Patients with Glaucoma Have Higher Psychological Disorder Prevalence, Severity

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Clinicians should consider having conversations pertaining to well-being with patients with glaucoma and referring them to appropriate support services when necessary.

Patients with glaucoma are more likely to have depression, anxiety, and sleep disorder compared with those who do not have glaucoma, according to a study published in the Canadian Journal of Ophthalmology.

Researchers conducted a meta-analysis of 45 studies including 995,538 patients with and without glaucoma. Primary outcome measures were the prevalence of anxiety, depression, and sleep disorders, and impact on Vision Related Quality of Life (VRQoL) for patients with glaucoma compared with controls.

The investigators determined that the prevalence of all 3 disorders was higher among patients with glaucoma. They found that about 19% of patients with glaucoma had depression and were more likely to have more severe depressive symptoms (standardized mean difference (SMD)=0.46, 95% CI, 0.19-0.73) compared with individuals without glaucoma.

Patients with primary angle-closure glaucoma (SMD=1.77, 95% CI, 1.31-2.24) tended to have more severe symptoms of depression compared with patients with other types of glaucoma.

A total of 25% of participants with glaucoma reported anxiety. These patients  were not only more likely to have anxiety, but a higher severity of anxiety-related symptoms (SMD=0.44, 95% CI, 0.08-0.81) compared with those in the control group.

Among the cohort with glaucoma, patients with primary angle-closure glaucoma (SMD=1.38 95%, CI, 0.94-1.82) and primary open-angle glaucoma (POAG) (SMD=0.66, 95% CI, 0.16-1.17) had significant anxiety levels.

Almost half of patients with glaucoma (47%) had sleep disorders (95% CI, 0.26-0.68) and worse sleep quality compared with the control group (SMD=0.72, 95% CI, 0.22-1.21). Those with primary angle-closure glaucoma (SMD=1.48, 95% CI, 1.14-1.82) or POAG (SMD=1.05, 95% CI, 0.34-1.76) had even poorer sleep quality still.

“Glaucoma is likely associated with higher rates of depression, anxiety, and sleep disorders as well as a greater severity of symptoms in glaucoma patients,” according to the researchers. “An open dialogue with patients that facilitates discussions about mental well-being and directs them to appropriate support services may help patients with glaucoma.”

Limitations of the study include potential confounding due to the possible inclusion of patients with other eye conditions and other factors such as age or socioeconomic status.


Groff ML, Choi B, Lin T, et al. Anxiety, depression, and sleep-related outcomes of glaucoma patients: a systematic review and meta-analysis. Can J Opthalmol. Published online March 16, 2022. doi: 10.1016/j.jcjo.2022.02.010