3.1 Carrying out visual rehabilitation training to improve self-management skills among patients
Various degrees of visual impairment have seriously affected the daily lives of AMD patients, including difficulty in the locating objects, increased susceptibility to falls and injured, poor night vision and impaired fine motor skills. Most patients lack coping skills and can only passively adapt to the limitations of daily life brought on by visual impairment, greatly affecting their quality of life. Visual rehabilitation is an emerging professional field that requires the collaborative participation of multiple as ophthalmology, optometry, vocational rehabilitation, sociology, and developed countries have a relatively advanced complete healthcare system for visual rehabilitation [10]. In China, visual rehabilitation work started relatively late. Since the 21st century, more and more attention has been paid to ophthalmologists, the Federation of Persons with Disabilities, and all walks of life. New eye rehabilitation centres have been established in Beijing, Shanghai, Tianjin, Wenzhou, Guangzhou, Shenzhen and other economically developed areas [11]. As pointed out in the "Twelfth Five-Year Plan for Visual Disability Rehabilitation"of China, 90% of patients with low vision groups need rehabilitation, while current visual rehabilitation institutions and service systems cannot meet the rehabilitation needs of low vision.Moreover the social awareness rate of visual rehabilitation is also very low [12]. All AMD patients in this interview group needed visual rehabilitation training,“I do not know how to obtain information and help.”Visual rehabilitation mainly includes the adaptation and use of visual aids, training in skills required for daily life and work, and psychological support, all tn enhance the capacity of patients to use their remaining vision and improve their self-management skills.Suggestion is establishing regional visual rehabilitation center and multidisciplinary team of experts.More individuals can receive visual rehabilitation training nearby by actively engaging with the community and families of AMD patients with low vision.This will improve their ability to live independently,manage their condition,and integrate better into society.Ultimately,this could help reduce the medical burden on families and society.
3.2 Increasing the dissemination of scientific knowledge and education about diseases promote the adoption of healthier lifestyles
According to this study individuals with AMD exhibit a significant knowledge deficit about the disease, its care, and comorbidity management. Most patients especially those from rural areas,are unaware that anti-VEGF therapy and a treatment plan can effectively treat wet AMD. Many of these patients never heard of AMD and are unaware that the condition can lead to blindness. Consequently, they often fail to take the disease seriously, missing out on the opportunity to receive the required treatment. After the diagnosis of AMD, most patients are eager to obtain professional disease health knowledge and guidance on the disease, they want to drop unhealthy habits and adopt new healthy behaviors to delay the progression of the disease and maximize the recovery or maintenance of existing vision. During the interview, patients pointed out that the medical staff mainly focused on eye-related problems during health education, neglecting the management of other underlying conditions.However, most patients have multiple underlying conditions concurrently. Health education provided by medical personnel should be centered on the patient and fully consider their individual needs. In their study,Wan Junli et al. [13] discovered that a majority of patients expressed dissatisfaction with the current level of awareness about wet AMD and desired greater access to professional health education and guidance. With the aging population in China, the number of individuals with AMD is growing rapidly. In promoting of healthy China, ophthalmic medical personnel should not limit their provision of health education to patients in hospitals, they should also actively extend their services to communities, counties, towns and villages through the medical consortium mode, as well as various media platforms and information technology products. It is necessary to conduct AMD-themed public education through a diverse range of channels that offer full coverage to expand public awareness of the disease, enhance accurate and avoid delays in treatment for AMD patients. This effort will also improve patient compliance with treatment and self-management and minimize the incidence of blindness.
The etiology and pathogenesis of age-related macular degeneration (AMD) is still unclear and the disease is difficult to treat, however in recent years, many studies have been conducted to investigate the factors that promote AMD. Multiple research results [14–17] have shown that the incidence of AMD is strongly and positively correlated with long-term smoking, long-term alcoholism, hypertension, cardiovascular and cerebrovascular diseases, and diabetes.Recent clinical research has shown a correlation between blood lipid levels and AMD. In terms of diet, Chew et al [18] suggested that long-term administration of vitamin C, vitamin E, beta carotene, and zinc could help slow the progression of AMD disease. Therefore, medical personnel should guide AMD patients to quit smoking and drinking, eat a balanced diet vegetables and fruits, increase their intake of foods rich in lutein and zeaxanthin, and consider taking appropriate vitamin C supplements, vitamin E, beta carotene and zinc. Moreover,it is crucial to proactively prevent conditions such as hypertension, cardiovascular and cerebrovascular diseases, diabetes and hyperlipidemia.
3.3 Attach importance to emotion management and improve psychological adjustment ability
The present interview demonstrates that most patients exhibit different degrees of worry, anxiety, depression and even despair and other negative emotions. Furthermore,it was found that patients with low social support, significant financial burdens, and impaired binocular vision were more prone to experiencing decreased sleep quality, potentially leading to long-term insomnia and other related problems. Studies in China and other countries have confirmed [19] that AMD patients are susceptible to depression due to visual impairment which decreases their activity and independence. Chen et al[20] the proportion of anxiety and depression in AMD patients prior to treatment was 60% and 75%, respectively, which negatively affected the sleep status, sleep disorders can hasten disease progression and diminish overall quality of life. As a result, evaluating the mental state of AMD patients and administering timely social and psychological interventions essential to alleviate the detrimental effects of sleep disorders on their well-being. Currently, domestic attention for AMD patients focuses primarily on the effectiveness of anti-VEGF drugs, studies have explored on the problems of daily activity disorders, psychological and social disorders associated with the disease. Social psychological intervention mainly includes cognitive behavioural therapy, mental health education, family therapy, individual support therapy, among others[21]. Studies in the United Kingdom, the United States and other countries, showed that psychological intervention improved the AMD patient’s cognition of the disease. Patients should adopt effective measures to relieve anxiety and depression, improve their problem-solving skills, which will improve their quality of life and self-efficacy [22]. Few studies have explored the emotional management and psychological intervention of AMD patients in China. Bian et al[23] developed a psychological intervention module for resolving anxiety and depression symptoms among AMD patients according to the core ideas and steps of the theoretical framework of adaptive leadership. By motivating patients to embrace adaptive changes physical symptoms and psychological as anxiety and depression can be reduced, while improving their visual function and self-management abilities.