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Study confirms strong association between anxiety, depression, glaucoma
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Researchers found that anxiety and depression are strongly linked with glaucoma, an association that does not change with age, according to a study in the American Journal of Ophthalmology.
Zhang and colleagues looked at 4,439,518 patients, of which 2,457,964 were female, 11,234 had glaucoma, 96,527 had anxiety, and 103,476 had depression.
Of those with glaucoma, 56.4% were white, 33.1% were black, 1.5% were Asian, and 0.4% were American Indian or Alaska Native. Also in the group with glaucoma, 1,916 had a diagnosis of anxiety, and 2,476 had a diagnosis of depression.
Of the 4,428,284 patients without glaucoma, 94,611 had been diagnosed with anxiety, and 101,000 had been diagnosed with depression.
The researcher noted that while other studies have found older age to be a risk factor for depression, this study found no differences among age groups.
“Thorough and continued patient education and encouraging treatment adherence are important for not only treating glaucoma itself, but also for improving patients’ quality of life,” the researchers wrote.
Furthermore, anxiety and depression can significantly detract from patients’ ability to follow treatment regimens.
The researchers also noted that glaucoma medication, such as topical -blockers and carbonic anhydrase inhibitors, can cause depression, and anxiety is a known side effect of oral corticosteroids.
They stressed the significance of collaboration between eye care professionals and psychiatrists and recommended screening questionnaires for depression and anxiety, such as the seven-item Generalized Anxiety Disorder and the nine-item Personal Health Questionnaire Depression Scale, which are validated and easily administered.
Future research should focus on determining specific risk factors that predispose glaucoma patients to anxiety and depression and which subgroups are at an increased risk, they said. – by Abigail Sutton
Disclosures: The researchers report no financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
If you have any doubt that your glaucoma patients are more likely to suffer psychological distress, Zhang and colleagues have put these doubts to rest.
The investigators screened a whopping database of 4.5 million patients to identify more than 11,000 glaucoma patients. For those of us who work with glaucoma patients every day, their finding that glaucoma patients are more likely be depressed and anxious is intuitively obvious. In light of these findings, here are a few things to continue doing as you work with your patients:
- Pay attention. Patients rarely volunteer information on their psychologic state.
- Discuss depression with your patients, especially those on beta-blockers.
- Have available a psychological services list and specific recommendations.
- Remember, your younger glaucoma patients are just as likely to be depressed or anxious.
As optometrists, we often spend more face-to-face time with our patients than our ophthalmologic colleagues. This makes for superior glaucoma care, whether you are providing glaucoma education, reviewing findings or making astute observations on your patient’s mental wellbeing.
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