Patients diagnosed with primary open-angle glaucoma (POAG) may experience a measurable decline in self-reported mental health after learning about their disease, even in the absence of notable changes in clinical vision or visual function, according to a cohort study published recently in JAMA Ophthalmology.
The study, conducted by Michael A. Kass, MD, of Washington University in St. Louis, and colleagues, evaluated patient-reported outcomes from the Ocular Hypertension Treatment Study (OHTS). Researchers analyzed data from 50 participants who developed early POAG and completed the National Eye Institute Visual Function Questionnaire-25 (VFQ) within 2 years before and 2 years after diagnosis. These individuals were compared to 100 matched controls from the OHTS cohort who did not convert to POAG over the same period.
The authors found a statistically significant reduction in the VFQ mental health subscale following diagnosis among patients with POAG. The mean VFQ mental health score declined by 6.5 points after diagnosis (from 94.5 to 88.0), compared to a 0.7-point decline in the control group. The between-group difference was –5.8 (95% CI, –9.05 to –2.60; P=.048). No substantive differences were found in any of the other 11 VFQ subscale scores.
The decline in mental health scores occurred despite the participants generally having mild, unilateral disease. Among the 50 individuals diagnosed with POAG, 44% were diagnosed based on optic disc changes and 56% based on visual field abnormalities, with or without optic disc changes. The control group was matched using propensity scores based on age, sex, race and ethnicity, systemic comorbidities, and baseline ocular characteristics.
The VFQ mental health scale includes 4 questions targeting frustration, embarrassment, worry, and feelings of lacking control due to vision. Other VFQ subscales, including those for general vision, near and distance activities, social functioning, and dependency, did not show similar changes in this analysis.
Because the VFQ was administered at 2-year intervals, the authors note that it is possible that any acute emotional impact of diagnosis may not have been captured. However, the sustained reduction in scores suggests that the psychological burden may persist well beyond the initial discussion of diagnosis. The authors posit that ongoing care, follow-up visits, and repeated discussions about disease progression may contribute to prolonged anxiety or depressive symptoms.
“These findings indicate that further studies are needed to confirm the association between POAG diagnosis and decrease in mental health score and to develop strategies to inform patients about their POAG diagnosis without producing undue distress, anxiety, and depression,” the authors concluded. GP