Automatic Self Transcending Meditation (ASTM) Plus Treatment As Usual (TAU) Versus TAU Alone in Patients With Severe Age Related Macular Degeneration (AMD), a Single Blind Randomized Controlled Longitudinal Study

OBJECTIVE: The investigators key objective is to study the effects of ASTM on HRQoL, depression, and anxiety in AMD patients. The second objective is to determine if there is an association between HRQoL, depression, and anxiety with routinely measured clinical variables. A mathematical model to compute HRQoL, depression, and anxiety from ophthalmic clinical variables will be developed in ASTM plus TAU as well as TAU alone group.

Study Design: The investigators plan to conduct a single-center, single blind longitudinal randomized controlled trial (RCT). Research participants will be 140 men and women (70 in each group).

Study Recruitment: Potential participants with severe AMD above 50 years of age will be screened - from the office practice of Dr. Mao as per inclusion and exclusion criteria at the Ivey Eye Institute, London, ON.

An ophthalmic examination - offered as a routine care - for each potential participant (i.e., measuring best-corrected Snellen visual acuity and pinhole acuities) will be conducted. Snellen acuity will be converted to LogMAR according to visual angle subtended by letters such as 20/20 = 0.0, 20/40 = 0.3, 20/50 = 0.3978. A value above 20/200 = 1.0 will be assigned to counting fingers, hand motions, and light perception. No light perception will receive a value of 0.0.

Questionnaire: Patients will undergo a standardized interview performed by a trained interviewer to measure HRQoL using the time trade-off method (TTO) in which potential participants will be asked couple of questions about their quality of life such as 1) how long participant expect to live? and 2) how many of those remaining years of life, if any, participant would be willing to trade in return for a treatment permitting to their current vision in each eye to be transformed to permanent perfect vision (20/20) bilaterally?. During the first office visit (screening visit), in the interview, patients will be asked demographic questions including age, gender, and associated medical conditions, such as concurrent ocular conditions, ocular disease other than AMD, previous ocular surgery, intraoperative complications, preoperative ocular pathology, chronic pain, general diseases that could affect the immune system, and actual infection. In addition, patients will be asked about co-morbidities such as, whether they have high blood pressure, diabetes, arthritis, heart condition, stroke, and other non-ocular medical conditions. Further, the following self-rated scales will be administered at the first office visit: TTO, Visual Function Questionnaire (VFQ-25), the Patient Health Questionnaire (PHQ-9), and Generalized Anxiety Disorder (GAD-7).