Glaucoma associated with poorer mental health, quality of life
Key takeaways:
- Compared with controls, patients with glaucoma had more psychiatric comorbidities and used more psychiatric medications.
- Patients with glaucoma scored significantly lower in general health vs. controls.
Patients with glaucoma appeared to have poorer general health, mental health and quality of life, with more severe visual field impairment linked to worsening physical health outcomes, according to a study published in Cureus.
Previous research shows that the progression of glaucoma, fear of blindness and limitations in performing daily activities lead to reduced quality of life (QoL) and mental health conditions such as anxiety and depression.
“Understanding and measuring QoL in glaucoma patients ... helps health care professionals educate patients about disease progression, reinforcing the importance of consistent therapy adherence, even when symptoms are absent,” João Alves Ambrósio, of the ophthalmology department at Unidade Local de Saúde de Entre Douro e Vouga in Santa Maria da Feira, Portugal, and colleague wrote.
“By showing how therapy can slow progression and improve QoL, clinicians can motivate patients to remain committed to their treatment,” Ambrósio and colleagues added, noting that assessing QoL can also strengthen the doctor-patient relationship.
Thus, the researchers sought to assess the impact glaucoma has on mental health and general and disease-specific QoL, as well as to examine the relationship between glaucoma severity and psychological and functional factors.
The cross-sectional study included 102 patients (mean age, 72.3 ± 7.6 years; 52% women) recruited from a glaucoma outpatient clinic who had a confirmed diagnosis of glaucoma, as well as 82 age-matched controls (51.2% women). Most (56.5%) patients with glaucoma had severe glaucoma.
The researchers used the 12-Item Short-Form Health Survey version two (SF-12v2) to assess physical and mental well-being, including physical functioning, role limitations due to physical health, vitality and social functioning. They also used the Glaucoma QoL Questionnaire (Glau-QoL-17) to determine the impact of glaucoma and glaucoma treatment on QoL, including treatment burden, daily life limitations and emotional well-being.
The researchers found that, compared with the control group, the glaucoma group had a significantly higher prevalence of psychiatric comorbidities (46.1% vs. 22%; P < .001) and greater use of psychiatric medications (46.1% vs. 20.5%; P = .005). Also, 64.7% of glaucoma patients reported anxiety related to the disease.
Further, the researchers found that, compared with controls, patients with glaucoma scored lower on the physical component (mean, 41.3 vs. 49.7; P < .001) and mental component (mean, 41.8 vs. 51; P < .001) of the SF-12v2. In terms of subdomains, the glaucoma group scored lower on physical functioning, role-physical, vitality, social functioning and mental health (all P < .001).
The glaucoma group also had significantly lower scores on Glau-QoL-17 compared with the control group (total score, 44 vs. 58; P < .001), especially in the areas of anxiety, self-image, psychological state, daily life, constraints and self-care (all P < .001).
Notably, these lower scores persisted after adjustments for age, sex, education level and other factors.
Finally, data from SF-12v2 further showed a significant association between the severity of visual field loss and physical (P = .028) and emotional (P = 0.035) role functioning. As severe visual field loss increased, general health perceptions (P = .015) and physical functioning scores (P = .004) decreased, as did the general physical score (P = .018).
The researchers reported several limitations to this study, including potential selection bias, given the fact that the control group had achieved higher levels of education (P < .001), and their inability to investigate driving status and living situation as confounding variables.
“Our findings underscore the importance of considering the psychological aspects of glaucoma management, particularly for patients with more advanced visual field loss,” Ambrósio and colleagues wrote.
“Incorporating mental health screening and counseling into routine glaucoma care could help alleviate the psychological burden associated with the disease,” they added.
Perspective
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Addressing the impact of glaucoma on quality of life is an integral part of glaucoma management. While this often centers on the visual limitations imposed by the disease, the psychological burden of a glaucoma diagnosis on quality of life may be neglected. Routine “mental check-ins” with patients may help clinicians identify stressors that patients may be experiencing related to their diagnosis and treatment. Adopting a clinical management approach that incorporates mental wellness and other treatment concerns as they relate to glaucoma into the management plan may alleviate patients’ uncertainty about their disease and foster improved engagement in their care.
As this study illustrates, it is important to recognize that psychological stressors can affect patients at any stage of the disease. Even those with mild stage disease may experience significant anxiety related to potential vision loss, perceived social consequences and an overall decline in quality of life. To help mitigate these concerns, clinicians may focus on providing clear information regarding the state of disease and their management, encourage the development of support networks within the family and community, and facilitate referrals to mental health professionals when appropriate.
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