Abstract
Purpose: :
To screen newly diagnosed patients of glaucoma for the presence of depression and evaluate the effect of topical medical therapy.
Methods: :
Sixty two patients (33 Males, 29 Females) diagnosed to have primary glaucoma (30 primary angle closure glaucoma and 32 primary open angle glaucoma) and 60 healthy age matched controls (32 Males, 28 Females) were screened for major depression using the Patient Health Questionnaire (PHQ-9, based on DSM IV criteria of the American Psychiatry Association) before starting topical medical therapy. A PHQ-9 score of 10 or more was taken as a positive screen for major depression and grading of Depression severity was performed according to the total PHQ-9 score: no depression (0-4), minimal symptoms (5-9), mild (10-14), moderate (15-19) and severe depression (>20). Patients and controls aged 40 years or above, with visual acuity ≥ 20/200 in the better eye were included. Patients with visual acuity < 20/200 in the better eye, history of surgery within last 6 months, previous therapy for glaucoma, history of systemic illness and chronic medical therapy for any illness were excluded from the study. Ocular evaluation included Vision testing, gonioscopy, applanation IOP, stereoscopic evaluation of optic nerve head, and visual field assessment (Humphrey SITA std. 30-2).The glaucoma patients were started on medical therapy (topical beta blockers were withheld in patients with a PHQ-9 score of 10 or above) and depression screening repeated after 3 months.
Results: :
The mean age of glaucoma patients was 55.24 ± 9.52 years and of controls was 54.90 ± 6.70 years (P =0.37). Mean visual acuity in better eye of glaucoma patients was 0.35 ± 0.03 (logMAR) as compared to 0.09 ± 0.01 in controls (P = 0.0001). Overall 9 patients (14.5%) had major depression and severity of depression was mild in 8 patients (12.9%) and severe in 1 patient. The mean PHQ-9 score before starting therapy was 10.75±1.03 and this decreased to 6.13±1.35 after 3 months (P = 0.0001). None of the patients screened positive for major depression at 3 months.
Conclusions: :
Depression screening by PHQ-9 revealed that nearly 15% newly diagnosed glaucoma patients suffered from major depression. There was a significant decrease in PHQ-9 depression scores after 3 months of topical ocular hypotensive therapy.