Macular Degeneration and Aging Study

Loss of independence and valued activities places Age-related Macular Degeneration (AMD)
patients at increased risk for depression, anxiety, and disability. Patients' emotional and
behavioral responses to AMD can exacerbate the long-term health threat of the disease and
contribute to preventable health care costs, loss of productivity, and burden to family
members.This is a randomized controlled trial of a psycho-social intervention that addresses
three mental health promotion goals: (1) increase emotional well-being, (2) improve future
outlook, and (3) protect or enhance current and future-oriented functioning.

The trial examines the effects of the PREPSI for 250 AMD patients, 60 and older, regardless
of actual vision acuity. All study participants receive 4 group-based vision education
classes and resource information. Subjects are then randomized to Preventive Problem Solving
Intervention (PREPSI) consisting of 8 sessions with certified problem-solving trainers or to
an Enhanced Attention Control arm.

Assessors blind to treatment condition measure Psychological Well-being immediately
post-intervention (Week 16) and at 6-month follow-up, Change in Future Outlook, including
Preparation for Future Care from baseline to 16 week and 6-month follow-up, and Vision
Functioning at 6 month follow-up. Measures include the Psychological Well-being Scale (Ryff &
Keyes, 1995), the Preparation of Future Care Needs Scale (Sörensen & Pinquart, 2001), and the
National Eye Institute Vision Functioning Questionnaire-25 (Stelmack, Stelmack, & Massof,
2002). The primary hypothesis is that PREPSI participants will report greater Psychological
Well-being and more Preparation for Future Care immediately post-intervention (at 16 weeks)
and at 6-month follow-up.

The PREPSI is a short, standardized modification of problem-solving therapy that trains
participants to identify and clearly define current and future problems, and then generate,
evaluate, choose, and implement solutions. The long-term goal of the investigators research
program is to improve quality of life in late adulthood by conducting basic and translational
research on preventive future planning.

Inclusion Criteria:

- Diagnosis of AMD

- 60 years and older

- Able to communicate in English.

Exclusion Criteria:

- Significant cognitive impairment at baseline (total score on Mini Mental State Exam
(MMSE) for the Blind <18, equivalent to <21 in the regular MMSE);

- Residence in a nursing home (assisted living facilities are acceptable);

- Patient is acutely suicidal or psychotic