Mood disorders in patients with chronic simple glaucoma

Mental stress as consequence and cause of vision loss: the dawn of psychosomatic ophthalmology for preventive and personalized medicine

The loss of vision after damage to the retina, optic nerve, or brain has often grave consequences in everyday life such as problems with recognizing faces, reading, or mobility. Because vision loss is considered to be irreversible and often progressive, patients experience continuous mental stress due to worries, anxiety, or fear with secondary consequences such as depression and social isolation. While prolonged mental stress is clearly a consequence of vision loss, it may also aggravate the situation. In fact, continuous stress and elevated cortisol levels negatively impact the eye and brain due to autonomous nervous system (sympathetic) imbalance and vascular dysregulation; hence stress may also be one of the major causes of visual system diseases such as glaucoma and optic neuropathy. Although stress is a known risk factor, its causal role in the development or progression of certain visual system disorders is not widely appreciated. This review of the literature discusses the relationship of stress and ophthalmological diseases. We conclude that stress is both consequence and cause of vision loss. This creates a vicious cycle of a downward spiral, in which initial vision loss creates stress which further accelerates vision loss, creating even more stress and so forth. This new psychosomatic perspective has several implications for clinical practice. Firstly, stress reduction and relaxation techniques (e.g., meditation, autogenic training, stress management training, and psychotherapy to learn to cope) should be recommended not only as complementary to traditional treatments of vision loss but possibly as preventive means to reduce progression of vision loss. Secondly, doctors should try their best to inculcate positivity and optimism in their patients while giving them the information the patients are entitled to, especially regarding the important value of stress reduction. In this way, the vicious cycle could be interrupted. More clinical studies are now needed to confirm the causal role of stress in different low vision diseases to evaluate the efficacy of different anti-stress therapies for preventing progression and improving vision recovery and restoration in randomized trials as a foundation of psychosomatic ophthalmology.

Glaucoma and systemic diseases

Glaucoma management may be extremely challenging, especially in elderly patients who have a variety of systemic diseases and take multiple medications. We obtained a comprehensive medical history in patients with primary open-angle glaucoma to determine which systemic diseases are most prevalent and which systemic medications are most commonly used. We have also reviewed the literature that addresses how these concomitant diseases and medical treatments influence the management of glaucoma. Knowledge of systemic diseases and potential drug interactions, especially between various systemic and glaucoma medications, is important for the safe management of glaucoma patients.

Personality traits, depression, and objectively measured adherence to once-daily prostaglandin analog medication in glaucoma

PURPOSE

To investigate the influence of personality traits, depression, and training on objectively measured adherence to once-daily prostaglandin analog medication.

METHODS

Adherence was measured with the Travalert Dosing Aid on 58 consecutive, regularly followed-up glaucoma patients already on self-administered travoprost. Before the 3-month data-collection period all patients received training on use of the device. Psychologic characteristics were measured using the State-Trait Anxiety Inventory, Eysenck Personality Questionnaire, and Beck Hopeless Scale and Depression Inventory. An adherent day was defined as travoprost instillation at 9 PM +/-2 hours.

RESULTS

Adherence was 77% for the total period. Social desirability was higher than normal (U test, P<0.0001). Seven patients (12.1%) showed mild-to-moderate depression, which was not significantly associated with decreased adherence (Kruskal-Wallis test, P=0.071). Severity of glaucoma, number of ocular and systemic medications, satisfaction with the recording device, and socio-economic characteristics had no influence on adherence.

CONCLUSIONS

Objectively measured adherence to once-daily prostaglandin analog medication was good, and not influenced by treatment characteristics or patient factors including mild-to-moderate depression. The elevated social desirability suggests that self-reported adherence is not a reliable measure of adherence in glaucoma.

Quality of life among patients with glaucoma in Sweden

PURPOSE

To assess the health-related quality of life (HRQOL) in an unselected sample of patients with glaucoma.

METHODS

The HRQOL was studied in a cross-sectional survey in 270 patients from two departments of ophthalmology in different parts of Sweden by using the Swedish Health-Related Quality of Life Survey, a generic HRQOL-instrument adapted from the Medical Outcomes Study.

RESULTS

Compared to a random Standard Population Sample, the glaucoma patients showed lower mean score only in the scale of 'Pain' (p < 0.05, effect size 0.17), but higher mean score in 'Sexual functioning' (p < 0.01, effect size 0.35). Significant factors correlated to a lower score on HRQOL-scales were decreased visual acuity and visual field, and comorbidity of cardiovascular and non-vascular systemic diseases. Regarding the topical medications, beta-blockers with or without miotic agents had no negative impact on the HRQOL.

CONCLUSION

Our findings indicate that health-related quality of life in glaucoma patients in general is good, especially when vision is intact, and that topical beta-blockers do not have any negative influence.