There are many cultural associations with growing older. Some of them are positive, such as the ability to retire and spend more time with loved ones. Others are less so, like the need for more routine visits to the doctor.
One common association with advanced age is the gradual decline of eyesight. As we grow older, the likelihood of developing a major eye disease with the potential to cause serious vision loss increases.
One of the top three causes of vision loss in both the United States and around the world is glaucoma. A number of studies have been conducted on the effects of glaucoma in recent years, investigating not only the physical characteristics of the disease but also the condition’s potential to impact patients’ mental and emotional lives.
Listed below is an overview of the relationship between the development of glaucoma and mental health issues, such as depression and anxiety.
What is glaucoma?
Before one can understand the mental health effects of the disease, it’s important to know what glaucoma is and how it affects a person’s vision. The term glaucoma describes a condition in which pressure caused by fluid buildup damages the optic nerve of the eye.
The optic nerve is the part of the eye responsible for transmitting all visual information taken in by the retina directly to the brain. It is a crucial component of one’s ability to see.
Most commonly, the disease occurs as primary open-angle glaucoma, which develops over a long period of time. It typically progresses because the eye is unable to drain fluid as efficiently as it should.
Conversely, the less common angle-closure (or “closed-angle”) glaucoma can manifest quite suddenly, occurring in acute attacks, though in some cases it does occur over the long term. Closed-angle glaucoma occurs when a person’s iris is too close to the eye’s drainage angle. This can suddenly cause drainage to stop altogether. Eye pressure then rises very quickly, and a person who does not receive treatment as soon as possible risks becoming totally blind.
If glaucoma is diagnosed early, physicians can generally offer treatment to slow the effects of the disease. Currently, however, no cure exists. Untreated glaucoma eventually results in the loss of peripheral vision. This can progress to diminished central vision, and ultimately result in total blindness.
According to the Bright Focus Foundation, over 60 million people around the world lived with the effects of glaucoma as of 2010. That number is anticipated to increase to as many as 80 million in the coming years.
How is glaucoma linked to depression and anxiety?
A handful of studies conducted over the last decade have identified an association between people living with glaucoma and the development of anxiety and depression. This finding was determined in one 2017 study to be true of people who live with glaucoma across all age groups. Another study from 2008 suggests that the likelihood of patients with glaucoma developing depression can increase with both age of onset and severity of vision loss.
Apart from experiencing the typical side effects of depression, glaucoma-related depression can make it more challenging for patients to follow treatment regimens, which puts them at risk of further vision loss. Studies also indicate that depression may increase feelings of isolation and intensify the feeling of being burdened by the effects of glaucoma, ultimately diminishing quality of life.
A 2018 study from the European Association for Predictive, Preventative, and Personalized Medicine (EPMA) Journal found that glaucoma can be both a cause and a symptom of persistent stress and anxiety. Elevated levels of the stress hormone cortisol can have an impact on the sympathetic and vascular nervous systems, ultimately affecting the function of the eyes and brain. Glaucoma was identified as one of two eye conditions that could be a side effect of anxiety and high, long-term stress.
Researchers have also noted that certain glaucoma medications can themselves cause depression and anxiety. Carbonic anhydrase inhibitors and topical-blockers in particular may leave some patients more vulnerable to the development of depression.
Additionally, patients with glaucoma-related vision loss may also experience sleep disorders related to circadian misalignment. These are also associated with various forms of depression and anxiety.
What can be done for glaucoma-related anxiety and depression?
Experts suggest patients can benefit from enlisting the help of mental health professionals alongside their ophthalmologists. It can also be helpful for patients to learn about the resources and community support available to them through organizations like the Glaucoma Research Foundation.
Lead researchers of the aforementioned 2008 glaucoma and depression study also noted that mental health conditions like depression tend to be both undertreated and under-recognized in older patients. This makes increased awareness in the medical community of the connection between the diseases click review an important first step toward addressing the issue.