Impact of Age-Related Macular Degeneration and Related Visual Disability on the Risk of Depression: A Nationwide Cohort Study

Abstract

Purpose: To evaluate the prospective association of age-related macular degeneration (AMD) and related visual disability (VD) with the risk of depression. Design: This nationwide population-based cohort study used authorized clinical data provided by the Korean National Health Insurance Service. Participants: A total of 3 599 589 individuals older than 50 years participated in the Korean National Health Screening Program in 2009. Methods: Age-related macular degeneration diagnosis and the presence of accompanying VD were verified using diagnostic codes and disability registration data. Data on covariates, including age, sex, income level, residential area, systemic comorbidities, and behavioral factors, were collected from health screening results and claims data. Patients were followed up until December 2019, and incident cases of depression were identified using registered diagnostic codes. The prospective association of AMD and related VD with new-onset depression was investigated using the multivariable-adjusted Cox proportional hazard model. Main Outcome Measures: Hazard ratios and 95% confidence intervals (CIs) for depression development according to the presence of AMD and VD. Results: During an average follow-up period of 8.52 years, 1 037 088 patients received new diagnoses of depression. Patients with previous diagnoses of AMD showed a greater risk of new-onset depression, with a hazard ratio of 1.15 (95% CI, 1.13–1.17) compared with the control group in the fully adjusted model. Patients with AMD and accompanying VD showed a further increased risk of depression, with a hazard ratio of 1.23 (95% CI, 1.16–1.30). Conclusions: Individuals with a diagnosis of AMD have a higher risk of depression developing in the future. The risk of depression is increased further in patients with AMD who demonstrate VD. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2023 American Academy of Ophthalmology