Can you imagine what it is like to see crisply and clearly with your own eyes after decades of blur when you were without glasses or contact lenses? In this age of laser eye surgery, I’m guessing plenty of you readers can. If you’ve had laser surgery to correct nearsightedness, for example, that first moment of being able to see immediately after the procedure (without “coke-bottle” glasses) is exhilarating.

But what about when the sight you’ve enjoyed all of your life is slowly taken away by an age-related disease? It might make you bitter…even depressed. In fact, up to 30% of people with age-related macular degeneration (AMD), which affects about two million Americans age 50 and older, do become clinically depressed.

Doctors have known that AMD and depression are linked, but it is only now that they are figuring out what to do about it. A team from Thomas Jefferson University in Philadelphia is the first to look into it through a study of a program that spurred elderly folks with AMD to be proactive about problem-solving and staying active. The program, called Behavior Activation, was shown to be nearly 50% better than basic mental health counseling in the study, which compared the two techniques.


In AMD, the macula, a small spot toward the back of the eyeball near the optic nerve that allows us to see what is directly in front of us in detail, starts to deteriorate. This causes blurring smack-dab in the middle of a person’s visual field. It can worsen, leading to vision that is peppered with blank spots as the disease progresses. Without rehabilitation and counseling to teach people how to compensate for vision loss, this throws a monkey wrench into the ability to read, cook, walk safely (or drive), sew or pursue any number of hobbies that rely on keen eyesight. It also wrecks the ability to see the faces of loved ones. These losses can create a “perfect storm” for serious depression.


To see whether their Behavior Activation program could prevent full-blown depression in folks with AMD, researchers at Thomas Jefferson University recruited 188 people who were mostly in their mid-80s, had AMD in both eyes and also were slightly depressed. All of the people were evaluated by optometrists and received $350 to purchase basic low-vision aids. Low-vision aids generally are large magnifying lenses or magnifying glasses but can also can be electronic magnifiers that use video technology to enlarge type and also extra-large–type gadgets, such as clocks, watches, phones and calculators.

Half of the study participants did not receive the Behavior Activation intervention. They were, however, visited six times over eight weeks by a social worker for one-hour counseling sessions. The other group received six one-hour sessions of Behavioral Activation with a specially trained occupational therapist over the course of eight weeks.

Behavioral Activation included low-vision rehabilitation, which teaches people with AMD how to best use their low-vision aids. It also teaches eye exercise tricks and techniques to compensate for vision problems and provides suggestions about how to use voice-activated technology and make living spaces as organized and accommodating as possible. And instead of psychotherapeutically talking about having AMD, people in the Behavior Activation group learned from their occupational therapists how to increase self-sufficiency by discussing how moods affect actions instead of just talking about their moods, which is what people in the basic mental health counseling sessions did. They also received advice about how to be as self-sufficient as possible, keep up with hobbies and interests and keep socially active.

At the end of the study, depression worsened to full-blown depression in 23% of people in the talk-therapy group (basically no change from the percent otherwise seen among people with AMD) compared with 13% of the people in the Behavior Activation group. What this says to me is that practical rehabilitation focused on how to compensate for physical disabilities and stay active instead of pity-partying can make a significant difference for older people dealing with vision loss.

But, as I mentioned, AMD is not just a disease of elderly people. It can begin to strike in middle age, and Behavioral Activation could very well help younger patients with AMD as well as elderly patients. There is no surefire cure for AMD, although drug treatment, laser surgery and vitamin supplementation can relieve or slow it down in some people, according to the American Academy of Ophthalmology. Its EyeCare America website is an excellent resource to learn more about preventing and living with AMD and other eye diseases. It even includes an invitation to get free eye care for people age 65 and older who qualify.

How can you stave off depression if AMD is setting in? Take advantage of the resources provided by the American Academy of Ophthalmology, and get a referral from your ophthalmologist to an occupational therapist or certified vision rehabilitation specialist and a mental health professional (psychologist or psychiatric social worker) skilled in behavioral therapy. The occupational therapist or rehab specialist can provide low-vision rehabilitation and the mental health professional will help you stay emotionally healthy and resilient, keep up with hobbies and stay socially active.