The association of symptomatic vitreous floaters with depression and anxiety.

PURPOSE: To evaluate the levels of anxiety and depression in patients with symptomatic vitreous floaters and to determine the possible correlations of psychological implications with the symptoms duration and possible improvement, the degree of posterior vitreous detachment, and the discomfort severity. METHODS: Ninety patients complaining for floaters and fifty-seven age- and gender-matched healthy-control subjects were recruited. Every participant underwent a complete ophthalmological examination, including funduscopy and optical coherence tomography scans, while clinical and demographic data were also gathered. The Patient Health Questionnaire-9 (PHQ-9), the Zung Depression Inventory-Self-Rating Depression Scale (Zung SDS), and the Hospital Anxiety and Depression Scale (HADS) were completed by everyone. RESULTS: Between the studied groups, no significant differences were detected regarding the clinical and demographic data (p > 0.05). The patients with floaters had significantly higher scores of PHQ-9, Zung SDS, HADS Anxiety, and HADS Depression (p < 0.001). After adjustment for several confounders, PHQ-9 (p = 0.041), Zung SDS (p = 0.003), and HADS Anxiety (p = 0.036) values remained significantly impaired. Among the patients, PHQ-9 and Zung SDS scores were significantly elevated in the patients with floaters duration less than 4 weeks (p < 0.05). Finally, anxiety and depression were significantly correlated with the symptoms duration and intensity, with the floater-associated discomfort, and with the stage of posterior vitreous detachment. CONCLUSION: Vitreous floaters have a negative impact on patients' psychological status, by the terms of enhanced depressive and anxiety levels. To the best of our knowledge, our study is the first in the literature to elaborate the aforementioned association, by assessing three different questionnaires simultaneously.

Patient-reported prevalence of metamorphopsia and predictors of vision-related quality of life in vitreomacular traction: a prospective, multi-centre study.

OBJECTIVES: To report the prevalence and severity of metamorphopsia, estimate its impact on vision-related quality of life (VRQoL) and evaluate predictors of VRQoL in patients with vitreomacular traction (VMT). PATIENTS AND METHODS: A prospective, cross-sectional multi-centre study in the United Kingdom of 185 patients with VMT, with or without a full thickness macular hole (FTMH). Self-reported metamorphopsia was determined using the metamorphopsia questionnaire. VRQoL was assessed using the Visual Function Questionnaire (VFQ-25). Physicians recorded clinical and ocular characteristics in both eyes including a physician assessment of metamorphopsia. ANOVA and predicted least-squares means were used to estimate the impact of metamorphopsia on VRQoL. Predictors of VRQoL were assessed using ordinary-least-squares regression adjusting for clinically important variables. RESULTS: The prevalence of self-reported metamorphopsia was 69.7% (95% CI 62.6-76.3%) and was higher in eyes with a concomitant FTMH vs. without FTMH (85.4% vs. 64.2%). Physician assessment of metamorphopsia was 53.0% (95% CI: 45.5-60.3%). Comparing eyes with metamorphopsia vs. without metamorphopsia, the VFQ-25 composite score was lower (82.3 vs. 91.4), and mean VA (LogMAR) was worse (0.44 vs. 0.33). The largest difference in VFQ-25 scores was observed for near activities (metamorphopsia: 75.3, No metamorphopsia: 90.2). The adjusted model showed that metamorphopsia severity and age were significantly associated with lower VFQ-25 scores. CONCLUSION: Metamorphopsia was highly prevalent in patients with VMT and associated with significantly lower VRQoL. Physician assessment of symptoms underestimated the self-reported presence of metamorphopsia. Metamorphopsia severity acts as a predictor of impaired VRQoL, over and above decrements due to reduced vision.

Idiopathic pigmented free-floating posterior vitreous cyst.

A 28-year-old female who complained of visual symptoms in the right eye was admitted to the ophthalmology clinic. She had been suffering from visual disturbance for about 5 years and her symptoms had become worse during the last 2 months. There was no previous history of trauma, infection or inflammatory disorders. A pigmented vitreous cyst was detected in her ophthalmologic examination. As the patient refused, laser cystotomy could not be performed. The pigmented vitreous cyst was possibly congenital in origin and described as a cystic choristoma from the primitive hyaloid system in the literature. The movements of the cyst, causing only transient blurring of vision, may rarely affect the visual axis. The visual acuity was 20/20 in the affected eye so it was suggested that she should be followed-up periodically for her cyst.

The influence of counselling on patient return following uncomplicated posterior vitreous detachment.

PURPOSE: To investigate the effect of patient counselling together with the use of information leaflets on the number of return visits for patients with acute, symptomatic, uncomplicated posterior vitreous detachment (PVD). METHODS: The study group comprised the first 50 patients diagnosed with uncomplicated PVD in 1998 when a standard protocol of structured patient counselling and leaflet distribution was employed following diagnosis of PVD. The control group comprised the first 50 patients in 1997 diagnosed with uncomplicated PVD before structured patient counselling was in place. A retrospective analysis of casualty case notes was made comparing the two groups. The number of eye casualty attendances within 1 year of first presentation with PVD was compared in the two groups. RESULTS: Seven patients from the control group returned because of photopsia or floaters; 3 of the 7 returned with no change in their original symptoms. Six patients from the study group returned. All had a definite change in their symptoms of photopsia or floaters. No patient in the study group who returned had old or persistent symptoms. Statistical analysis comparing return visits of patients with no change in symptoms in the two groups by Fisher's Exact Test gave a p value of 0.13. CONCLUSION: Patients counselled following uncomplicated PVD did not return to eye casualty in the absence of new symptoms. Patient counselling is an important part of the management of PVD because it makes patients aware of which symptoms are important predictors of serious vitreoretinal pathology.