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Psychological Impact on Glaucoma Patients

by | Feb 1, 2023 | Manuscripts | 0 comments

Dipti Bharti, M. Optom

Fellow Optometrist, Dr. Shroff’s Charity Eye Hospital, New Delhi, India

 

Glaucoma is a chronic progressive optic neuropathy resulting from the structural changes of the Optic Nerve Head (ONH) & subsequently causing permanent visual field loss, which in turn leads to irreversible blindness. Intra Ocular Pressure is currently considered one of the major risk factors of glaucoma. As we know, chronic disease is known to be highly associated with psychological disturbances like depression & anxiety. (1-2)

It is in line with the maximum study that the high prevalence of anxiety or depression as a consequence of being diagnosed with glaucoma results from the fear of potential blindness, & impaired daily tasks. (3-4)

World health organization (WHO) has defined quality of life (QoL) as an individual’s perspective of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. (5)

Impairment of QoL in glaucoma may be attributed to visual disability and psychosocial factors such as lack of awareness about the disease as well as knowledge of having a potentially blinding condition.

Additional factors such as long-term medication, adverse effects of medication, long- term follow-up may further aggravate the problem. (6)

Some studies show anxiety and/or depression may lead to the development of diseases like respiratory disorders, cardiovascular disorders, Gastroenterology disorders and raise amygdala. (7-9)

These emotional responses evoke secretions of neurotransmitters and stimulate the autonomic nervous system (ANS), which affects multiple organs. (10)

The ANS which can be affected by emotions is also important in the development of glaucoma progression. (11,12)

Factors affecting the quality of life in glaucoma: –

  • Disability due to visual field defect
  • Adverse effects related to treatments
  • The psychological impact of a diagnosis of glaucoma
  • Financial & economic perspective.
    • i. Disability due to visual fields:

      Glaucoma initially affects peripheral vision and in severe cases, it affects paracentral & central vision. Some indications, include:

      • o Bumping objects while walking,
      • o In the advanced stage, the patient becomes dependent on Daily living task
      • o Decrease contrast sensitivity and dark adaptation
      • o Difficulty in the night driving, fear of falling increases
    • ii. The adverse effect of drugs:

      To lower or control IOP, patients use anti-glaucoma medication (AGM) for the long term which has some side effects like:

      • a) Prostaglandin Analogues (e.g., Latanoprost, Bimatoprost, Travoprost): Help to lower IOP, which has certain side effects, such as darkening of iris colour,
        Trichomegaly (eyelash growth), Conjunctival hyperaemia
      • b) Beta-blockers (e.g., Timolol, betaxolol): Reduce the production of aqueous humour by acting on a ciliary body, inhibiting the beta-adrenergic receptors, the
        side effects include dry eye, punctate keratitis, ocular stinginess
    • iii. The psychological impact of a diagnosis of glaucoma(13)
      • o Individuals with glaucoma tend to develop negative emotions such as anxiety or depression which are detrimental to their daily functioning & well-being.
      • o Some patients misinterpret the diagnosis of glaucoma as that of impending blindness.
      • o Daily routine change, regular use of medication, lifelong treatment, and fear of blind lead to psychological stress for the patients.
    • iv. Financial and economic perspective:

      As glaucoma becomes a financial burden to the patient due to the cost of treatment whether medical or surgical.
      Due to long-term treatment in medication, and diagnostic test, hospital fee leads to financial loss to those employed on daily wages.

      This leads to adhering to treatment & follow-ups which increase the risk of loss of livelihood.

Management options:

  • Patient counselling

Necessary periodic motivation requires for treatment & follow-up as patients suffer from psychological stress & feeling panic & depressed

  • Assessment of psychological state & quality of life
  • Vocational training

As the disease progress to advanced stages, patients limit their livelihood. In this situation, patients need vocational training as well as education on how to utilise their functional vision by using Low Vision Devices (LVD). This will help the patient’s Daily standard of living (DSL) as well as improve independence and confidence to enhance the quality of life.

  • Creating awareness among the general population

With a constant increase in glaucoma patients in our society, it is paramount to improve their knowledge about glaucoma and help such patients by promoting motivation.

 

References:

  1. Clarke DM, Currie KC. Depression, anxiety, and their relationship with chronic diseases: a review of the epidemiology, risk, and treatment evidence. Medical Journal of Australia. 2009 Apr;190:S54-60.
  2. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. The Lancet. 2007 Sep 8;370(9590):851-8.
  3. Rezapour J, Nickels S, Schuster AK, Michal M, Münzel T, Wild PS, Schmidtmann I, Lackner K, Schulz A, Pfeiffer N, Beutel ME. Prevalence of depression and anxiety among participants with glaucoma in a population-based cohort study: The Gutenberg Health Study. BMC ophthalmology. 2018 Dec;18(1):1-9.
  4. Gelder M, Gath D, Mayou R. Oxford textbook of psychiatry. Oxford university press; 1989.
  5. World Health Organiztion. WHOQOL: Measuring Quality of Life. WHO; 2014? [Last accessed on 2022 Oct 02]. Available from: http://wwwwhoint/healthinfo/survey/whoqol-qualityoflife/en/ [Google Scholar]
  6. Kalyani VK, Dayal A, Chelerkar V, Deshpande M, Chakma A. Assessment of psychosocial impact of primary glaucoma and its effect on quality of life of patients in Western India. Indian Journal of Ophthalmology. 2020 Nov;68(11):2435.
  7. Suls J, Bunde J. Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions. Psychological bulletin. 2005 Mar;131(2):260.
  8. Sibelli A, Chalder T, Everitt H, Workman P, Windgassen S, Moss-Morris R. A systematic review with meta-analysis of the role of anxiety and depression in irritable bowel syndrome onset. Psychological medicine. 2016 Nov;46(15):3065-80.
  9. Martin EI, Ressler KJ, Binder E, Nemeroff CB. The neurobiology of anxiety disorders: brain imaging, genetics, and psychoneuroendocrinology. Clinics in laboratory medicine. 2010 Dec 1;30(4):865-91.
  10. Hoehn-Saric R, McLeod DR, Funderburk F, Kowalski P. Somatic symptoms, and physiologic responses in generalized anxiety disorderand panic disorder: an ambulatory monitor study. Archives of general psychiatry. 2004 Sep 1;61(9):913-21.
  11. Shin DY, Jeon SJ, Park HY, Park CK. Posterior scleral deformation and autonomic dysfunction in normal tension glaucoma. Scientific Reports. 2020 May 18;10(1):1-7.
  12. Park HY, Jung SH, Park SH, Park CK. Detecting autonomic dysfunction in patients with glaucoma using dynamic pupillometry. Medicine. 2019 Mar;98(11).
  13. Dayal A. Psychosocial aspects of glaucoma. InOcular Hypertension-The Knowns and Unknowns 2021 Apr 21. IntechOpen.

 

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