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Georgios Vakros, James Hodson, Philip Ian Murray, Saaeha Rauz; Association between Anxiety and Depression with the Frequency of Eye Drops in Inflammatory Eye Disease Patients. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5550.
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Patients with chronic inflammatory eye disease (IED) often require lifelong treatment including the use of frequently applied topical therapy. Therapeutic regimens are arduous and maintaining adherence can impact upon daily activities and general wellbeing. We wished to assess anxiety, depression and quality of life in patients with IED and if there is an association with the administration of topical medication.
200 consecutive patients with IED - Ocular Surface Disease (OSD, 100) and Uveitis (100) - completed a self-administered questionnaire that comprised a patient reported measure of ocular symptoms (Ocular Surface Disease Index (OSDI)) and validated wellbeing questionnaires (Hospital Anxiety and Depression (HAD), World Health Organisation Quality of Life-BREF (WHO QOL-BREF)), together with supplemental questions on the frequency of eye drops and the use of systemic glucocorticoids. Descriptive and non-parametric tests were used to analyse the impact of topical medication on depression, anxiety and quality of life scores within the group as a whole and when stratified into the two clinical groups.
Patients (126(63%) female, 74(37%) male) with a mean (±SD) age 54±5 years (OSD, 56±1; uveitis, 51±1; p=0.032) from a variety of ethnic backgrounds (White 132(66%), Black 8(18%), South Asian 45(23%) and Other 5(3%)) reported moderate/severe ocular symptoms as measured by the OSDI. Forty patients (20%) were found to be clinically depressed and 33(16.5%) had clinical anxiety. There was no difference between the two groups. The frequency of the eye drops had a direct impact on both anxiety and depression with a more pronounced effect in the OSD patients (p<0.001). The use of systemic glucocorticoids was also a significant factor linked to anxiety and depression (p=0.005). In patients who demonstrated anxiety or depression, quality of life was reduced in all four domains measured (physical, psychological, social relationships, environmental (p<0.001)).
The use of frequent topical medications impacts upon and positively correlates with the psychological status of IED patients with 1:5 developing anxiety and depression. These patients also demonstrate a poorer quality of life. This highlights the need for counselling in the IED clinic either through a clinical psychologist or eye clinic liaison officer.
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