalmologist. I agree with all of that, but I think there’s more. I think ophthalmologists shouldn’t be thinking in such a narrow fashion when other ramifications originate around the ocular conditions.

What is necessary to integrate depression care in ophthalmology?

Ophthalmologists will have many questions. How do you detect depression in your ophthalmology patients? How do you refer patients to professional help? Who will do the detection?

You can certainly utilize a questionnaire, but how? Will you send it to all patients using the EMR before the appointment? We don’t have methodology research to investigate that. We need more of that. Secondly, how do you make the referral work? I think this process is quite as important as the ability to recognize depression.

Do you have a vision for ophthalmology’s role in managing depression?

If I were to visualize the future, ophthalmologists would first have to embrace that this is part of their responsibility and, equally as important, have empathy for their patients. Once we embrace this responsibility, we will develop good methodologies. Maybe it requires a targeted questionnaire. There are short, simple questionnaires for depression that you can use. I’m not saying that you should have everybody fill out those questionnaires; maybe it should be targeted toward patients with visual impairment, for example.

Then, we need a system where patients who are vulnerable to depression are picked up by the referral process. We must think hard about how we make the referral. We certainly do not want to overwhelm the mental health system. Ophthalmologists should use targeted strategies for picking up high-risk patients with depressive symptoms. The goal, what I visualize, are methodologies and simple ways to ensure the patients who need the care get the care.