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Samuel Berchuck, Alessandro A Jammal, Eduardo Bicalho Mariottoni, Sayan Mukherjee, Felipe A Medeiros; The relationship between concomitant mental health disorders and disease severity among glaucoma patients. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1994.
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To investigate the prevalence of anxiety and depression in glaucoma patients, and to understand the relationship between a mental health diagnosis and structural and functional measures of disease severity.
We performed a retrospective cross-sectional analysis of patients from the Duke Glaucoma Repository (DGR), a complete collection of electronic health records (EHR) from the Duke Eye Center between 2009 and 2018. Consisting of over 100,000 patients over 18 years of age, DGR includes standard billing EHR data, but also has a complete record of clinical exams, including imaging and visual fields. Our cohort included patients with a diagnosis of glaucoma and at least one good quality visual field and optical coherence tomography (OCT) image of their better eye, with the most recent exams recorded for analysis. International Classification of Diseases (ICD) codes were used to identify diagnoses of glaucoma and to exclude concurrent diseases. Within our cohort, patients were further classified into mental health diagnosis groups based on ICD codes, problem list, and medications. Only mental health diagnoses within five years of the most recent visual field and OCT exams were recorded. Adjusted differences in retinal nerve fiber layer (RNFL) thickness (μm) and mean deviation (MD, dB) were calculated for each mental health group relative to the patients with no mental health diagnosis. Differences were calculated using linear regression, adjusting for age, race, gender, ethnicity, and glaucoma type.
Our cohort consisted of 5,800 glaucoma patients, of which 3,638 (63%) had no mental health diagnosis, 286 (5%) had anxiety, 1,511 (26%) had depression, and 365 (6%) had both anxiety and depression. Mental health status was significantly associated with structural and functional glaucoma disease severity after adjustment, with differences in RNFL thickness (Anxiety: -2.35μm, Depression: 0.93μm, and Both: 0.27μm; P = 0.015) and MD (Anxiety: -1.17dB, Depression: -0.16dB, Both: -0.16dB; P = 0.013).
A diagnosis of anxiety and/or depression is common in glaucoma patients and is associated with varying levels of disease severity, based on both structural and functional measures. Preliminary results indicate that a diagnosis of concomitant anxiety is associated with worse severity, while the relationship of depression is less clear.
This is a 2020 ARVO Annual Meeting abstract.
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