E-PsEYE: mentally healthy with E-health

Klinisch onderzoek

Hilde van der Aa has conducted research on the cost-effectiveness of E-PsEYE, a cognitive behavioral therapy based E-health intervention, supported by social workers, to reduce depression and anxiety in people with macular edema receiving anti-VEGF injections.


Senior onderzoeker


ZonMw Doelmatigheid




Why are we doing this study?

Retinal exudative diseases (i.e. age-related exudative macular degeneration, diabetic retinopathy and macula oedema) are the leading cause of vision loss in older adults. They cause pathologically changed, and newly formed blood vessels to leak and damage the retina, reducing vision. There is currently no cure for these diseases, but pharmacological inhibition of the vascular endothelial growth factor (anti-VEGF) in the eye can have a beneficial effect. Anti-VEGF drugs that reduce the leakage and slow the growth of new blood vessels are injected into the eye at various intervals (often monthly). For approximately one third of the patients these injections lead to a substantial improvement in vision. Therefore, anti-VEGF treatment is increasingly being offered in ophthalmic practice. However, about one third has to deal with further vision loss despite treatment

The process of progressive visual impairment and uncertainty surrounding the effect of anti-VEGF injections can have a major impact on the psychosocial well-being of patients. Previous research has shown that about half of the patients experience depression and/or anxiety symptoms, such as fear that vision will deteriorate, fear of becoming blind, fear of the injections themselves, uncertainty about the treatment, anger, sadness. If these complaints persist for a longer period of time, they can have a negative influence on people’s quality of life and the visual and physical condition of people can deteriorate further.

What is the aim of this study?

The aim of this study was to offer a guided self-help course (called E-PsEYE) via the Internet to support this target population with depression and anxiety symptoms and to investigate its cost-effectiveness.

How did we conduct this study?

Patients who received E-PsEYE were provided with information about the eye injections and the possible consequences. In addition, exercises were provided on the basis of cognitive behavioral therapy to learn to deal with these feelings. Patients from the ophthalmology outpatient clinic of eight hospitals followed the E-PsEYE intervention from home with the support of a Royal Dutch Visio social worker. These social workers had telephone and digital contact with patients to see how they were doing and to motivate them to complete the course. The cost-effectiveness of the intervention was established in a randomized controlled trial (n=174). A total of 5 measurements were taken (digitally or by telephone) from all participants: at the start of the study, after 3 months, 6 months, 9 months and 12 months follow-up.

Important results & conclusions

After 12 months, a small significant decrease in depression was found in favor of the patients who receieved E-PsEYE, but no significant decrease in anxiety or improvement in quality of life was found. Modest societal cost savings were found that could not be attributed with sufficient certainty to the intervention. Several barriers and facilitators were mentioned. Strategies that focus on these barriers and facilitators may improve the use of E-PsEYE in the future, e.g. more intensive support on using e-health applications and support for the recognition of mental complaints.


van der Aa, H. P. A., van Rens, G. H. M. B., Verbraak, F. D., Bosscha, M., Comijs, H. C., & van Nispen, R. M. A. (2021). Anxiety and depression in patients who receive anti-VEGF treatment and the usability and feasibility of e-mental health support: the E-PsEYE pilot study. Ophthalmic and Physiological Optics41(4), 808-819. https://doi.org/10.1111/opo.12837

van der Aa, H. P. A., van Rens, G. H. M. B., Verbraak, F. D., Bosscha, M., Koopmanschap, M. A., Comijs, H. C., Cuijpers, P., & van Nispen, R. M. A. (2017). Economic evaluation of an e-mental health intervention for patients with retinal exudative diseases who receive intraocular anti-VEGF injections (E-PsEYE): protocol for a randomised controlled trial. BMJ Open7(11), e018149. https://doi.org/10.1136/bmjopen-2017-018149