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Risk of depression increases with severity of glaucoma, age
Questionnaires that rated elderly glaucoma patients’ mental outlook show that physicians should treat disease more aggressively.
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Geriatric glaucoma patients who have greater visual loss are more prone to depression than nonglaucoma patients of the same age, an increased risk that physicians should be aware of when treating patients, a study found.
 Ivan Goldberg |
Increasing age is also a risk factor for depression, but elderly pa- tients with advanced glaucoma had a higher risk of developing depression than elderly ocular hypertension patients, according to a poster study by
Ivan Goldberg, MBBS, FRANZCO, FRACS, and Simon E. Skalicky, BSc, MBBS. They presented results of the study at the American Glaucoma Society meeting.
“Glaucoma impacts patients’ quality of life,” the study authors said in the poster. “Factors such as progressive peripheral field loss, impaired visual function, multiple treatments including topical beta-blockers and surgery may contribute to depression in glaucoma. Depression, in turn, can affect a glaucoma patient’s quality of life and perception of disease burden.”
The questionnaire
In a telephone interview, Dr. Goldberg said he and Dr. Skalicky analyzed results of 131 glaucoma patients and 34 control subjects who completed the validated Geriatric Depression Scale-15 (GDS-15) questionnaire and a quality-of-life questionnaire. The glaucoma patients were divided according to visual field loss into mild, moderate and severe groups. All subjects were 60 years and older, with the mean age of each group increasing with disease severity, according to the study.
Dr. Goldberg said he decided to study depression in glaucoma patients after hearing a psychiatrist speak at a conference about general uses of the GDS-15. It is the first study to examine depression in glaucoma using this survey. The questionnaire, outlined in a study published in Family Practice in 1994, rates patients’ mental outlook based on their responses to a list of questions.
This quality-of-life study is the second that Dr. Goldberg and colleagues have conducted using a survey to score glaucoma patients. The first, which he presented in a paper session at last year’s AGS meeting, examined results from only the Glaucoma Quality of Life-15 (GQL-15) questionnaire. Patients in this year’s poster study answered the GDS-15 and the GQL-15, in addition to an objective assessment of function related to vision, according to Dr. Goldberg.
Different patient populations and researchers were involved in each study, he said. The studies are pending publication in the Journal of Glaucoma.
Results
In the poster study, Drs. Goldberg and Skalicky found that the prevalence of depression increased as glaucoma progressed, with statistically significant differences in patients 70 to 79 years old. Age and visual field score were independent risk factors for depression, they found.
The results show a need for physicians to address elderly glaucoma patients’ increased risk of depression, Dr. Goldberg said.
“We have to re-think our attitude to glaucoma because people’s approach often is [that] the mild to moderate glaucoma cases don’t cause problems, so you don’t have to be too aggressive in your treatment,” he said. “What these results are showing is that, in fact, if you ask the right questions, people are having increasing problems, and every bit of vision that is eroded is important to try to avoid, so treatment does need to be more aggressive.”
Results from the studies show how questionnaires can benefit all glaucoma patients’ well-being, Dr. Goldberg said. They can provide physicians with a more encompassing view of patients’ mental well-being and their ability to cope in real-life situations.
The questionnaires are easily completed and can be filled out by patients as they wait for their examinations, he said. The surveys are also easy to score and evaluate. As soon as physicians have results from the surveys, they can modify their therapeutic approach and even make appropriate referrals based on those results.
“You can get a feel for which patients are having problems, and you could actually learn a lot about your patients and what’s happening to them as … people, as the disease is progressing,” Dr. Goldberg said.
Treating depression
Drs. Goldberg and Skalicky said depression tends to be under-recognized and undertreated in the geriatric population. More awareness of the risk of depression could help glaucoma patients receive earlier treatment.
Depression can be approached by physicians in different ways, including working with a patient’s general practitioner to treat the disease medically or referring patients to community services that could assist them. Spending additional time educating patients about visual loss and glaucoma can also help ease their concerns and depressed feelings after diagnosis, Dr. Goldberg said.
“The challenge is to recognize it,” he said. “There’s no easy answer. I think you need to be aware, take the appropriate generalized steps of support, sometimes with medical therapy, depending on how severe it is.”
For more information:
- Ivan Goldberg, MBBS, FRANZCO, FRACS, is a clinical associate professor at the University of Sydney, and director of Eye Associates and the Glaucoma Services at Sydney Eye Hospital. He can be reached at 187 Macquarie St. Park House, Floor 4, Suite 2, Sydney NSW 2000, Australia; 61-2-9247-9972; fax: 61-2-9232-3086; e-mail: eyegoldberg@gmail.com.
References:
- D’Ath P, Katona P, et al. Screening, detection and management of depression in eldery primary care attenders. I: The acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions. Fam Pract. 1994;11:260-266.
- Nelson P, Aspinall P, et al. Quality of life in glaucoma and its relationship with visual function. J Glaucoma. 2003;12:139-150.
- Erin L. Boyle is an OSN Staff Writer who covers all aspects of ophthalmology.