This randomized, controlled clinical trial will test the efficacy of Problem-Solving
Treatment (PST) to improve vision function in older persons with age-related macular
degeneration (AMD). AMD is a highly prevalent, disabling disease of aging that causes
severe vision loss and functional decline. It is the leading cause of blindness in older
persons in the United States and may affect more than 10 million people. Currently, there
are no effective treatments to restore vision. Thus, improving Vision Function is a major
goal of treatment. Vision function refers to vision-related abilities to perform daily
living activities (e.g. reading recipes to prepare meals). Decrements in vision function
will become a major public health problem as the population ages and the prevalence of AMD
increases. PST is a brief, standardized, cognitive-behavioral treatment that teaches
We believe PST will enable patients with AMD find practical solutions to vision-related
problems and thereby improve vision function.
We will recruit 240 AMD patients from the retina clinics of Wills Eye Institute,
Philadelphia, PA, with bilateral AMD and visual acuity worse than 20/70 in the better eye.
PST-trained therapists will deliver 6 1-hour, in-home sessions to the 120 subjects
randomized to PST. The control treatment is Supportive Therapy (ST), a similarly
structured, standardized psychological treatment that controls for the non-specific effects
of treatment (n=120). ST contains no active elements beyond its non-specific components; in
this way it is a placebo treatment. Independent raters, masked to treatment assignment,
will assess Targeted Vision Function (primary outcome) and vision-related quality of life
(secondary outcome) at 3 months to assess PST's efficacy, and at 6 months to evaluate its
long-term effects. As the population ages, the disability of AMD will become more
prevalent, costly, and burdensome to patients, families, and ophthalmologists. This makes
devising and testing practical and affordable interventions to improve vision function a
The primary hypothesis will address treatment group differences in Targeted Vision Function
at 3-months, and secondary hypotheses will the long-term effect (6-months) of Problem
Solving Treatment (PST) on TVF and vision-related quality of life.
- Being at least 65 years old
- Having bilateral Age-Related Macular Degeneration (AMD) (atrophic or neovascular)
- Having a best corrected visual acuity of 20/70 or worse
- Moderate difficulty in at least one valued vision functional goal
- Ophthalmologic Criteria. Patients who have uncontrolled glaucoma (continued visual
field loss and increase in optic nerve cupping), diabetic retinopathy (due to macular
edema), or cataracts for which surgery within 6 months is likely will not be eligible
to participate. This information will be obtained from patients' ophthalmology
charts and discussion with the patient's ophthalmologist.
- Cognitive Impairment Criteria. Cognitive functioning will be evaluated by the
Project Director during the telephone screen (see Chapter 9). Patients with
cognitive impairment will not be eligible to participate.
- Health Criteria. Patients with life-threatening illness (e.g., terminal cancer, need
for oxygen) will not be eligible to participate. Information regarding heath status
will be gleaned from patient's ophthalmology charts.