Download The Eye/Brain Connection: The Eye/Brain Connection

The Eye/Brain Connection:
What You Need to Know About
Vision & Mental Health
Vincent Young, M.D.
Vincent Young
Young, M
M.D.
D
• Board certified ophthalmologist since
1985
• Chairman, Division of Ophthalmology
p
gy at
Albert Einstein Medical Center,
Philadelphia
• President, American Association of
Dispensing Ophthalmologists
• Member AAO, American Medical
Association, Philadelphia County
Medical Societyy
What Our Eyes Reveal About Us
How Our Mood Affects Our Vision
• Mood impacts how
much we see
• Good mood = more
brain activity, take
i more visual
in
i
l iinfo
f
• Bad mood = “tunnel
vision”
2009 Univ. of Toronto study
Today’ss Discussion
Today
•
•
•
•
Scope of mental health problems
Mental health in the national spotlight
Connection between vision and mental health
Role of vision plan in improving mental health
– Detection
– Treatment
– Prevention
• Role of vision and benefits industries
What Is Mental Health?
Cognitive/emotional well-being;
the absence of a mental disorder
Mental Health Issues
• Poor mental state
– Depressed, disengaged,
stressed
• Mental disorders
– Mood disorders
• Depression
• Bipolar disorder
– Personality disorders
• Schizophrenia
–
–
–
–
Anxiety disorders
Eating disorders
ADHD
Autism
Image Credit:
C
NIMH
Scope of Mental Health Problems
1 in
i 4 U.S.
U S adults
d lt
suffer from a diagnosable
mental disorder every year
• 6% have a serious
mental illness
• Leading cause of
disability in ages
15 44
15-44
Scope of Mental Health Problems
Mental
M
t l illness
ill
accounts
for over 10%
off national
i
l
disease
burden
National Economic Burden of Chronic
Disease
Toll on Workplace
• Annual lost workdays per worker
– 65.5 bipolar disorder
– 27.2
27 2 major
j d
depressive
i di
disorder
d
• Impact on earnings
– Mean reduction $16,306 (serious mental illness)
• $317 billion estimated economic burden of
serious mental illness alone
Mental Health in the
National Spotlight
Mental Health Coverage Trends
• Parityy laws have shortened g
gap
p between mental, g
general
healthcare coverage
• Still barriers to care
– E
E.g.
g availability through healthcare plans
plans, pre-existing
pre existing conditions
conditions,
limits on treatment
• Resources are tight
– States pulling back mental health spending
Patient Protection and Affordable Care Act
• Part of Obama healthcare reform
• Intended to allow more people
access to health insurance
• Has provisions to ensure mental
health
ea t co
coverage
e age o
on pa
par with
t medical
ed ca
• Mental health defined as “essential
essential
benefit”
Mandated Changes for Employers
• If offer mental health coverage,
g , must
– Have same allowances / restrictions as
health plan
– Include prescription drugs
drugs, mental health
/ addictions treatment, rehabilitation
– Not exclude pre-existing conditions
• Taxes for non-compliance
– Exemption for companies
< 50 ees
• Most employers keeping mental
health coverage
g
National Spotlight:
I fl
Influence
off Recession
R
i
Financial stress linked to
rise in mental health
problems
• 50% Americans report
irritability, anger, fatigue or
sleeplessness
• Unemployed = 4 x risk for
severe mental illness
• Pay cuts or reduced hours =
2 x risk
Role of a Vision Plan in
Improving Mental Health
Detection ~ Treatment ~
Prevention
Detecting Mental Health
Issues Through Eye Care
Preventive Role of Eye Exams
We alreadyy know comprehensive
p
exams can detect
• Vision problems
• Eye
E diseases
di
• Systemic diseases
• Diabetes
• Hypertension
• Cancers
…but the eyes can also provide
clues to mental illness
Bipolar Disorder
• 2.6% of U.S. adults
• Slower to switch gaze
from one image to
another
• ERG
G shows
s o s reduced
educed
adaptation to darkly lit
settings in bipolar
disorder / schizophrenia
Schizophrenia
• 1 in 100 U.S. adults
• Abnormalities in eye
movements may identify
risk
– Rate and “smoothness” of
tracking objects with eyes
Alzheimer s
Alzheimer’s
• More than 5.3 million Americans
– Prevalence doubled since 1980
– 6th leading cause of death
• Detection with brain scans costly
• “Clues” present in eyes
–
–
–
–
Cataract
Thinning
g of nerves in retina
Drusen
Unusually sensitive to pupil dilation drug
• Future eye test measuring cell death
Treating and Preventing
Mental Health Issues With
Vision Care / Vision Wear
Visual / Mental Health Cycle
How We See
How We Feel
Visual / Mental Health Cycle
Poor Visual
Health
More likely to
have a poor
mental state,
which
hi h can
contribute to
mental health
issues
Poor Mental
Health
More likely to have
vision issues, and
take medications
that make them
worse
Thoughts of Vision Loss Distressing
• A
Americans
i
ffear vision
i i
loss more than memory
loss heart disease
loss,
• Quality of life
implications
• Societal stigma
Those With Vision Problems More
Lik l tto H
Likely
Have M
Mental
t lH
Health
lth IIssues
• Link between vision loss,
depression
• 22% feel depressed at
time of eye disease
diagnosis
• 2.3 x greater risk for
clinical
li i l d
depression
i
Depressed patients 3 x
more likely not to follow
treatment – potentially
worsening vision loss or
disease p
progression.
g
Photo Credit: NIMH
Those With Vision Problems More
Lik l tto H
Likely
Have M
Mental
t lH
Health
lth IIssues
• Untreated poor vision in
elderly linked to dementia
• Seniors with poor vision 5 x
more likely to develop
cognitive decline
• Seniors with poor vision
without
ih
iintervention
i 10 x risk
i k
for Alzheimer’s
Those With Mental Health Issues More
Lik l tto H
Likely
Have Vi
Vision
i P
Problems
bl
• Depressed people have lower
contrast sensitivity
– See world in shades of grey
• Depressed
p
AMD p
patients have
worse vision than nondepressed AMD patients
• People with schizophrenia,
bipolar disorder may have
perceptual
t l problems
bl
(f
(from
retinal deficits)
Those With Mental Health Issues More
Lik l tto H
Likely
Have Vi
Vision
i P
Problems
bl
• Medications can cause:
–
–
–
–
Blurry vision
S
Sensitivity
iti it tto lilight/glare
ht/ l
Susceptibility to UV damage
Increase in certain eye diseases
• Higher
g
risk of cataract in older adults taking
g
antidepressants
• 6 of 20 most prescribed meds are pain or
depression related
Vision Problems Tied to
B h i lP
Behavioral
Problems
bl
• Undiagnosed vision
problems common in
“problem”
problem children
– 80% of those diagnosed with
learning problems
– 50% of “delinquents”
• Vi
Vision
i problems
bl
iimpactt
social abilities
– Increases risk for depression
anxiety, aggression
Overall Takeaways for Managed
Vision Care Channel
Why Vision Coverage Is Important
f Mental
for
M
lH
Health
lh
• Important for employees
with ((or at-risk for)) mental
health issues
• Early detection
– Mental
M t l health
h lth conditions
diti
– Vision problems/eye disease
that may contribute
Why Vision Coverage Is Important
f Mental
for
M
lH
Health
lh
• Vision wear for prevention and
treatment
– Corrected vision associated with
fewer problems, enhanced mood
– Glare protection
(photochromics/AR) to enhance
contrast, address light sensitivity
from medications
– UV blockage to prevent damage
Education and Leadership
• Ensure HR clients have updated info on
quality
lit vision
i i plans
l
• Use mental health angle
g to show link
between eye/overall health
• Promote vision care for prevention
AND disease management
• Address emotional impact of
vision loss by offering
diagnosed employees
pp materials
support
– Steps to treat eye
disease, improve sight
Consider extra
coverage for
patients
diagnosed with
mental health
issues.
Opportunities for
I
Inter-Plan
Pl R
Referrals
f
l
• Those diagnosed with
eye disease – referred
for mental health
counseling
• Those diagnosed with
mental health issue –
referred for eye exam,
offered premium
eyewear
Questions