Anxiety and Depression are More Prevalent in Primary Angle Closure Glaucoma Than in Primary Open-Angle Glaucoma

Quality of life and mental health status of glaucoma patients

Introduction

Glaucoma, a leading cause of irreversible blindness worldwide, poses significant challenges to patients' quality of life (QOL) and mental well-being.

Methods

This study aimed to investigate the complex interplay between clinical, demographic, and psychological factors and their impact on QOL among patients diagnosed with glaucoma. A cohort of 201 glaucoma patients, with a mean age of 70 years, participated in the study.

Results

Descriptive analyses revealed that participants reported living with a glaucoma diagnosis for an average of 13.38 years, highlighting the chronic nature of the disease in the cohort. Comorbidity was shown to be in close relationship with QOL, where with additional health problems have lower QOL scores (M = 34.86, SD = 18.25), as well as higher levels of anxiety (M = 10.64, SD = 5.38) and depression (M = 13.42, SD = 7.37). Correlation analyses further unveiled robust associations between clinical characteristics and psychological outcomes, with lower visual acuity strongly correlated with reduced QOL (rR = -0.74, pR < 0.001; rL = -0.78, pL < 0.001) and higher levels of anxiety and depression. Additionally, longer duration of glaucoma diagnosis was moderately associated with poorer QOL (r = 0.56, p < 0.001) and increased psychological distress, highlighting the cumulative burden of living with the disease over time. Mediation analyses indicated that duration of diagnosis partially mediated the relationship between depression and QOL, as well as anxiety and QOL, suggesting that the prolonged experience of living with glaucoma may exacerbate the impact of psychological distress on QOL.

Discussion

These findings underscore the importance of holistic patient care approaches that address both the physical and psychological aspects of glaucoma to improve patient outcomes and enhance overall well-being.

Depression and Eye Disease-A Narrative Review of Common Underlying Pathophysiological Mechanisms and their Potential Applications

Background: Depression has been shown to be associated with eye diseases, including dry eye disease (DED), cataracts, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR). This narrative review explores potential pathophysiological connections between depression and eye disease, as well as its potential correlations with ocular parameters. Methods: A literature search was conducted in August 2022 in PUBMED, EMBASE, and PsycINFO. Published articles related to the subject were consolidated and classified according to respective eye diseases and pathophysiological mechanisms. Results: The literature reviewed suggests that common pathophysiological states like inflammation and neurodegeneration may contribute to both depression and certain eye diseases, while somatic symptoms and altered physiology, such as disruptions in circadian rhythm due to eye diseases, can also influence patients' mood states. Grounded in the shared embryological, anatomical, and physiological features between the eye and the brain, depression is also correlated to changes observed in non-invasive ophthalmological imaging modalities, such as changes in the retinal nerve fibre layer and retinal microvasculature. Conclusions: There is substantial evidence of a close association between depression and eye diseases. Understanding the underlying concepts can inform further research on treatment options and monitoring of depression based on ocular parameters.

Increased incidence of acute primary angle closure during the COVID-19 outbreak in China: A retrospective analysis

This study aimed to investigate the incidence and clinical characteristics of acute primary angle closure (APAC) during the Coronavirus Disease 2019 (COVID-19) pandemic in China. This was a retrospective study of patients diagnosed with APAC in a glaucoma clinic over a 5-year period. We compared the number of APAC cases during the COVID-19 outbreak (December 7, 2022 to January 7, 2023) with those during the same period in previous years and 2 months prior to the outbreak. We also collected data on the demographic and clinical features of APAC patients, such as age, sex, disease course, visual acuity, intraocular pressure (IOP), and lens opacity. We included 95 eyes of 88 patients with APAC were included. Of these, 65 were female and 23 were male. The mean age was 68.0 ± 8.1 years. The median disease course was 10.8 ± 9.5 days. There was a significant increase in the number of APAC cases during the COVID-19 outbreak compared with the same months over a 5-year period (44 vs 51, P < .001). A higher proportion of women developed APAC during the outbreak period than during the non-outbreak period (P < .001). Eyes with APAC in the outbreak period had a lower mean IOP than those in the preceding 6 months (40.5 ± 8.8 mm Hg vs 46.1 ± 10.1 mm Hg; P = .043). No significant differences were observed in disease duration, lens opacity, or bilateral or unilateral onset between the 2 groups. Our study suggests a potential correlation between APAC and COVID-19, marked by a significant surge in APAC cases concurrent with the COVID-19 outbreak. However, the underlying mechanisms and preventive strategies remain to be elucidated.

Evaluation of the Observational Associations and Shared Genetics Between Glaucoma With Depression and Anxiety

Purpose

Glaucoma, a leading cause of blindness worldwide, is suspected to exhibit a notable association with psychological disturbances. This study aimed to investigate epidemiological associations and explore shared genetic architecture between glaucoma and mental traits, including depression and anxiety.

Methods

Multivariable logistic regression and Cox proportional hazards regression models were employed to investigate longitudinal associations based on UK Biobank. A stepwise approach was used to explore the shared genetic architecture. First, linkage disequilibrium score regression inferred global genetic correlations. Second, MiXeR analysis quantified the number of shared causal variants. Third, specific shared loci were detected through conditional/conjunctional false discovery rate (condFDR/conjFDR) analysis and characterized for biological insights. Finally, two-sample Mendelian randomization (MR) was conducted to investigate bidirectional causal associations.

Results

Glaucoma was significantly associated with elevated risks of hospitalized depression (hazard ratio [HR] = 1.54; 95% confidence interval [CI], 1.01-2.34) and anxiety (HR = 2.61; 95% CI, 1.70-4.01) compared to healthy controls. Despite the absence of global genetic correlations, MiXeR analysis revealed 300 variants shared between glaucoma and depression, and 500 variants shared between glaucoma and anxiety. Subsequent condFDR/conjFDR analysis discovered 906 single-nucleotide polymorphisms (SNPs) jointly associated with glaucoma and depression and two associated with glaucoma and anxiety. The MR analysis did not support robust causal associations but indicated the existence of pleiotropic genetic variants influencing both glaucoma and depression.

Conclusions

Our study enhances the existing epidemiological evidence and underscores the polygenic overlap between glaucoma and mental traits. This observation suggests a correlation shaped by pleiotropic genetic variants rather than being indicative of direct causal relationships.

Risk Factors for Primary Angle-closure Glaucoma: A Systematic Review and Meta-analysis of 45 Studies

SIGNIFICANCE

This study summarized primary angle-closure glaucoma (PACG)-related factors across different dimensions.

OBJECTIVES

This review aimed at systematically summarizing the associated factors of PACG in published literatures.

METHODS

A systematic review and meta-analysis were conducted by searching the electronic databases including PubMed, EMBASE, and Web of Science from their inception to November 2021. The pooled risk estimates of continuous and categorical variables were calculated using weighted mean difference (WMD) and odds ratio (OR; 95% confidence intervals [CIs]), respectively.

RESULTS

We included 45 studies in this review. In the meta-analysis, intraocular pressure (WMD, 3.13; 95% CI, 2.37 to 3.89), anterior chamber depth (WMD, -0.52; 95% CI, -0.70 to -0.34), axial length (WMD, -0.77; 95% CI, -1.26 to -0.28), retinal nerve fiber layer (WMD, -21.23; 95% CI, -30.21 to -12.25), and spherical equivalent (WMD, 1.02; 95% CI, 0.66 to 1.38) were the most common ophthalmic anatomic factors, and lower body weight (WMD, -3.65; 95% CI, -6.48 to -0.82) was the most significant general morphological indicators. The presence of cataract (OR, 3.77; 95% CI, 3.46 to 4.11) and hyperlipidemia (OR, 1.10; 95% CI, 1.02 to 1.20) were significantly associated with PACG. Increased level of triglyceride (WMD, 0.17; 95% CI, 0.06 to 0.27) was associated with PACG. In addition, an association between short-term antidepressant exposure (OR, 1.36; 95% CI, 1.08 to 1.70) and acute angle-closure glaucoma was observed.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

This review identified a few consistent factors related to PACG, providing important information for primary care physicians, general ophthalmologists, and public health professionals to counsel their patients on PACG risks.

Anxiety, depression, and sleep-related outcomes of glaucoma patients: systematic review and meta-analysis

OBJECTIVE

This study aims to synthesize data quantifying the prevalence and severity of common psychological conditions in patients with glaucoma.

DESIGN

Systematic review and meta-analysis.

METHODS

Databases including Ovid MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library, Web of Science, Open Grey, and ProQuest Theses and dissertations were searched. Two reviewers independently assessed and screened all studies, followed by quality assessment of included studies using the modified Downs and Black checklist. Data were pooled using fixed-effect and random-effects models.

RESULTS

Of 2067 studies identified by the search strategy, 57 passed full-text screening, and 45 studies (4 995 538 subjects) were eligible for analysis. Overall, the prevalence of depression (effect size [ES] = 0.19, 95% CI 0.16-0.23; n = 31), anxiety (ES = 0.25, 95% CI 0.21-0.30; n = 18), and sleep disorders (ES = 0.47, 95% CI 0.26-0.68; n = 7) were high in patients with glaucoma. Similarly, symptomatic measurements of depression (standardized mean difference [SMD] = 0.46, 95% CI 0.19-0.73), anxiety (SMD = 0.44, 95% CI 0.08-0.81), and sleep quality (SMD = 0.72, 95% CI 0.22-1.21) were significant in glaucoma patients.

CONCLUSIONS

A higher prevalence and severity of depression, anxiety, and sleep disorders was experienced in patients with glaucoma compared with patients without glaucoma. Caregivers as well as health care providers may need to be aware of unique psychological and social stressors placed on glaucoma patients.

Assessment of anxiety and depression in patients with Posner-Schlossman syndrome

BACKGROUND

To assess the anxiety and depression levels in patients with Posner-Schlossman syndrome (PSS) and to determine the potential risk factors.

METHODS

In this cross-sectional study, a total of 195 participants, including 93 PSS patients and 102 healthy controls were recruited. Sociodemographic and clinical information were collected for all participants. Hospital Anxiety and Depression scale (HADS) was administered to evaluate the anxiety and depression levels. Visual function (VF) and quality-of-life (QOL) questionnaires were administered to assess variables potentially associated with anxiety and depression.

RESULTS

Increased anxiety level was observed in 22 (23.7%) PSS patients as compared to 10 (9.8%) of controls (P = 0.009). While the frequency of depression between the two groups was not significantly different (P = 0.349). The mean anxiety and depression scores were 6.98 ± 4.20 and 6.44 ± 3.66 in PSS patients as compared to 6.67 ± 3.21 (P = 0.564) and 5.96 ± 2.93 (P = 0.311) in controls. Logistic regression analysis showed mental well-being was significantly associated with anxiety (odds ratio [OR] = 0.920, 95% confidence interval [CI] = 0.881-0.962, P < 0.001) and depression (OR = 0.959, CI = 0.926-0.994, P = 0.023) in PSS patients.

CONCLUSION

More patients with PSS may experience anxiety as compared to healthy controls. Mental well-being is an independent risk factor for anxiety and depression. It is important for ophthalmologists to be aware of these factors and should pay more attention on mental health when PSS is managed in clinic.

Topiramate-Induced Aqueous Misdirection in a Nanophthalmic Eye

A 51-year-old female was referred to the emergency department with a one-day history of severe right eye pain, blurry vision, and conjunctival injection. A review of past ocular history was notable for nanophthalmos and narrow angles with patent peripheral iridotomies. Anterior segment exam findings were consistent with aqueous misdirection and a review of medications indicated recent topiramate initiation for headaches and depression. The acute attack was initially controlled with medical management and plans for future surgical intervention were made. Although ocular screening prior to initiation of topiramate is not recommended, this case highlights the importance of pre-screening in a patient with a pre-existing condition such as nanophthalmos. Additionally, this case addresses the ocular side effects of anti-depressants and the emerging relationship between glaucoma and depression. Appropriately addressing these issues and coordinating care with behavioral health providers has the potential to prevent optic nerve damage and loss of vision.

Effects of primary angle-closure glaucoma on interhemispheric functional connectivity

Background

Previous studies on primary angle-closure glaucoma (PACG) primarily focused on local brain regions or global abnormal brain activity; however, the alteration of interhemispheric functional homotopy and its possible cause of brain-wide functional connectivity abnormalities have not been well-studied. Little is known about whether brain functional alteration could be used to differentiate from healthy controls (HCs) and its correlation with neurocognitive impairment.

Methods

Forty patients with PACG and 40 age- and sex-matched healthy controls were recruited for this study; resting-state functional magnetic resonance imaging (rs-fMRI), and clinical data were collected. We used the voxel-mirrored homotopic connectivity (VMHC) method to explore between-group differences and selected brain regions with statistically significant differences as regions of interest for whole-brain functional connectivity analysis. Partial correlation was used to evaluate the association between abnormal VMHC values in significantly different regions and clinical parameters, with with age and sex as covariates. Finally, the support vector machine (SVM) model was performed in classification prediction of PACG.

Results

Compared with healthy controls, patients with PACG exhibited significantly decreased VMHC values in the lingual gyrus, insula, cuneus, and pre- and post-central gyri; no regions exhibited increased VMHC values. Subsequent functional connectivity analysis revealed extensive functional changes in functional networks, particularly the default mode, salience, visual, and sensorimotor networks. The SVM model showed good performance in classification prediction of PACG, with an area under curve (AUC) of 0.85.

Conclusion

Altered functional homotopy of the visual cortex, sensorimotor network, and insula may lead to impairment of visual function in PACG, suggesting that patients with PACG may have visual information interaction and integration dysfunction.

Anti-PANoptosis is involved in neuroprotective effects of melatonin in acute ocular hypertension model

Acute ocular hypertension (AOH) is the most important characteristic of acute glaucoma, which can lead to retinal ganglion cell (RGC) death and permanent vision loss. So far, approved effective therapy is still lacking in acute glaucoma. PANoptosis (pyroptosis, apoptosis, and necroptosis), which consists of three key modes of programmed cell death-apoptosis, necroptosis, and pyroptosis-may contribute to AOH-induced RGC death. Previous studies have demonstrated that melatonin (N-acetyl-5-methoxytryptamine) exerts a neuroprotective effect in many retinal degenerative diseases. However, whether melatonin is anti-PANoptotic and neuroprotective in the progression of acute glaucoma remains unclear. Thus, this study aimed to explore the role of melatonin in AOH retinas and its underlying mechanisms. The results showed that melatonin treatment attenuated the loss of ganglion cell complex thickness, retinal nerve fiber layer thickness, and RGC after AOH injury, and improved the amplitudes of a-wave, b-wave, and oscillatory potentials in the electroretinogram. Additionally, the number of terminal deoxynucleotidyl transferase dUTP nick-end labeling-positive cells was decreased, and the upregulation of cleaved caspase-8, cleaved caspase-3, Bax, and Bad and downregulation of Bcl-2 and p-Bad were inhibited after melatonin administration. Meanwhile, both the expression and activation of MLKL, RIP1, and RIP3, along with the number of PI-positive cells, were reduced in melatonin-treated mice, and p-RIP3 was in both RGC and microglia/macrophage after AOH injury. Furthermore, melatonin reduced the expression of NLRP3, ASC, cleaved caspase-1, gasdermin D (GSDMD), and cleaved GSDMD, and decreased the number of Iba1/interleukin-1β-positive cells. In conclusion, melatonin ameliorated retinal structure, prevented retinal dysfunction after AOH, and exerted a neuroprotective effect via inhibition of PANoptosis in AOH retinas.

Anatomical Evidence for the Neural Connection from the Emotional Brain to Autonomic Innervation in the Anterior Chamber Structures of the Eye

OBJECTIVE

Previous studies have shown that the autonomic nervous system (ANS), which can be affected by emotions, is important in the occurrence or progression of glaucoma. The autonomic innervation distributed in the anterior chamber (AC) structures might play an efferent role in the neural regulation of intraocular pressure (IOP). This study aimed to investigate the anatomic neural connection from the emotional brain to autonomic innervation in the AC.

METHODS

A retrograde trans-multisynaptic pseudorabies virus encoded with an enhanced green fluorescent protein (PRV531) and non-trans-synaptic tracer FAST Dil were injected into the right eye of mice, respectively. Fluorescent localization in the emotional brain and preganglionic nuclei was studied. Five and a half days after PRV531 injection into the right AC, fluorescent signals were observed in several emotional brain regions, including the amygdala, agranular insular cortex, lateral septal nuclei, periaqueductal gray, and hypothalamus. Autonomic preganglionic nuclei, including Edinger-Westphal nucleus, superior salivatory nucleus, and intermediolateral nucleus, were labeled using PRV531.

RESULTS

The sensory trigeminal nuclei were not labeled using PRV531. The fluorescence signals in the nuclei mentioned above showed bilateral distribution, primarily on the ipsilateral side. Seven days after injecting FAST Dil into the AC, we observed no FAST Dil-labeled neurons in the central nervous system.

CONCLUSION

Our results indicate a neural connection from the emotional brain to autonomic innervation in the AC, which provides anatomical support for the emotional influence of IOP via the ANS.

Association of Mood Disorders, Substance Abuse, and Anxiety Disorders in Children and Teens With Serious Structural Eye Diseases

PURPOSE

We sought to evaluate the association between 5 eye diseases (including glaucoma, cataract, congenital optic nerve disease, congenital retinal disease, and blindness/low vision) and mental illness in a pediatric population.

DESIGN

Cross-sectional study.

METHODS

A de-identified commercial insurance claims database, OptumLabs Data Warehouse, between January 1, 2007, and December 31, 2018, was used. Children and teens less than 19 years of age at the time of eye diagnosis were included. Demographics and mental illness claims were compared, looking at the association of mental illness and eye disease claims.

RESULTS

A total of 11,832,850 children and teens were included in this study with mean age of 8.04 ± 5.94 years at the first claim. Of the patients with at least 1 of the 5 eye diseases (n = 180,297), 30.5% had glaucoma (n = 54,954), 9.5% had cataract (n = 17,214), 21.4% had congenital optic nerve disease (n = 38,555), 26.9% had congenital retinal disease (n = 48,562), and 25.9% had blindness or low vision (n = 46,778). There was a statistically significant association, after adjusting for confounding variables, between at least 1 of the 5 eye diseases and schizophrenia disorder (OR = 1.54, 95% CI = 1.48-1.61, P < .001), anxiety disorder (OR = 1.45, 95% CI = 1.43-1.48, P < .001), depressive disorder (OR = 1.27, 95% CI = 1.25-1.29, P < .001), and bipolar disorder (OR = 1.27, 95% CI = 1.21-1.31, P < .001), but a reversed association with substance use disorder (OR = 0.88, 95% CI = 0.86-0.90, P < .001).

CONCLUSIONS

We found associations between eye disease in children and teens and mental illness. Understanding these relationships may improve mental illness screening and treatment in the pediatric population.

The prevalence of anxiety symptoms and disorders among ophthalmic disease patients

Background:

Progressive and irreversible vision loss has been shown to place a patient at risk of mental health problems such as anxiety. However, the reported prevalence of anxiety symptoms and disorders among eye disease patients vary across studies. Thus, this study aims to clarify the estimated prevalence of anxiety symptoms and disorders among ophthalmic disease patients.

Methods:

Relevant studies on the prevalence of anxiety symptoms and disorders among eye disease patients were collected through international databases, PubMed, Scopus, and Web of Science. A random-effects model was used to determine the pooled prevalence of anxiety symptoms and disorders among ophthalmic disease patients.

Results:

The 95 included studies yielded a pooled prevalence of 31.2% patients with anxiety symptoms and 19.0% with anxiety disorders among subjects with ophthalmic disease. Pediatric patients were more anxious (58.6%) than adults (29%). Anxiety symptoms were most prevalent in uveitis (53.5%), followed by dry eye disease (DED, 37.2%), retinitis pigmentosa (RP, 36.5%), diabetic retinopathy (DR, 31.3%), glaucoma (30.7%), myopia (24.7%), age-related macular degeneration (AMD, 21.6%), and cataract (21.2%) patients. Anxiety disorders were most prevalent in thyroid eye disease (TED, 28.9%), followed by glaucoma (22.2%) and DED (11.4%). When compared with healthy controls, there was a twofold increase on the prevalence of anxiety symptoms (OR = 1.912, 95% CI 1.463–2.5, p < 0.001) and anxiety disorders (OR = 2.281, 95% CI 1.168–4.454, p = 0.016).

Conclusion:

Anxiety symptoms and disorders are common problems associated with ophthalmic disease patients. Thus, comprehensive and appropriate treatments are necessary for treating anxiety symptoms and disorders among ophthalmic disease patients.

Effects of non-pharmacological interventions on anxiety, depression, and sleep quality in patients with postoperative glaucoma: A protocol for systematic review and network meta-analysis

BACKGROUND

Glaucoma is the second most-common blinding ophthalmic disease in the world, and its incidence has been rising year by year in recent years. Currently, the main treatment of glaucoma still relies on surgery. Glaucoma patients often suffer from various psychological problems like anxiety and depression not only because of the lack of understanding of the surgical treatment of glaucoma, but also the long-term stress and the poor prognosis. As alternative therapies, non-pharmacological interventions can greatly alleviate psychological burdens and improve sleep quality in surgically treated glaucoma patients. Randomized controlled trials of non-pharmacologic interventions for glaucoma have been reported, although the results remain conflicting. Evidences for determining the efficacy of non-pharmacologic interventions for glaucoma are scant. This study aims to assess the effects of non-pharmacological interventions on anxiety, depression, and sleep quality in patients with postoperative glaucoma through a network meta-analysis.

METHODS

A systematic search of relevant literatures published before August 2021 about the effects of non-pharmacological interventions on anxiety, depression, and sleep quality in patients with postoperative glaucoma will be performed in Wanfang, VP Information Chinese Journal Service Platform, China National Knowledge Infrastructure, Chinese BioMedicine Literature Database, Pubmed, Embase, Cochrane, and Web of science. Two reviewers will be independently responsible for literature screening and selection, quality assessment, and data extraction. WinBUGS 1.4 will be used for the network meta-analysis.

RESULTS

This meta-analysis will provide additional and stronger evidences for non-pharmacological interventions on anxiety, depression, and sleep quality in patients with postoperative glaucoma, which will help clinicians and decision makers to make an optimal therapeutic strategy.

CONCLUSION

This study will provide a reliable evidence-based basis for the clinical application of non-pharmacological interventions on anxiety, depression, and sleep quality in patients with postoperative glaucoma.

ETHICS AND DISSEMINATION

Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms. This review would be disseminated in a peer-reviewed journal or conference presentations.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/TYJPK.

Impact of anxiety and depression on progression to glaucoma among glaucoma suspects

AIMS

To assess the impact of anxiety and depression in the risk of converting to glaucoma in a cohort of glaucoma suspects followed over time.

METHODS

The study included a retrospective cohort of subjects with diagnosis of glaucoma suspect at baseline, extracted from the Duke Glaucoma Registry. The presence of anxiety and depression was defined based on electronic health records billing codes, medical history and problem list. Univariable and multivariable Cox proportional hazards models were used to obtain HRs for the risk of converting to glaucoma over time. Multivariable models were adjusted for age, gender, race, intraocular pressure measurements over time and disease severity at baseline.

RESULTS

A total of 3259 glaucoma suspects followed for an average of 3.60 (2.05) years were included in our cohort, of which 911 (28%) were diagnosed with glaucoma during follow-up. Prevalence of anxiety and depression were 32% and 33%, respectively. Diagnoses of anxiety, or concomitant anxiety and depression were significantly associated with risk of converting to glaucoma over time, with adjusted HRs (95% CI) of 1.16 (1.01, 1.33) and 1.27 (1.07, 1.50), respectively.

CONCLUSION

A history of anxiety or both anxiety and depression in glaucoma suspects was associated with developing glaucoma during follow-up.

Seasonal variations and climatic factors on acute primary angle-closure admission in southern China: a 5-year hospital-based retrospective study

PURPOSE

To delineate the seasonality of acute primary angle-closure (APAC) admission in a coastal city of southern China and its association with climatic factors.

METHODS

A total of 1155 Chinese subjects with principal diagnosis of APAC attack were recruited from 2012 to 2016, and their medical records were retrieved. Monthly climatic factors were obtained from the Meteorological Bureau of Shantou. Monthly and seasonal APAC admissions were compared, and its correlation with climatic factors was evaluated.

RESULTS

APAC admission was higher in female subjects (75.9%) with an overall mean age of 64.7 ± 9.3 years. APAC admission was highest in summer with the peak onset in June. The peak of APAC admission for female subjects aged ≤ 65 years was in June, and that for> 65 years was in July. The peak of APAC admission for male subjects aged > 65 years was in August. Precipitation was positively correlated with APAC admission rate for both aged ≤ 65 (β = 0.415, p = 0.001) and > 65 years old (β = 0.364, p = 0.004) female subjects. In contrast, surface temperature was positively correlated with APAC admission rate for male subjects aged > 65 years (β = 0.441, p < 0.001). No climatic factor was correlated with APAC admission rate for male subjects ≤ 65 years.

CONCLUSIONS

This study revealed the peak season of APAC admission in summer, and surface temperature and precipitation are the associated factors. Close monitoring of climate changes could help to reduce the incidence of APAC attack.

Cerebral Modifications in Glaucoma and Macular Degeneration: Analysis of Current Evidence in Literature and Their Implications on Therapeutic Perspectives

Glaucoma and macular degeneration are leading causes of irreversible blindness, significantly compromising the quality of life and having a high economic and social impact. Promising therapeutic approaches aimed at regenerating or bypassing the damaged anatomical-functional components are currently under development: these approaches have generated great expectations, but to be effective require a visual network that, despite the pathology, maintains its integrity up to the higher brain areas. In the light of this, the existing findings concerning how the central nervous system modifies its connections following the pathological damage caused by glaucoma and macular degeneration acquire great interest. This review aims to examine the scientific literature concerning the morphological and functional changes affecting the central nervous system in these pathological conditions, summarizing the evidence in an analytical way, discussing their possible causes and highlighting the potential repercussions on the current therapeutic perspectives.

Personality types of patients with glaucoma: A systematic review of observational studies

OBJECTIVES

To synthesize recent empirical research on the association between personality and glaucoma among this sub-population.

METHODS

PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Scopus and ScienceDirect databases were searched to identify eligible studies published between January 1950 and March 2019 in any language. The quality of included observational studies was assessed using an 11-item checklist which was recommended by Agency for Healthcare Research and Quality (AHRQ). After using the checklist, 12 papers are included into the systematic review.

RESULTS

There are some differences on the studies about the negative personality of glaucoma patients. In spite of these differences, most included studies significantly showed that glaucoma patients tend to or do have some specific personality.

CONCLUSION

The extant research could demonstrate that glaucoma patients tend to have some negative personality in some extent. Future studies are needed to provide more convincing support to personality of glaucoma patients.

Depression in glaucoma patients: A review of the literature

Purpose: The purpose of this review was to evaluate the association between glaucoma and depression and to identify possible risk factors for depressive symptoms in glaucoma patients.Methods: A total of 587 abstracts were screened and 32 studies were deemed eligible for inclusion in this review.Results: An association of glaucoma and depression was found, while advanced disease stage, older age, female sex and faster visual loss progression were recognized as potential risk factors for depression in patients with glaucoma.Conclusions: Our findings may have important clinical significance, such as alerting ophthalmologists to implement a multidisciplinary approach in patients with glaucoma. Further research is needed to examine this association in different types of glaucoma and try to investigate the underlying pathophysiological mechanisms to establish a causal inference between glaucoma and depression.

Influence of painless one-eye blindness on depression, anxiety and quality of life in glaucoma patients with a normal fellow eye

Background

For clinical practice it is important to evaluate and compare anxiety, depression and quality of life of glaucoma patients with painless one-eye blindness and a normal fellow eye to unaffected age-matched individuals from a similar environment.

Methods

Twenty-eight stable glaucoma patients (age, mean ± SD: 69.0 ± 13.3 years) with one normal and one painless blind eye, and 26 controls (age: 67.0 ± 14.0 years) completed the standard Hungarian adaptations of the Beck Depression Inventory, Beck Anxiety Inventory, Spielberger-Trait Anxiety Inventory, Hopelessness Scale, and Quality of Life Questionnaire SF-36 with the assistance of trained psychologist interviewers within 3 months after a detailed ophthalmological examination.

Results

The groups did not differ in age, gender distribution, number of children, grandchildren and people in their household (p ≥ 0.235). The best corrected visual acuity (BCVA) of the diseased eye was minimal (median: 0.00), while BCVA of their better eye (median: 1.0) did not differ from that of the control group (p ≥ 0.694). Compared to the control group, the patients’ scores were significantly higher for depression (p ≤ 0.01), cognitive and psychophysiological symptoms of anxiety (p ≤ 0.05) and hopelessness (p ≤ 0.013), and lower (worse) for physical function, vitality, general health and bodily pain (p ≤ 0.045). No difference was found between the groups for mental health, physical role functioning, emotional role functioning and social role functioning (p ≥ 0.117).

Conclusion

Our results show that patients with glaucoma-related one-eye blindness may require regular psychological support even when the visual performance of the fellow eye is fully maintained on the long run, and the patients’ everyday functioning is normal.

Visual Impairment and Mental Health: Unmet Needs and Treatment Options

Purpose

An estimated 2.2 billion people are visually impaired worldwide. Given that age-related vision loss is a primary cause of vision impairment, this number is projected to rise with increases in average lifespan. Vision loss often results in significant disability and is associated with a substantial economic burden, reduced quality-of-life, concurrent medical issues, and mental health problems. In this review, the mental health needs of people with vision impairment are examined.

Patients and methods

A review of recent literature on mental health outcomes and current treatments in people with visual impairment was conducted.

Results

Considerable data indicate that rates of depression and anxiety are elevated among people with visual impairments. Moreover, individuals of lower socioeconomic status may be at increased risk for vision impairment and subsequent mental health problems. Existing psychosocial interventions for improving mental health in people with visual impairment show some promise, but are limited by low adherence and lack generalizability.

Conclusion

In order to improve outcomes, a better understanding of the mechanisms linking visual impairment and poor mental health is needed. It will also be essential to develop more effective interventions and expand access to services to improve the detection and treatment of mental health problems in this population.

The impact of glaucoma on the mental health of primary open-angle glaucoma patients attending a teaching hospital in South East Nigeria

Objective:

To evaluate the effect of glaucoma on the mental health of primary open-angle glaucoma patients using Hospital Anxiety and Depression Scale (HADS)

Materials and Methods:

This was a hospital-based comparative study in which 180 glaucoma patients and controls 18 years and above who met the inclusion criteria were selected consecutively in the Eye Clinic of Federal Medical Centre, Owerri, Imo State, in 2017. Data were collected using a questionnaire and the HADS protocol. All the participants underwent comprehensive ocular examination, and glaucoma was graded using visual field perimetric indices and mean deviation.

Results:

The mean age for cases was 58.14 ± 13.88 years, whereas that of the control group was 57.19 ± 13.76 years. The majority of glaucoma respondents had the moderate form of the disease followed by the severe form. The glaucoma patients showed evidence of poor mental health with 59 (32.8%) of them anxious and 39 (21.7%) depressed compared to controls (P < 0.001). The mean scores for anxiety and depression were 6.02 ± 4.8 and 5.20 ± 4.5, respectively, for glaucoma patients, whereas those for the control group were 0.63 ± 1.8 and 0.64 ± 2.1, respectively (P < 0.001). There was no uniform correlation between the mental health of patients and the variables under study.

Conclusion:

Primary open-angle glaucoma affects the mental health of patients. This effect is worsened by the severity of the disease and influenced by the occupation and educational level of the patients. Multidisciplinary management of primary open-angle glaucoma patients is recommended.

Investigation of Corneal Astigmatism in Chinese Patients With Primary Angle Closure Disease

PURPOSE

The purpose of this study was to analyze the demographics and distribution of corneal astigmatism before lens extraction in patients with primary angle closure disease (PACD).

METHODS

Preoperative partial coherence interferometry was performed in patients with PACD. The demographic and biometric data, including corneal astigmatism and keratometry (K), were recorded.

RESULTS

The study comprised 808 cases (1001 eyes) with a mean age of 67.66±9.07 years, and the mean axial length was 22.55±0.89 mm. The mean corneal astigmatism was 1.08±0.78 diopter (D). Corneal astigmatism was between 0.25 D and 1.25 D in 66.50% of the eyes, 1.25 D or higher in 29.68% of the eyes and <0.25 D in 3.82% of the eyes. The corneal astigmatism of primary angle closure suspect (PACS), primary angle closure (PAC) and primary angle closure glaucoma (PACG) were 1.08±0.77 D, 0.98±0.62 D, and 0.89±0.69 D, respectively. In total, 50.60% of the eyes were classified as astigmatism against the rule (ATR), 28.69% of the eyes were with the rule, and 20.71% of the eyes were oblique. ATR astigmatism increased significantly with age (P<0.001). After matching, corneal astigmatism of PACD was 1.07±0.77 D, although it was statistically significantly higher than that of ARC (0.98±0.66 D, P=0.018), the 2 demonstrated no clinical difference.

CONCLUSIONS

The results provide normative data of corneal astigmatism for PACD patients. Corneal astigmatism was mainly distributed between 0.25 D and 1.25 D. The findings largely concur with published results in age-related cataract subjects.

Measuring Disability in Glaucoma

BACKGROUND

Glaucomatous visual field loss can have far-reaching and debilitating consequences on an individual, affecting one's ability to perform many important tasks. Although assessment of glaucoma-related disability constitutes an important part of clinical care, there remains a lack of organized, detailed information on the most suitable methods to capture disability in glaucoma.

PURPOSE

This review details the available methods to measure glaucoma-related disability and highlights important findings from studies utilizing these various methods.

METHODS

The literature was reviewed to identify papers evaluating disability in glaucoma and findings were summarized by research methodology used and area of impairment.

RESULTS

Identified methods for capturing glaucoma-related disability included qualitative descriptions, glaucoma-specific quality of life questionnaires, vision-specific questionnaires, general health questionnaires, functional domain-specific questionnaires, evaluation of task performance, event assessment (ie, falls and motor vehicle accidents), and real-world behavior (ie, daily physical activity). Findings using these methods show a strong relationship between glaucoma and/or glaucoma severity and difficulties with reading, driving, mobility, and other tasks such as prehension and facial recognition. In addition, glaucoma has financial and psychological implications on the patient, and can affect caregivers in some cases as well.

CONCLUSIONS

A wide variety of research tools have been used to characterize the disability resulting from glaucoma. Together, these tools show that glaucoma affects many abilities which are important for independent living. Strengths and limitations of the various research techniques are discussed so that future studies may use the method(s) most suitable for answering the research question posed.

Influences of personality characteristics and coping modes on anxiety in primary glaucoma patients

AIM

To examine the influences of personality characteristics and coping modes on the anxiety of primary glaucoma patients.

METHODS

A total of 200 individuals, including 50 with primary angle-closure glaucoma, 60 with primary open angle glaucoma and 90 control participants, filled out the State-Trait Anxiety Inventory, NEO Five-Factor Inventory, and Medical Coping Modes Questionnaire. Sociodemographic information was also collected. Data were analyzed via the Spearman rank correlation test and stepwise regression.

RESULTS

The personality and coping variables are predictive and jointly account for a significant amount (45.3%-54.2%) of variance across the two subscales of anxiety measures. Notably, neuroticism seems to be most closely related to anxiety disturbances in glaucoma patients. The level of resignation is positively linked to anxiety scores.

CONCLUSION

Some personality factors and coping modes help to predict the process of anxiety disorders in primary glaucoma patients. Recognizing the predictive role of these variables in the patients may further enrich clinical research in glaucoma and help to design more effective interventions involving both ophthalmology and psychiatry.

Sleep Disorders are a Prevalent and Serious Comorbidity in Dry Eye

Purpose

Sleep is an essential life habit and closely associated with lifespan, diabetes, hypertension, and mental health. Sleep disorders are a prominent, but overlooked problem in patients with dry eye disease (DED), characterized by a poor sleep index, short sleep duration, long sleep latency, and poor subjective sleep. DED and sleep disorders are more prevalent in women than men. Moreover, sleep quality in DED is worse than in other eye diseases, including glaucoma, retinal diseases, cataract, and allergic and chronic conjunctivitis.

Methods

We reviewed the literature for studies investigating sleep and health, eyes and sleep, and DED and sleep, in terms of systemic and eye health, especially in women.

Results

Two studies reported that approximately half of patients with DED suffer from poor sleep. The severity of mood disorders, including anxiety and depression, is correlated strongly with sleep disorders in DED, and the symptoms and signs of DED, especially pain, also are correlated with sleep quality. Sleep disorders are documented in primary Sjögren's syndrome and an association with sleep apnea and depression is suggested. Primary Sjögren's syndrome includes arthritis and other rheumatic disease causing pain and fatigue; however, how sicca contributes to sleep disorders is not known.

Conclusions

Possible explanations for sleep disorders in DED may be depression, pain, and eye exposure at night. Reciprocal effects may be expected and consultation-liaison psychiatry is recommended for the management of sleep disorders in DED. Topical medication and lid heating also may be advantageous for sleep quality in DED.

Altered whole-brain gray matter volume in primary angle closure glaucoma patients: a voxel-based morphometry study

The study aimed to compare the whole-brain gray matter volume (GMV) and white matter volume (WMV) difference between primary angle closure glaucoma (PACG) patients and health controls (HCs) using a voxel-based morphometry method. A total of 27 patients with PACG (17 males and 10 females) and 27 HCs (17 males and 10 females), closely matched for age and education, were enrolled in the study. All subjects underwent magnetic resonance imaging (MRI) scans. The MRI data were processed using SPM8 software in voxel-based morphometry 8 toolbox. The relationship between the mean GMV values of brain regions and the clinical features including psychological testing and mean retinal nerve fiber layer (RNFL) thickness in PACG groups were analyzed by using Pearson correlation. Compared with HCs, PACG patients showed significantly decreased GMV values in the left cerebellum posterior lobe (CPL), right extra-nuclear, and right superior temporal gyrus. In contrast, PACG patients showed significantly increased GMV values in the left CPL, right CPL, right superior temporal gyrus, right thalamus and right insula (P<0.01). Moreover, in the PACG group, the left mean RNFL showed a positive correlation with the mean GMV values of the left CPL (r=0.719; P<0.001) and the right mean RNFL showed a positive correlation with the mean GMV values of the left CPL (r=0.721; P<0.001). The Hamilton depression score showed a positive correlation with the mean GMV values of right insula (r=0.897; P<0.001). Our results demonstrated that PACG patients showed altered brain structure in various regions related to visuomotor function, thalamocortical pathway, and emotion function, which might provide a useful informations to understanding the anatomy neural mechanisms of deficit in vision loss and depression in PACG.

Frequency-dependent neural activity in primary angle-closure glaucoma

OBJECTIVE

In this study, we aimed to investigate the frequency-dependent spontaneous neural activity in primary angle-closure glaucoma (PACG) using the amplitude of low-frequency fluctuations (ALFF) method.

PATIENTS AND METHODS

In total, 52 PACG individuals (24 males and 28 females) and 52 normal-sighted controls (NS; 24 males and 28 females) who were closely matched in age, sex, and education underwent resting-state magnetic resonance imaging scans. A repeated-measures ANOVA and post hoc two-sample t-tests were conducted to analyze the different ALFF values in two different frequency bands (slow-4, 0.027-0.073 Hz and slow-5, 0.010-0.027 Hz) between the two groups. Pearson's correlation analysis was conducted to reveal the relationship between the mean ALFF values and clinical variables in the PACG group.

RESULTS

Compared to the NS group, the PACG group had high ALFF values in the right inferior occipital gyrus and low ALFF values in the left middle occipital gyrus, left precentral gyrus, and left postcentral gyrus in the slow-4 band. The PACG group had high ALFF values in the right inferior occipital gyrus and low ALFF values in the left inferior parietal lobule, left postcentral gyrus, and right precentral/postcentral gyrus in the slow-5 band. Specifically, we found that the abnormal ALFF values in the bilateral posterior cingulate gyrus and bilateral precuneus were higher in the slow-4 than in the slow-5 band, whereas ALFF in the bilateral frontal lobe, right fusiform, and right cerebellum posterior lobe were higher in the slow-5 than in the slow-4 band. The greater mean ALFF values of the right inferior occipital gyrus were associated with smaller retinal nerve fiber layer thickness and greater visual fields in PACG group in the slow-4 band.

CONCLUSION

Our results highlighted that individuals in the PACG group showed abnormal spontaneous neural activities in the visual cortices, sensorimotor cortices, frontal lobe, frontoparietal network, and default mode network at two frequency bands, which might indicate impaired vision and cognition and emotion function in PACG individuals. These findings offer important insight into the understanding of the neural mechanism of PACG.

Subcortical visual pathway may be a new way for early diagnosis of glaucoma

Glaucoma is the leading cause of irreversible blindness worldwide, which is now viewed as a disease of brain with pathogenesis not fully understood. The main diagnostic methods are examining the retinal nerve fiber layer through optical coherence tomography and investigating visual field defect, but these methods present disadvantages in clinical practice. Studies have shown that patients with glaucoma often suffer negative emotion like anxiety and depression which is related to abnormal or reduced amygdala. Moreover, selective reduction of fMRI responses to transient achromatic stimuli in the superficial layer of the superior colliculus was found in the early glaucoma patients. By summarizing previous studies, we developed a hypothesis: superior colliculus-pulvinar-amygdala subcortical visual pathway may be involved in the incidence or progression of glaucoma. Validating this hypothesis would further clarify the mechanism of glaucoma and lead to the development of a more sensitive method for making an early diagnosis of glaucoma.

Illness uncertainty, anxiety and depression in Chinese patients with glaucoma or cataract

This study evaluated illness uncertainty, anxiety and depression among glaucoma patients and cataract patients in China. 263 patients with primary glaucoma and 100 patients with age-related cataract were recruited sequentially from Zhongshan Ophthalmic Center between October 2013 and March 2016. All the participants completed questionnaires for socio-demographic information, Mishel Uncertainty in Illness Scale (MUIS) and Hospital Anxiety and Depression Scale (HADS). 25 of the 263 glaucoma patients and 21 of the100 cataract patients finished two copies of the same questionnaires before and after surgery. Statistics were analyzed using SPSS17.0 software. We observed that glaucoma patients had higher MUIS and HADS score than did cataract patients. Multivariate logistic regression analysis indicated risk factors for illness uncertainty, anxiety and depression for glaucoma patients were high HADS score, poor visual acuity (VA) in the better eye and education level respectively. Risk factors for the same parameters of cataract patients were high HADS-A score, poor VA in the better eye and high illness uncertainty respectively. Scores of MUIS and HADS both decreased after surgery, but the change in HADS score among glaucoma patients was not significant. Clinical workers should take these factors into account to improve therapy, especially for glaucoma patients who undergo surgery.

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.

Changes of Visual Pathway and Brain Connectivity in Glaucoma: A Systematic Review

Background: Glaucoma is a leading cause of irreversible blindness worldwide. The increasing interest in the involvement of the cortical visual pathway in glaucomatous patients is due to the implications in recent therapies, such as neuroprotection and neuroregeneration. Objective: In this review, we outline the current understanding of brain structural, functional, and metabolic changes detected with the modern techniques of neuroimaging in glaucomatous subjects. Methods: We screened MEDLINE, EMBASE, CINAHL, CENTRAL, LILACS, Trip Database, and NICE for original contributions published until 31 October 2017. Studies with at least six patients affected by any type of glaucoma were considered. We included studies using the following neuroimaging techniques: functional Magnetic Resonance Imaging (fMRI), resting-state fMRI (rs-fMRI), magnetic resonance spectroscopy (MRS), voxel- based Morphometry (VBM), surface-based Morphometry (SBM), diffusion tensor MRI (DTI). Results: Over a total of 1,901 studies, 56 case series with a total of 2,381 patients were included. Evidence of neurodegenerative process in glaucomatous patients was found both within and beyond the visual system. Structural alterations in visual cortex (mainly reduced cortex thickness and volume) have been demonstrated with SBM and VBM; these changes were not limited to primary visual cortex but also involved association visual areas. Other brain regions, associated with visual function, demonstrated a certain grade of increased or decreased gray matter volume. Functional and metabolic abnormalities resulted within primary visual cortex in all studies with fMRI and MRS. Studies with rs-fMRI found disrupted connectivity between the primary and higher visual cortex and between visual cortex and associative visual areas in the task-free state of glaucomatous patients. Conclusions: This review contributes to the better understanding of brain abnormalities in glaucoma. It may stimulate further speculation about brain plasticity at a later age and therapeutic strategies, such as the prevention of cortical degeneration in patients with glaucoma. Structural, functional, and metabolic neuroimaging methods provided evidence of changes throughout the visual pathway in glaucomatous patients. Other brain areas, not directly involved in the processing of visual information, also showed alterations.

Decision-making Impairments in Primary Angle-closure Glaucoma Patients

Background:

Primary angle-closure glaucoma (PACG) is a common eye disease and a common cause of blindness. Inappropriate medical decisions severely affect the prognosis. This study investigated decision-making under risk in PACG patients.

Methods:

Thirty patients with first acute attack of PACG before surgery and thirty healthy controls were included in the study. Decision-making under risk was evaluated with the game of dice task (GDT). The results of Eysenck Personality Questionnaire (EPQ) and GDT between PACG patients and healthy controls were compared.

Results:

Risky decisions in PACG patients were more than those in healthy controls as measured by mean score of GDT (12.47 ± 5.72 vs. 4.33 ± 3.30, P < 0.001). Higher neuroticism score in EPQ was found in PACG patients compared to healthy controls (14.97 ± 3.93 vs. 9.90 ± 4.49, P < 0.001). Neuroticism scores in EPQ were associated with decision-making performance (r = 0.417, P = 0.001).

Conclusions:

Neuroticism positively correlated with risky decisions. Decision-making might be influenced by neuroticism. Future studies will show whether therapy compliance will be improved by emotional management and psychological intervention in PACG patients.

Dry eye, sleep quality, and mood status in glaucoma patients receiving prostaglandin monotherapy were comparable with those in non-glaucoma subjects

Purpose

Prior studies suggested that glaucoma patients suffer worse dry eye and mood and sleep disorders than non-glaucoma subjects. Prostaglandin analogues are first-line therapy for glaucoma, inducing few instillation problems and sufficient pressure-reduction effects. This study compared dry eye, sleep quality, and mood status between glaucoma patients receiving prostaglandin monotherapy and non-glaucoma subjects.

Methods

This cross-sectional study evaluated 1520 patients (579 males and 941 females) for glaucoma status and dry eye-related symptoms (dryness, eye fatigue, photophobia, pain, blurring) and signs (Schirmer test, tear break-up time, corneal staining scores). Of the total cohort, 93 patients were also evaluated by Pittsburgh sleep quality index (PSQI) and hospital anxiety and depression score (HADS). Inclusion criteria were consecutive patients ≥ 51 years of age and best-corrected visual acuity ≥ 20/25. Glaucoma patients included those treated with prostaglandin or a fixed combination including prostaglandin. Exclusion criteria were history of ocular surgery within one month. Data were analyzed using the chi-square or Mann-Whitney U tests, at 5% significance.

Results

There were no significant differences in dry eye-related signs and symptoms between the control (n = 1431, mean age of 66.9 years) and glaucoma groups (n = 89, 67.9 years). The psychiatric sub-analysis of the control (n = 61, 66.2 years) and glaucoma groups (n = 32, 67.3 years) revealed mean scores of 5.02 ± 3.10 and 5.16 ± 3.46 for PSQI (normal range ≤ 5), 9.47 ± 5.61 and 9.42 ± 7.36 for HADS (normal range ≤ 10), 4.84 ± 3.22 and 4.71 ± 3.45 for anxiety (normal range ≤ 5), and 4.63 ± 3.05 and 4.71 ± 4.40 for depression (normal range ≤ 5), respectively, without statistical significance.

Conclusions

Our results were comparable between glaucoma patients on prostaglandin monotherapy and non-glaucoma subjects for dry eye-related clinical manifestations, sleep quality, and mood status.

The Association Between Glaucoma, Anxiety, and Depression in a Large Population

PURPOSE

To investigate the association between glaucoma and each of anxiety and depression.

DESIGN

Retrospective case-control study.

METHODS

Settings: University of North Carolina hospitals and outpatient clinics.

STUDY POPULATION

All patients over the age of 18 years seen between July 1, 2008 and October 1, 2015 were included.

OBSERVATION PROCEDURE

International Classification of Diseases codes were used to identify cases of glaucoma, as well as anxiety and depression.

OUTCOME MEASURE

Odds ratios (OR) were calculated for glaucoma and each of anxiety and depression. OR were also calculated for above diagnoses separated by age group and sex.

RESULTS

A total of 4 439 518 patients were screened, of which 11 234 (0.3%) have glaucoma, 96 527 (2.2%) have anxiety, and 103 476 (2.3%) have depression. The adjusted OR was 10.6 (95% confidence interval [CI] 10.0-11.0) for glaucoma and anxiety and 12.3 (95% CI 11.8-12.9) for glaucoma and depression. The likelihood of having anxiety and depression along with glaucoma did not change with age (P = .088, P = .736).

CONCLUSION

There was a statistically significant association between glaucoma and each of anxiety and depression.

Assessment of Depression, Anxiety, and Quality of Life in Singaporean Patients With Glaucoma

PURPOSE

To determine the prevalence and risk factors for anxiety disorder and depression among glaucoma patients in Singapore, and to assess the relationship between quality of life (QOL) and depression/anxiety.

METHODS

In this cross-sectional study, glaucoma patients aged 21 and above with a known diagnosis of primary open-angle glaucoma or primary angle-closure glaucoma were recruited from a tertiary care hospital. Patients with other types of glaucoma, and coexisting ocular or psychiatric disorders were excluded.Ophthalmic examination was carried out on all participants, which included best-corrected visual acuity (BCVA), intraocular pressure (IOP), gonioscopy, standard automated perimetry, and optic disc evaluation. Sociodemographic information and treatment histories were also collected.The Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Visual Function Questionnaire (VFQ25) were administered to evaluate for depression, anxiety, and impact on QOL, respectively.

RESULTS

A total of 100 patients were included in this study. The mean age was 67.1±12.0 years (range, 24 to 90 y). The frequency of depression and anxiety among our patients was 30% and 64%, respectively. The mean HAM-D score was 4.37±4.17 (range, 0 to 17), whereas the mean HAM-A score was 2.38±2.80 (range, 0 to 13). The mean VFQ25 score was 78.8±16.0 (range, 42.4 to 97.0). The poorest subscale on the VFQ25 was driving, with a mean score of 42.4±42.6 (range, 0.0 to 100.0).We did not find any significant difference between the presence of depression/anxiety between patients with primary open-angle glaucoma (P=0.263) and primary angle-closure glaucoma (P=0.830). Risk factors for depression included: female sex (P=0.020), higher logMAR BCVA in the worse eye (P=0.004), higher cup-disc ratio (P=0.016), lower MD in the better and worse eye (P=0.022 and 0.001, respectively), and lower mean VFQ25 score (P<0.001). Risk factors for anxiety included: lower MD in the worse eye (P=0.004) and lower mean VFQ25 score (P=0.004). There was also no significant association between the use of topical β-blockers/carbonic anhydrase inhibitors with depression (P=0.793) or anxiety (P=0.282).

CONCLUSIONS

There is a relatively high prevalence of depression (30%) and anxiety disorders (64%) among glaucoma patients in Singapore. Female glaucoma patients are more likely to suffer from depression. Other risk factors for depression include higher cup-disc ratio, higher logMAR BCVA, lower MD, and a lower mean VFQ25 score. Risk factors for anxiety disorder include lower MD and lower mean VFQ25 score. Ophthalmologists could consider use of the VFQ25 as an assessment for impairments in QOL in a glaucoma patient. If a glaucoma patient is at high risk of depression or anxiety disorder, a multidisciplinary management approach involving ophthalmology and psychiatry may be required.

The Prevalence of Depression and Depressive Symptoms among Eye Disease Patients: A Systematic Review and Meta-analysis

The prevalence of depression among different eye disease patients varies across studies and has not been systematically reviewed. This study is to provide a summary of the prevalence of depression among eye disease patients. PubMed, Medline, Embase and Cochrane Library were searched from January, 1990 to December, 2015 to identify studies with information on the prevalence of depression among ophthalmic patients. A random/fixed-effects meta-analysis was used to estimate the pooled prevalence of depression among eye disease patients. Heterogeneity was assessed with the I² test. 28 studies were selected from 3162 references. The overall pooled prevalence of depression or depressive symptoms with eye disease was 25% (1502/6589 individuals, 95% CI, 0.20–0.30) ranging from 5.4% to 57.0%. Regarding different disease categories, the highest prevalence was revealed for dry eye disease (DED) with 29%, followed by 25% for glaucoma patients, 24% for age-related macular degeneration (AMD) patients, 23% for cataract patients. The increased pooled prevalence of depression was identified in those with eye diseases compared with healthy controls (OR, 1.59; 95% CI, 1.40–1.81; I² = 68.5%). Substantial heterogeneity was identified across most estimates (I² > 75%). Further research is needed to identify effective strategies for preventing and treating depression among eye disease patients.

Psycho-ophthalmology: Contributions of Health psychology to the assessment and treatment of glaucoma

BACKGROUND

Asymptomatic in its early stages, glaucoma is the second leading cause of blindness worldwide. While psychosocial factors are taken into consideration for a host of diseases such as cancer, heart disease and autoimmune conditions, to date, psychological issues have been ignored in the clinical management of glaucoma.

OBJECTIVE

This work reviews the most relevant contributions from a health psychology perspective for the assessment and treatment of glaucoma, which is emerging in the field of psycho-ophthalmology.

METHOD

To provide scientific evidence regarding contributions of psychology to the comprehension of glaucoma, a bibliographic review of three databases (Psicodoc, PsycInfo and Medline) was conducted, spanning the period between 1940 and 2016.

RESULTS

This review yielded a total of 66 studies published in the period analysed and identified three areas where health psychology has made substantive contributions to glaucoma screening, monitoring and treatment: the emotional impact on patients suffering from glaucoma, the adherence to treatment and the effects of stress on intraocular pressure.

CONCLUSIONS

A health psychology approach for research and therapy of glaucoma must focus on the management of the negative affect associated with the diagnosis, the optimisation of treatment adherence and the stress management of the intraocular pressure measurements.

Patient-Reported Vision-Related Quality-of-Life Differences between Primary Angle-Closure Glaucoma and Primary Open-Angle Glaucoma

Purpose

To investigate the different impacts on patient-reported vision-related quality of life (pVRQOL) outcomes in patients with primary angle-closure glaucoma(PACG) and primary open-angle glaucoma(POAG).

Methods

Prospective cross-sectional study. PACG and POAG patients who had a best-corrected visual acuity(BCVA) in the better eye equal to or better than 20/60, intraocular pressure controlled at or below 25 mmHg and reliable visual field test were invited to participate. The control group included patients with BCVA in the better eye equal to or better than 20/60 and who did not have major eye disease. A validated Taiwanese version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25(T)) was performed to assess pVRQOL. The association between each domain of NEI VFQ-25(T) among 3 groups was determined using multivariable linear regression analysis.

Results

A total of 106 PACG, 186 POAG, and 95 controls were enrolled. In multivariable regression analysis of all three groups(PACG/POAG/controls), compared to POAG, PACG showed a weakly positive association with social functioning (R² = 0.13, β = 0.22, P = 0.04). PACG showed no significantly negative impact on pVRQOL compared to controls. Taking only glaucoma patients into consideration, PACG patients had a higher score on social functioning compared to POAG (R² = 0.16, β = 0.27, P = 0.01). The results of other domains of NEI VFQ-25(T) between the two groups did not differ significantly(p>0.05).

Conclusions

In patients with controlled disease, the impact of PACG and POAG on most domains of NEI VFQ-25(T) were similar, except for better social functioning in PACG compared to POAG.

Decreased sleep quality in high myopia children

The aim of the present study was to evaluate sleep quality in myopic children and adults. This cross sectional study surveyed 486 participants aged from 10 to 59 years with refractive errors using a questionnaire containing the Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS). Children (< 20 years) in the high myopia group exhibited the poorest PSQI scores (P < 0.01), while the adults showed no such correlations. Subscales of PSQI and HADS in children disclosed that the high myopia groups had the shortest sleep duration (P < 0.01), worst subjective sleep scores (P < 0.001), and latest bedtime (P < 0.05). Regression analyses in children significantly correlated myopic errors with PSQI (P < 0.05), sleep duration (P < 0.01), and bedtime (P < 0.01). Sleep efficacy (P < 0.05) and daytime dysfunction (P < 0.05) were significantly better in contact-lens users compared to the respective non-user groups across all participants. In conclusion, sleep quality in children was significantly correlated with myopic error, with the high myopia group worst affected.

Depressed visual field and mood are associated with sleep disorder in glaucoma patients

The aim of the present study was to evaluate sleep and mood disorders and related ocular parameters in glaucoma patients. We focused on visual fields and the retinal nerve fibre layer, because decreased circadian photoreception by damaged intrinsically photosensitive retinal ganglion cells is suspected in glaucoma. A cross-sectional study was performed on 140 subjects: 69 with glaucoma and 71 normal controls. Individuals with cataract, dry eye, or retinal pathology were excluded from the study. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS) and underwent comprehensive ophthalmological examinations for glaucoma. Patients with advanced glaucoma had significantly worse PSQI scores than normal controls (P < 0.05). Stepwise multivariate linear regression analysis revealed PSQI was significantly correlated with the mean deviation in the worse eye, the number and frequency of medications, and anxiety and depression subscores of the HADS after adjustment for age and sex (P < 0.05). We did not find a significant correlation between PSQI scores and the thickness of retinal nerve fibre layer. In conclusion, the subjective sleep quality of glaucoma patients was correlated with visual field loss and mood status.

Long-Term Use of Selective Serotonin Reuptake Inhibitors and Risk of Glaucoma in Depression Patients

This study investigated whether the long-term use of selective serotonin reuptake inhibitors (SSRIs) influences the risk of primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) in the Chinese ethnic population in Taiwan.The authors retrieved the data under analysis from the National Health Insurance Research Database in Taiwan and identified 26,186 newly diagnosed depression patients without preexisting glaucoma. The study cohort included 13,093 patients with over 1 year of SSRI use, and a comparison cohort of 13,093 patients who had never used SSRIs. The main outcome was a diagnosis of POAG or PACG during follow-up. The authors used univariable and multivariable Cox proportional hazards regression models to assess the effects of SSRIs on the risk of POAG and PACG.The cumulative incidences of POAG and PACG between the SSRI and comparison cohorts exhibited nonsignificant differences (log-rank test P = .52 for POAG, P = .32 for PACG). The overall incidence of POAG in the SSRI cohort was nonsignificantly higher than that in the comparison cohort (1.51 versus 1.39 per 1000 person-years), with an adjusted hazard ratio of 1.07 (95% confidence interval = 0.82-1.40). The overall incidence of PACG in the SSRI cohort was nonsignificantly lower than that in the comparison cohort (0.95 versus 1.11 per 1000 person-years), with an adjusted hazard ratio of 0.85 (95% confidence interval = 0.62-1.18).The long-term use of SSRIs does not influence the risk of POAG or PACG in depression patients.

Network Centrality of Resting-State fMRI in Primary Angle-Closure Glaucoma Before and After Surgery

Purpose

Using voxel-wise degree centrality (DC), as measured by resting-state fMRI, we aimed to study alterations in the brain functional networks in patients with primary angle-closure glaucoma (PACG) and to reveal the plastic trajectories of surgery.

Methods

A total of 23 preoperative PACG patients (49.48 ± 14.37 years old) were recruited to undergo a resting-state fMRI scan, and 9 of them were rescanned 3 months after surgery. All PACG patients underwent a complete ophthalmologic examination, including intraocular pressure (IOP), retinal nerve fiber layer (RNFL) thickness, vertical cup to disc ratio (V C/D), and average cup to disc ratio (A C/D). Another 23 gender- and age-matched healthy controls (48.18 ± 9.40 years old) underwent scanning once for comparison. The group difference in DC was calculated in each voxel, and the correlations between the DC value and each of the clinical variables were analyzed in the PACG patients.

Results

Preoperative PACG (pre-PACG) patients showed significantly decreased DC in the bilateral visual cortices but increased DC in the left anterior cingulate cortex (ACC) and caudate (p < 0.05, corrected) compared with the controls. Statistical analysis showed a significantly negative correlation between DC in the bilateral visual cortices and the IOP score and between DC in the anterior cingulate cortex (ACC) and both the A C/D and V C/D scores in the pre-PACG patients. Three months after surgery, these postoperative PACG (post-PACG) patients showed a significantly increased DC in both the bilateral visual cortices and the left precentral gyrus compared with the pre-PACG patients.

Conclusions

Our results suggest that PACG may contribute to decreased functional centrality in the visual system and to increased degree centrality in cognition-emotional processing regions. Alterations in visual areas seem to parallel the cup to disc ratio, but not the duration of angle closure. The changes of functional centrality in PACG patients after operation may reveal the plasticity or degeneration of the visual-associated brain areas. Our findings may provide further understanding of the pathophysiology of PACG.

The temperament and character personality profile of the glaucoma patient

BACKGROUND

To determine the temperament and character profile of glaucoma patients.

METHODS

A total of 234 patients (104 with primary open angle glaucoma, and 130 control subjects without any ocular disease) were selected for this prospective, cross-sectional study. All the participants underwent a comprehensive ophthalmological examination, including the best corrected visual acuity, intraocular pressure measurement, gonioscopy, and visual field analysis. All the participants were given the Turkish version of the Temperament and Character Inventory (TCI). The TCI is a self-reported evaluate, with 240 true/false items measuring four domains of temperament; harm avoidance (HA), persistence (PS), novelty seeking (NS), reward dependence (RD), and three domains of character; self-transcendence (ST), cooperativeness (C), self-directedness (SD).

RESULTS

The glaucoma patients achieved the higher scores than the controls for the HA and SD dimensions (p < 0.001 and p = 0.033). The glaucoma patients scored lower than the controls for the NS, P and ST dimensions (p < 0.001, p < 0.001 and p = 0.002). There were no differences in the RD and C scores between the patients and the controls (p = 0.944 and p = 0.343). There was no correlation between the duration of illness and the TCI dimensions. Disease severity was positively associated with HA (r = 0,220, p = 0,025) and the anticipatory worry (r = 0.227, p = 0.021) dimension.

CONCLUSIONS

Glaucoma patients had a different personality profile to healthy individuals. This may affect treatment compliance and is also important when coping with maladaptive patient attitudes.