Anxiety in glaucoma suspects may be associated with future diagnosis
Click Here to Manage Email Alerts
Glaucoma may be more likely to develop in glaucoma suspects with a history of anxiety or both anxiety and depression, according to a retrospective cohort study in British Journal of Ophthalmology.
“While there is substantial evidence, the role of psychiatric disorders in glaucoma remains complicated,” Samuel Berchuck, PhD, of Duke University, and colleagues wrote. “Although they may certainly be a consequence of visual loss and glaucoma diagnosis, they may also contribute to disease progression over time.”
To assess the relationship among anxiety, depression and glaucoma progression, Berchuck and colleagues evaluated data from 3,259 adults with a diagnosis of glaucoma suspect in the Duke Glaucoma Registry from 2012 to 2019 and recorded the time to glaucoma diagnosis from the baseline glaucoma suspect diagnosis.
Various combinations of psychiatric diagnoses were considered in the study: anxiety vs. no anxiety; depression vs. no depression; and a mutually exclusive four-level categorical variable of no psychiatric diagnoses, anxiety only, depression only, and both anxiety and depression. Diagnoses of anxiety or depression had to be present 5 years before the baseline diagnosis of glaucoma suspect.
Within the cohort, 1,465 patients (46%) had either depression or anxiety, and 607 patients (19%) had both depression and anxiety. Psychiatric diagnoses were more likely in women and Caucasian patients (both P < .001).
Glaucoma was diagnosed in 911 patients (28%) during follow-up, with an association between glaucoma and psychiatric diagnosis at baseline (P = .013). Of patients with both anxiety and depression, 33% were diagnosed with glaucoma during follow-up.
Risk for glaucoma development was increased by 20% in patients with baseline anxiety (P = .010) and by 15% in patients with baseline depression.
In multivariable modeling, the effect of anxiety remained statistically significant, but depression did not. In patients with both psychiatric diagnoses, the effect was statistically significant.
Risk for glaucoma development also increased with older age, male gender, higher IOP and worse disease severity at baseline, while Asian race was found to be a protective factor.
“Given that a diagnosis of anxiety or depression in our study occurred before an eventual diagnosis of glaucoma, our findings may suggest that anxiety is a predictive factor in developing glaucoma, not only a consequence of glaucoma,” Berchuck and colleagues wrote. “The reason why anxiety would be associated with worse outcomes in suspects is unclear.”
Perspective
Back to Top
Glaucoma is not a disease lacking diagnostic and therapeutic options. What is missing is effective patient education on the importance of prevention and treatment.
Studies have shown up to half of glaucoma patients remain undiagnosed, and up to 80% of those under care are not following their doctors’ instructions. An enigmatic and potentially blinding condition like glaucoma can take a disproportionate toll on those already suffering from anxiety.
Research is now verifying the association between mental health and disease progression. A recent study in non-human primates showed stress raises IOP. Anxious glaucoma suspects seeking a second opinion are commonly welcomed in my practice. Most of these patients have not been misdiagnosed but simply ineffectively counseled. I have seen the relieved look on the faces of patients who gain a better understanding of their condition. Managing a patient’s anxiety may be as critical in preventing disease progression as medication or advanced diagnostics. Advising a glaucoma suspect’s family physician of the diagnosis and offering them the opportunity to speak to a therapist may also be helpful. A more holistic approach to health care should be embraced, keeping in mind the intersection of mental health, glaucoma prevention and effective treatment.
Collapse
Read more about
Click Here to Manage Email Alerts