It is now well known that emotional health significantly impacts physical and overall health. Depression and anxiety, for instance, can result in a wide variety of symptoms ranging from unpleasant to life-threatening, and even obstruct the healing process despite proven treatment strategies. 

An increasing number of professionals outside the mental health arena, from hairdressers to sports team coaches, are being trained to recognize and respond to signs of anxiety, depression, domestic abuse, and suicidality because they are in a position to observe and interact with people in ways that don’t feel threatening. Ophthalmologists could easily be added to these ranks.  

Think Beyond Eye Care

Dr. Benjamin Casella, an award-winning optometrist in Augusta, Georgia, recalls detecting possible signs of child abuse during an office visit–a vitreous hemorrhage in a young child with no obvious systemic condition or history of trauma. ODs are also in a position, he says, to see and hear what their patients may be trying to tell them, both verbally and nonverbally, so it’s important to look and listen and think beyond eye care to patients’ overall health.

Depression, Anxiety, and Glaucoma

Studies show that anxiety and depression are higher in patients with glaucoma than those without glaucoma and can influence how patients respond to clinical recommendations. Recent research published in BMJ Open Ophthalmology indicated that emotional health could potentially affect patient care.

In the study, 100 patients from the glaucoma and retina divisions of the Wilmer Eye Institute in Baltimore, Maryland filled out the Patient Health Questionnaire (PHQ-9) for depression and the Generalized Anxiety Disorder (GAD-7) tool to assess the likely presence and severity of depression and/or anxiety. The patients’ results were given to their respective ophthalmologists just before an eye exam. 

Following the exams, the ophthalmologists filled out surveys concerning whether the patients’ scores for depression and/or anxiety changed the doctors’ clinical approaches to communication, treatment, follow-up, etc.

What Patients Said, and How Doctors Responded

According to the questionnaires filled out by the patients:

• 48% showed minimal anxiety or depression as their worst score on the surveys
• 27% showed mild to moderate depression or anxiety as their worst score
• 20% showed no anxiety or depression per the surveys prior to the exam
• 5% showed moderate to severe depression or anxiety
• 2% had suicidal thoughts

As for the surveys filled out by the doctors after the examinations were over, based on the patient scores:

• 99% did not change follow-up for any patients 
• 90% paid attention to depression and anxiety in their patient assessment 
• 90% found the questionnaire useful
• 82% did not change their behavior 
• 4% referred a patient to a social worker or psychologist/psychiatrist for further care

None of the doctors changed their treatment based on the patient scores, and 100% thought ophthalmologists were not adequately trained on how depression and anxiety could affect treatment adherence. 

What This Could Mean for Your Practice

The study results suggest that knowledge of a patient’s emotional health could impact both the approach to and consequences of patient care. The training of doctors and screening of patients concerning patients’ emotional health status could have a significant positive impact on patients’ overall health.

*Casella, B. P. (2021, Oct. 20). Beyond Anxiety in Patients with Glaucoma. Optometry Times.   https://www.optometrytimes.com/view/beyond-anxiety-in-patients-with-glaucoma