Exploring vision tests as a surrogate for depression screening in patients with a visual impairment: A cross-sectional study

Abstract

Purpose

To investigate if vision tests can act as a surrogate for depression screening in visually impaired adult patients, and explore the association between self-reported visual function and depression.

Design

Cross-sectional.

Methods

Consecutive adult patients (≥18 years) (n = 237) who received a low vision assessment at a hospital-based vision rehabilitation clinic between July 2018 to March 2020, were recruited into the study. The clinic serves patients that have a visual acuity ≤6/15 in the better seeing eye, constricted visual fields <20°, or functional deficits relating to vision loss. Patients were screened for depression using the Patient Health Questionnaire-9 (PHQ-9). The association between risk of depression and vision tests (distance visual acuity, reading acuity, critical print size, contrast sensitivity, and fixation stability) and patient reported visual function (The National Eye Institute, Visual Functioning Questionnaire-25 (VFQ-25)), was measured using multivariable linear regression modelling.

Results

Eighteen percent of patients scored ≥10 on the PHQ-9, indicating risk of major depression. There was no significant association between the vision test scores and the PHQ-9. However, there was a significant association between distance visual acuity (p = 0.010), reading acuity (p = 0.008), contrast sensitivity (p < 0.0001) and the VFQ-25 mental health domain. Further, all VFQ-25 domains were significantly associated with the PHQ-9.

Conclusion

While the vision test scores were not significantly associated with risk of depression, self-reported visual functioning was. We were unable to demonstrate vision tests acting as a surrogate for the PHQ9 when identifying patients at risk of generalized depression. Further investigation is warranted to determine if a correlation can be found with a different mental health-screening tool.