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Tharmathurai and colleagues report no relevant financial disclosures.
A study of depression in primary open-angle glaucoma patients found a higher rate in older adults, which can affect adherence to glaucoma treatment.
“Depression significantly reduces adherence to treatment,” Sangeetha Tharmathurai, MMed, of the University of Science, Malaysia, and colleagues wrote in the Journal of Glaucoma. “Therefore, early identification of depression among patients with glaucoma is important in preventing the progression of the disease and eventual blindness.”
Tharmathurai and colleagues recruited 360 primary open-angle glaucoma (POAG) patients aged 60 years and older from two ophthalmology clinics in Malaysia during their follow-up glaucoma appointments; most patients were women (n = 195). Investigators stratified patients by glaucoma severity (mild, moderate, severe or end stage) using the modified Advanced Glaucoma Intervention Study (AGIS) scoring system.
As the primary researcher, Tharmathurai conducted face-to-face interviews with participants using the Malay Version Geriatric Depression Scale 14 (mGDS-14) questionnaire. In the mGDS-14 questionnaire, each yes/no question is scored 1 or 0, and a score of 8 or more indicates depression. To compare mean depression scores between the groups, researchers used one-way analysis of variance (ANOVA).
Study results showed 16% of participants had depression, with a higher percentage of depression in those with end stage glaucoma. Investigators reported a significant increase in the mean mGDS-14 score by severity of POAG.
“Based on the finding from the present study, physicians, especially ophthalmologists, psychiatrists and gerontologists, should possess a higher index of suspicion of depression in treating older adults with POAG,” Tharmathurai and colleagues wrote. “Addressing this problem may improve the quality of life of older adults and prevent unwanted sequelae, including suicide.”
Perspective
While it is natural to focus on delivery of eye care as optometrists, we must not forget that we are caring for people and not just managing ocular conditions. Glaucoma is generally progressive, and even the idea of losing vision (let alone actually experiencing it) can be psychologically traumatizing.
There is a well-established link between glaucoma and depression in older adults. Mental health is not only important for the patient’s overall happiness, but depression also has an adverse effect on adherence.
Although this study was limited in scope, it does highlight a common theme found in previous research: the potentially debilitating impact of POAG on quality of life. As clinicians, we must choose our words carefully and consider that patients may not be OK even if they seem fine. Always give glaucoma patients a way to contact their provider and ask follow-up questions. Staff must be trained to identify red flags and offer resources. If depression has a negative effect on adherence, imagine what some positive reinforcement can do. Always assume your patient is trying their best to navigate life’s many challenges. What they need is our support, not our reprimands.
Mark Eltis, OD, FAAO
Lecturer, University of Waterloo
Private practice, Toronto
Member, Optometric Glaucoma Society
Disclosures: Eltis reports no relevant financial disclosures.