A (3:12)

Right.

B (3:12)

So irreversible vision loss makes it harder to read, it makes it harder to drive, it can make it very difficult to work in the kitchen, prepare food, makes it difficult to walk safely, it can be difficult to see people's faces, enjoying a favored television program and being able to see and manage the bills, write the checks. And so this is the main reason that depression occurs in irreversible vision loss.

A (3:44)

And that's a lot of very significant life change. So it's not surprising then, if we kind of frame it that way. I'm curious, though, what kind of time frame are we talking about when it comes to depression? With vision loss, do we find that it's happening shortly after someone comes out of the doctor's office with that diagnosis, or does it take a while, or what's the situation there?

B (4:11)

Sure, I would say it can vary, but in general, it comes on very slowly and we might even say insidiously over time. It can occur over many months. It could even occur over a year or more. An individual may start out with a difficulty in a daily living activity, but they're still able to participate in it. It's not as easy as it used to be. And then as the eye condition progresses over time, multiple activities of daily living become affected. And it's not just difficulty doing them, it's that you can't do them at all.

A (4:53)

Right.

B (4:53)

And in a way, as the I can'ts outweigh the I cans, the greater the likelihood of depression is of developing.

A (5:04)

So I want to circle back to something I really like, the way you put this. You said that depression can happen kind of insidiously. We don't recognize that it's happening. And that may seem surprising on the surface, because if we think about depression, I think most of us have maybe a symptom or two in mind, and those symptoms are really, really intense. And we think, oh, depression, it's very easy to recognize if you have it or not. But I don't think that's necessarily true. Right. So can you just go through a few of those symptoms that people are facing with depression, and then are there ways that your healthcare provider might kind of get at this with you?

B (5:56)

Absolutely. And you are absolutely correct. The average individual is not really going to sense this going on. Might minimize the significance of the symptoms. But, yeah, let me share with you. Common symptoms. Having little interest or pleasure in doing things. Another symptom Is feeling down, depressed, or hopeless. Sometimes an individual may just feel tired or having little energy to do things. And over time, there can be a trouble concentrating on things. Definitely individuals too can feel bad about themselves. There might almost even be a sense of diminished worth because of the irreversible vision loss that they have. And Ricky, what I would tell you is that I really want to encourage your listeners to take these symptoms seriously as they can be hard to see in yourself. It's important to ask those that are around you a lot in your social circles, concentrate if they're actually making comments about seeing those things in you. You might even ask them if they see those things in you, because it is one of those things where we tend to minimize and what happens with depression is we have an irreversible vision loss, it's not getting any better, it might progress, and it can tend to be a downward spiral. And so those are things where you really want to be careful in. I definitely recommend if people have such symptoms that they actually talk to their primary care providers. So notice that's not their eye doctor, it's their primary medical doctor that they see for regular health visits and let them know that you're having these symptoms. The primary care doctor can actually administer a screening test for depression. And this is a few questions. It can be two, it can be four, it can be more. But from the answers that you give to those questions, it helps the primary care doctor to understand whether this is likely depression or not. The conversation they have with you can be very helpful. If they do diagnose depression. There is very good treatments available for depression. It's unrecognized depression that is the more significant problem.

A (8:33)

Right. You have to be aware that it's going on either through listening to what people around you are saying or taking that look inside yourself or. Or even listening to this conversation and you're having that checklist going, yeah, I am having trouble concentrating. I do feel tired, I do feel listless. And some of these things. So if you recognize in whatever way, whether that's through your healthcare professional or any number of other ways, you figure out, I think this is what's going on with me. What kinds of treatments are available? And I guess particularly are there things that people can do when that depression is definitely related directly to this vision loss that they've got, you bet.

B (9:22)

So if you are discussing this with your primary care doctor, they do have different options available to them. Certainly there are a number of different medications that can medically treat depression. The primary care doctor May refer you to a counseling professional, a mental health professional who basically can administer different therapies. One example is something called cognitive behavioral therapy. And these can be very helpful to address the depression. I would say though, and I think in terms of your bringing this up and this is so relevant, and if the irreversible vision loss is a big part of the cause of depression, then low vision rehabilitation services have been studied in regards to treating depression and have been shown to be extremely helpful. Now, what are low vision rehabilitation services? So to give you an example, I'm a low vision rehabilitation specialist. So I'm a board certified ophthalmologist. You typically go to the eye doctor to manage your eye disease and prescribe glasses. So that's not the work that I do. I actually manage the impairment caused by the vision loss. So when a patient comes to my office, there is about a two hour initial visit. And during that time we're doing a lot of things. First of all, we're doing an extensive functional history to understand why what areas of daily living the individual is having challenges because of the irreversible vision loss. We then look at how they're adjusting and adapting to the vision loss. And that's where I will always administer a depression scale test so I can talk directly to the patient in my exam chair if there is a reason that they need to see someone else like the patient, primary care doctor to address that, we can have a compassionate discussion about that. I will do a test to evaluate the quantity and quality of the patient's remaining vision. So it helps me to know what they have to work with. And then we work with the wealth of resources that are available to the patient. So this can be adaptive equipment, magnifying tools, telescopic lenses to electronic magnifiers, headborne video eyewear, or working with computers and smartphones, Addressing the challenges and seeing what types of adjustments can help people to move forward and do the best that they can with the vision that they have. So in my office, I'll develop a rehabilitation plan and I have occupational therapists that work alongside of me that can implement the plan. And they do that in the patient's home and they do it in the office where they're working with adaptive equipment. With the patients in the areas of daily living in which they're struggling, they can suggest modifications that can be made in the environment in their home to help them to live as safely as they can. We also will discuss other services available in the community and online resources such as Hadley. Wonderful online resources and that way, you can become familiarized with all the things that can equip you to deal with these challenges as best as you can. And those types of services make a dent on depression. And so you may need the medical treatment, you may need the counseling, but being aware of the resources and managing the challenges caused by irreversible vision loss certainly goes at the core of why depression with irreversible vision loss occurs. And so it's a wonderful treatment, if you will.

A (13:23)

Well, this has been really informative, really incredible. And it's, as we talk about it, it makes a lot of sense. But I don't think people frame it this way very often to say that when you have a major life change like this, you're going to have feelings, and they're not always going to be positive feelings, but there are reasons that you're feeling the way you do. And I think more importantly to point out, there are ways that you can address some of those things and you don't have to feel that way forever. So as we wrap up, I'm wondering if you have just any final thoughts that we didn't cover previously that you want to leave our listeners with.

B (14:09)

Yes. So the one thing is that I want to encourage your listeners to pursue the resources right now. But also, as the eye condition progresses, so often the magnifier that you might use becomes to where it doesn't help you. That doesn't mean there isn't something else out there that may help you as the disease progresses. We have individuals in our office who really have very little vision to work with, but there are still resources to help them. They're just concentrating on using their other senses better, like touch and hearing, and then they can still move forward in living with this as well as they can. The other thing I want to suggest to them is they're all seeing eye care providers, ophthalmologists, optometrists. And what I would share with you is that eye care providers that are managing the disease that causes your irreversible vision loss, they are great and skilled at treating the eye disease. They are great and skilled at protecting the remaining eyesight that you have. They're going to do everything they can to try and protect what's there. But evidence shows that they're not as great and skilled at managing the impairment caused by the disease, asking about it, and making appropriate recommendations of resources where you can get the help to live with the vision loss as well as you can. In fact, I would ask your listeners right now, how did you find out about Hadley. Has Hadley been helpful to you? Was your eye care provider the one who referred you to Hadley and other low vision services? And I'm going to guess for many of you, it probably was not your eye care provider?

A (16:06)

Absolutely.

B (16:08)

So what I want to share with you is something that I think could benefit your eye care provider significantly. The next time you go in for a visit with your eye care provider, I want to encourage you to share with them the value of these services. If you've worked with a low vision specialist, Hadley, any other services that you have that have helped you share with them how helpful that they have been, remember that your eye care providers are seeing lots of other patients with this eye condition, and this might help them to start mentioning these types of resources to patients. And if that happens, the impairment is getting addressed. The individual that is sitting in the eye doctor's examining chair, who's struggling with the impairment, who might be at risk for depression, if they know what resources are out there, then they can get that help, and then that is going to minimize the risk of having depression. So I want you to consider doing that. I think it would be a tremendous service to your eye care provider.

A (17:22)

That is such an excellent point. We want to hear fewer of those stories where people come out of the eye doctor's office with the there's nothing medically we can do, and then they're not sure where to turn next. So I think just having that conversation, when you have found something helpful to pay it forward, if you will share with your doctor so that they in turn can share with their other patients. Thank you so much for dropping by, Dr. Shepherd, spending a little time with us and just sharing your knowledge and your experience. It's really, really helpful.

B (17:57)

Thank you so much. This is a tremendous opportunity for me. And I also want to thank you because I have many patients, and I will tell you that I have patients that come in. It was not the eye care doctor where they learned about me. It was Hadley. They went online, they then saw about low vision specialists. They then googled to see what's in their area. And then here they are coming into my office. So Hadley helps is doing absolutely wonderful work at helping people be aware of how to manage the impairment caused by the disease. So I'm just absolutely thrilled with the services you provide.

A (18:38)

Thank you so much for that. We really appreciate it. And if you're listening right now and you're so struggling to figure some of these things out, Hadley does have a number of ways that we can help with that. Of course, there's the practical side, so just showing you some of those ways to get back to doing all those things that you love. And then there's the emotional side as well. So if you are really dealing with those strong feelings and kind of feeling stuck, we have a couple of services that you might find helpful. One, there's our peer to peer program where you can get matched with someone and just have that support and that knowledge that you're not going through this alone. And we also have our adjusting and coping together support groups. So that's where a small group of people get together for a couple months and just talk through some of these really strong feelings and figure out some answers together, some ways to cope with these things. So if you would like information about any of that, do give us a call. 800-323-4238. Thank you again, Dr. Shepherd. We so appreciate your time and your willingness to share your knowledge with us. It's really helpful. And as always, thank you all for listening. Got something to say? Share your thoughts about this episode of Hadley Presents or make suggestions for future episodes. We'd love to hear from you. Send us an email@podcastadleyhelps.org that's P O D C A S T hadleyhelps.org or leave us a message at 847-784-2870. Thanks for listening.