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Study found association between glaucoma, depression
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A cross-sectional study of a community-based cohort in Japan found a significant association between glaucomatous optic disc and depression, independent of a number of other risk factors for depression, including daily light exposure.
The authors specifically focused on daily light exposure as a potential confounding factor, because progressive retinal ganglion cell death might lead to dysfunctional perception of light stimuli and consequent circadian misalignment with decreased nocturnal melatonin secretion, they said in the study.
Such alterations were associated in previous studies with depressive symptoms. In addition, glaucoma patients might tend to limit their daylight activities, further decreasing the beneficial effects of daylight exposure.
In the study, 770 participants with a mean age of 70.9 years were included. Assessment of glaucomatous disc was conducted on fundus photographs using spectral domain OCT with a high-resolution fundus camera (3D-OCT2000, Topcon). Depressive symptoms were identified using a short version of the Geriatric Depression Scale questionnaire.
Depressive symptoms were observed in 114 participants (14.8%), and glaucomatous optic disc was detected in 40 participants (5.2%).
The prevalence of depression was significantly higher in the group of patients with glaucomatous optic disc, accounting for 30% of the patients as compared with 14% in the group without glaucoma. This association remained significant after multivariate regression analysis adjusted for daytime and nighttime light exposure.
The association between glaucoma and depression was proved in several studies, including a large American study on more than 4 million patients. However, this was the first study evaluating daytime light exposure as a confounding factor, they said.
The authors pointed out that further studies on this association should be conducted, also to validate the possible benefits of daytime bright-light therapy, suggested by some studies as a treatment for depression.
“It remains uncertain whether bright-light therapy is effective for improving mood status in patients with glaucoma; thus, further interventional studies are needed to test the effectiveness in clinically diagnosed patients for glaucoma,” they wrote. – by Michela Cimberle
Disclosure: Yoshikawa reported no relevant financial disclosures. Please see the study for the other authors’ financial disclosures.
Perspective
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Mark Eltis, OD, FAAO
We know that intrinsically photosensitive ganglion cells directly affect circadian rhythm function and that circadian dysrhythmia may lead to depression. Considering that glaucoma patients experience ganglion cell loss, is glaucoma-associated depression light-mediated? If so, glaucoma patients with more light exposure might suffer less depression. Furthermore, would light exposure therapy improve mood in depressed glaucoma patients? Yoshikawa and colleagues confirmed a clear association between depression and glaucomatous optic nerves, but this association was found to be independent of light exposure.
Unlike age-related macular degeneration or dry eye there are very few lifestyle modifications that have been shown to soften the impact of glaucoma. I am routinely asked this question and can see my patient’s frustration at the lack of clear answers. This lack of control over the disease is frustrating for patients and doctors alike.
Future studies may find factors that contribute to glaucoma-associated depression besides visual field loss. Ultimately, the glaucoma-depression association is most certainly multifactorial, but in-office light therapy is not currently advised. In the meantime, identifying depressed glaucoma patients and connecting them to the appropriate health care providers is critically important.
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