Kiran Rabheru is a Full Professor of Psychiatry at the University of Ottawa and Geriatric Psychiatrist at The Ottawa Hospital. He serves as Medical Director of the Geriatric Psychiatry, Electroconvulsive Therapy, and the Behavioral Support Programs at TOH. He obtained his medical degree from the University of Western Ontario. He is a Certificant and Fellow of the College of Family Physicians of Canada (CCFP, FCFP). He went on to complete his specialty training in Psychiatry, subspecializing in Geriatric Psychiatry, in which he is Board Certified in Canada (FRCP) and the United States (DABPN).
He is designated as a Founder of the subspecialty of Geriatric Psychiatry by the Royal College of Physicians and Surgeons of Canada. He is recipient of the Outstanding Achievements in Geriatric Psychiatry in Canada award by the Canadian Academy of Geriatric Psychiatry (www.cagp.ca) and has served as its President of the CAGP He serves as Chair of the Board of the International Longevity Centre (www.ilccanada.org), Board member of the International Psychogeriatric Association (www.ipa-online.org ), and Chair of the Section of Positive Psychiatry of the World Psychiatric Association (https://www.wpanet.org/). Dr. Rabheru was honoured to be elected as Chair of the Steering Committee for the Global Alliance for the Rights of Older People (https://rightsofolderpeople.org), a network of over 380 members from over 80 counties worldwide, united in the work to strengthen and promote the rights and the voice of older persons globally.
nAMD and mental health: Addressing the ageing eye
Alan Cruess is Professor in the Department of Ophthalmology and Visual Sciences at Dalhousie University, Nova Scotia, Canada. He has completed two 5-year terms as Head of the Department, and as District Chief of Ophthalmology of Capital Health in Nova Scotia (2003-2014). Previously, Dr. Cruess was Professor and Head of the Department of Ophthalmology at Queen’s University (1992-2003). Doctor Cruess’ main research interests are in clinical trials of new therapies and in imaging biomarkers for age-related macular degeneration (AMD), diabetic retinopathy, and retinal vascular occlusions. He has been actively involved in several clinical trials investigating diabetic macular edema (DME), choroidal neovascularization secondary to AMD, and novel new therapies for dry (atrophic) age-related macular degeneration. Dr. Cruess is a member of the Canadian Medical Association, the Canadian Ophthalmological Society, the Macula Society, the Retina Society, and Club Jules Gonin. He is also a Fellow of the Royal College of Physicians and Surgeons of Canada and a Life Member and Fellow of the American Academy of Ophthalmology (AAO). He is a Past President of the Canadian Ophthalmological Society (2006-2008) and has served on the Board of Directors of the Pan-American Association of Ophthalmology and on the Council of the American Academy of Ophthalmology. Dr. Cruess has also served on the Board of the Canadian National Institute for the Blind (CNIB), one term on the inaugural Board of Vision Loss Rehab Canada (VLRC), and served as the Chair of the Scientific Advisory Board of AMD Alliance International.
Professor Tariq Aslam is a Consultant Ophthalmologist specialising in Medical Retinal disease at Manchester Royal Eye Hospital and Professor of Ophthalmology and Interface Technologies at the University of Manchester.
He began his medical training at Oxford University and completed his medical retina fellowship at Moorfields Eye Hospital. His first research doctorate from Oxford University involved clinical trials in ophthalmic surgery and a further PhD from Heriot Watt University investigated technology applications in ophthalmology. Both doctorate theses utilised his skills in computer programming and his most recent led to a prize for the best PhD across all University disciplines. His current research explores many clinical interests in retina including psychological aspects and the potential for computerised and technological enhancement of patient care including novel device development. He has over 150 peer reviewed publications, predominantly as lead author, a number of patents and is an investigator on multiple commercial as well as investigator lead studies. He plays an active role as advisor to many international expert Ophthalmic groups on research and clinical care. He is Editor of Eye News and Ophthalmology and Therapy. His research has led to a spin-out medical technology company with awards for social impact, which is his ultimate research goal.
Supriya Venigalla, International Federation on Ageing, Canada
Kiran Rabheru, ILC Canada, Canada
Alan Cruess, Dalhousie University, Canada
Tariq Aslam, Manchester Royal Eye Hospital; University of Manchester; Vision Academy, United Kingdom
Rapid population ageing, the almost epidemic rise in neovascular age-related macular degeneration (nAMD) and the continued lack of government investment in health promotion and prevention strategies has the potential to result in unprecedented psychological toll on patients and their families. The future of nAMD management lies in a well-developed model that is patient-centred and harnesses the latest research in the field – improving the language used by healthcare professionals, testing the most effective examples of practice with feasibility studies at a country level, screening for psychological symptoms in routine eye care, ensuring referrals, and continuing to monitor mental status.
- Mental health screening at the time of the diagnosis, regular screening and appropriate referrals for psychological symptoms, and therapeutic interventions need to be incorporated into primary
- Current care practices must be redesigned to position the patient as the leader of their health care
- Rates of depression and anxiety in nAMD are high even among patients who received anti-VEGFtreatment.
- Mental health and nAMD are inextricably linked.
Presenter #1, Kiran Rabheru
Mechanisms Linking Visual Impairment to Poor Mental Health
The number of people aged 65 or older is projected to reach 1.5 billion by 2050. 20% of them will have mental health conditions e.g., dementia, depression, and anxiety. Loss of vision is a critical sensory mediator of mental health conditions and psychosocial disability, impacting 85% of perception, learning, cognition, and activities. Neovascular age-related macular degeneration (nAMD), is a common cause of permanent vision impairment and blindness in older persons. nAMD’s prevalence increases with age resulting in poorer quality of life, increased health care and economic cost, cognitive, psychological, and functional impairment. This session explores the mechanisms linking visual impairment to poor mental health that are essential for effective recognition, identification, and intervention of conditions and psychosocial disability in older persons.
Presenter #2, Alan Cruess
Factors Contributing to the Burden of nAMD
Age is a major independent risk factor for nAMD and therefore as life-expectancy rises worldwide, the large and ever-increasing number of patients with nAMD and its attendant visual loss is associated with high likelihood of both depression and anxiety. Falls and crashes are increased dramatically. Many factors contribute, including but not limited to loss of independence, socioeconomic status, caregiver availability, and support. This session will review nAMD from these perspectives.
Presenter #3, Tariq Aslam
Towards a Framework for Optimal Ophthalmic Care
A chance discovery of severe depression in a clinic patient led the team to a comprehensive study of the prevalence of anxiety and depression in patients attending intravitreal injection clinics for treatment of their wet macular degeneration. Findings revealed significant levels of anxiety and depression that were hitherto undiagnosed and had never been addressed.
To configure clinical care so that the issue could be addressed within the confines of a very busy macular treatment centre, information gathered from this study and other published work, helped to develop a template to allow for improved communication, screening, and action on poor patient well-being whilst at the same time minimising impact on efficient patient flow and ophthalmic care. This session will explore the results of the study including points which would inform improvements in service as well as the developed template andearly data on its implementation and acceptability in a modern practice.