Glaucoma is a progressive eye disease characterized by retinal ganglion cell death and vision loss. There is currently no effective treatment for ganglion cell degeneration, and the treatment of glaucoma is focused on lowering intraocular pressure (IOP) and preventing progression. 

Various studies have linked glaucoma with anxiety and depression. Many of them indicate that receiving a glaucoma diagnosis can lead to psychological stress. Anxiety and depression are reactions to stress, and they elicit the secretion of neurotransmitters that stimulate the autonomic nervous system. 

A new study published in Scientific Reports explored the question of whether or not anxiety and depression may impact glaucoma disease progression.*  

What they did

In the two-year retrospective case-control study, conducted at Seoul St. Mary’s Hospital between December 2018 and February 2020, scientists monitored 251 participants who had open-angle glaucoma (OAG).

The Beck Anxiety Inventory (BAI) and Beck Depression Inventory-II (BDI-II) were used to evaluate participants’ anxiety and depression. Patients were classified into the following groups, according to their scores:

• High-anxiety group 
• Low-anxiety group 
• High-depression group 
• Low-depression group 

What they found

Among the 251 glaucoma patients:

• 44 (16.7%) were in the high-anxiety group.
• 209 (83.3%) were in the low-anxiety group. 
• 40 (15.9%) were in the high-depression group.
• 211 (84.1%) were in the low-depression group.

In the high-anxiety group:

• The incidence (new cases) of disc hemorrhage (bleeding in the optic nerve head and retina) was higher. 
• Mean IOP and peak IOP were higher.
• The rate of retinal nerve fiber layer (RNFL) thinning during follow-up was faster. 

Disc hemorrhage (though rare) and elevated IOP are well-known risk factors for both the development and progression of glaucoma. Research also shows that, in OAG, substantial RNFL thinning must occur before flaws in the visual field become detectable. 

In this study, the following symptoms were shown to be associated with a faster rate of RNFL loss:

• Numbness or tingling
• Feeling hot
• Leg wobbliness 
• Dizziness or lightheadedness 
• Heart pounding or racing
• Unsteadiness
• Feeling terrified or afraid 
• Having a flushed face

In the high-depression group:

• Visual field mean deviation scores were worse, particularly for patients with guilt/punishment feelings or self-dislike.
• Heart rate variability was significantly higher.

What it means

The study results demonstrated that anxiety is significantly associated with:

• Variation in IOP
• Occurence of disc hemorrhage
• Faster rates of RNFL thinning in patients with glaucoma

IOP is one of the mechanical risk factors, and disc hemorrhage one of the vascular risk factors, that indicate insufficient blood flow. Decreased ocular blood flow is linked to glaucoma development and progression. Therefore, it is likely that the collective physiological impacts of anxiety and depression affect both the development and progression of glaucoma.

*Shin, D. Y., Jung, K. I., Park, H. Y., L., & Park, C. K. (2021, Jan. 19). The Effect of Anxiety and Depression on Progression of Glaucoma. Scientific Reports.     https://www.nature.com/articles/s41598-021-81512-0 

Any sources from outside of Prevent Blindness do not imply an endorsement from Prevent Blindness. The contents of the material used are the responsibility of the authoring organization, Responsum Health.