Diagnosis of POAG linked to significant decline in mental health scores

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Mae Gordon, PhD, and colleagues identified an association between the diagnosis of primary open-angle glaucoma and a decrease in patients’ mental health score. She is from the Department of Ophthalmology and Visual Sciences, and the Institute for Informatics, Data Science, and Biostatistics, Washington University School of Medicine, St. Louis. They reported their findings in JAMA Ophthalmology.¹

They pointed out that some patients can experience stress when they are diagnosed with glaucoma and advised that clinicians should be aware of the accompanying potential for a decrease in the patient’s mental health status.

This cohort study was an outgrowth of the phase 1 and 2 Ocular Hypertension Treatment Study (OHTS).^2,3 This is post hoc analysis included the prospective data from the OHTS trial obtained from patients with ocular hypertension who developed early POAG and had completed the National Eye Institute’s Visual Function Questionnaire-25 (VFQ) within 2 years before and within 2 years after the POAG was diagnosed. Patients completed the questionnaire every 2 years between January 2001 and December 2008. A control group was comprised of propensity-matched participants with ocular hypertension who did not develop POAG during the same period.

The study’s main outcome measure was the change in the VFQ mental health score before and after POAG was diagnosed in the group of patients with POAG compared with changes during the same period in the controls who did not develop POAG.

Post hoc analysis results

The investigators reported that 50 participants (21 women; 17 Black patients; mean age, 67.9 years) with POAG were included in the study. The control group included 100 OHTS control participants (37 women; 34 Black patients; mean age, 66.6 years).

Based on the questionnaire results, the investigators reported that among the participants who developed POAG, the means ± standard deviations of the mental health scores before and after development of POAG were, respectively, 94.5 ± 8.6 and 88.0 ± 13.6; this translated to a mean change of −6.5 ± 11.3. In the matched control group, the mean changes in the mental health scores before and after development of POAG were, respectively, 93.3 ± 8.9 and 92.6 ± 8.0, ie, a mean change of −0.7 ± 8.3. The mean difference in the mental health scores between and after development of POAG in the POAG and control groups was −5.8 ± 9.4 (95% confidence interval, −9.05 to −2.60; P = 0.048).

The authors concluded, “These findings support the need for further studies to confirm the association between the diagnosis of POAG and a decrease in the mental health score and to develop strategies to inform patients about their POAG diagnosis without that information causing undue distress, anxiety, and depression.”

Another recent study on the topic

A collaboration⁴ of Portuguese and Spain researchers led by first author Jennifer Jesus, MD, found “a high occurrence of psychiatric pathologies among individuals with glaucoma.” She is from the Unidade Local de Saúde de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.

She and her colleagues conducted a systematic review of six databases (CINAHL, MEDLINE, PsycINFO, Web of Science, Scopus, and the Cochrane Library) and one gray literature source (Google Scholar), covering the period from 2013 to 2024.

They identified 29 studies that included 13,326,845 subjects were include. “Depression and anxiety were the most common conditions identified, with depression rates ranging from 6.6% to 57% and anxiety from 12.11% to 49%. Other less frequent but still significant conditions like sleep disorders, psychosis, dementia, and post-traumatic stress disorder also were observed,” the investigators reported

In addition, they found that the psychiatric severity was affected by socio-demographic factors, glaucoma severity, and treatment duration.

Jesus and colleagues commented, “Given the high occurrence of psychiatric pathologies among individuals with glaucoma, it is essential to develop comprehensive care strategies that address both eye and mental health needs. Multidisciplinary collaboration among ophthalmologists, psychiatrists, psychologists, and primary care physicians is crucial for developing personalized treatment plans that effectively manage both the ocular and psychological aspects of the disease.”

References

1. Gordon MO, Gao F, Burkland J, et al. for the Ocular Hypertension Treatment Study Group. Diagnosis of primary open-angle glaucoma and mental health status. JAMA Ophthalmol. Published online June 5, 2025. doi:10.1001/jamaophthalmol.2025.1374

2. Gordon MO, Kass MA, for the Ocular Hypertension Treatment Study G. The Ocular Hypertension Treatment Study: design and baseline description of the participants. Arch Opthalmol. 1999;117:573–583. doi: 10.1001/archopht.117.5.573.

3. Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002;120:701-713, discussion 829-830.

4. Jesus J, Ambrósio J, Meira D, Rodriguez-Uña I, Beirão JM. Blinded by the mind: exploring the hidden psychiatric burden in glaucoma patients. Biomedicines 2025; 13:116; https://doi.org/10.3390/biomedicines13010116