Ophthalmologists and other eyecare professionals are being urged to address patients’ mental health after new research linking it with glaucoma.
Researchers in America have established a link between the two, with each feeding the other and possibly worsening the patients’ mental and ocular health.
“Factors like anxiety, depression, and allostatic load – the cumulative burden of stress on one’s mind and body – are intertwined with the effects of glaucoma,” said Dr Sarah Van Tassel, director of the Glaucoma Service and Glaucoma Fellowship at Weill Cornell Medicine Ophthalmology in New York City.
“For instance, patients with glaucoma may experience psychological disturbances that reduce their vision-related quality of life, and they may be at greater risk of depression than others,” she said.
Dr Van Tassel suggested that having glaucoma can contribute to a patient’s stress and depression and, conversely, stress and depression might influence factors that contribute to the progression of the disease.
“Taking steps to help patients manage their mental health may help improve their quality of life.”
The researchers reviewed a number of studies, including several linking visual field (VF) defects with both the incidence of falls and the fear of falling. Among these, a three-year study of 342 patients with primary open-angle glaucoma found that inferior peripheral VF defects were significantly associated with fear of falling.
They concluded that anxiety could affect glaucoma progression through “stimulation of the autonomic nervous system, however the mechanism is not known”.
“It’s a complex web of interactions, and it’s not as well understood in eye disease [as in some systemic diseases],” said Dr Van Tassel.
“We know that for diabetes and other chronic conditions, depression mediates outcome. But that hasn’t been as clearly established in glaucoma.”
But they believed that some patients “may be at greater risk for depression, including those who are female, live in isolation, have a low income, engage in substance abuse, and are older”.
The research also suggested treatments to help ease that anxiety and depression, and its potential ongoing impact on glaucoma.
Dr Sandra Sieminski pointed to the importance of a holistic approach to patient care in glaucoma.
“I think that, beyond helping our glaucoma patients lower their intraocular pressure (IOP), we can support them in addressing their level of anxiety and depression, too. Together, these approaches can be important in helping to slow or stop the disease process.”
That included meditation.
A study involving 60 patients showed that Mindfulness Meditation was associated with reduced IOP.
Other tools included good education, low vision and social services, and mental health therapy.
The conversation about mental health can feel intimidating, said Dr Van Tassel.
“I usually say something like ‘Dealing with glaucoma can be really tough. Who do you lean on to help support you?’”
“Patients are almost always grateful to have the subject of mental health broached,” she said.
More reading
Positive results for PolyActiva biodegradable implant for glaucoma
Dr Elvis Ojaimi first to implant telescopic lens at Epworth Freemasons, Melbourne
Glaukos submits FDA application for iDose TR glaucoma implant
