Anxiety, Depression May Foretell Glaucoma Diagnosis

Shot of a stressed businesswoman with headache in the office.
Researchers have identified a significant association between glaucoma and psychiatric disorders in glaucoma suspects, suggesting that depression and anxiety can predict progression.

Anxiety and depression are known to potentially develop as a consequence of developing glaucoma. But a new study, published in the British Journal of Ophthalmology, suggests they may also operate as predictive factors of the sight-threatening disease’s development.1 A North Carolina-based research team demonstrated that the presence of certain psychiatric disorders — particularly with regards to patients who are already glaucoma suspects — are associated with a future diagnosis of glaucoma, even after controlling for known risk factors.1 

The retrospective cohort study reviewed the records of adults with glaucoma and glaucoma suspects from the Duke Glaucoma Registry from 2012 to 2019.1 All 3259 patients were glaucoma suspects at baseline and were followed for an average of 3.60 years.1

The investigators found that 1015 (32%) patients had anxiety and 1057 (33%) had a diagnosis of depression.1 A total of 1465 (46%) patients had either depression or anxiety, while 607 (19%) had both anxiety and depression.1 Of the 3259 patients, 911 subjects (28%) received a diagnosis of glaucoma during follow-up.1 They also identified an association between a glaucoma diagnosis and psychiatric diagnosis groups at baseline (P =.013).1

Of the patients with both anxiety and depression, 33% would eventually receive a glaucoma diagnosis.1 Additionally, 113 (28%) subjects who had anxiety alone and 120 (27%) who had depression alone developed glaucoma.1 Female and Caucasian patients had an increased risk of having a psychiatric diagnosis at baseline (both P <.001).1

“Our study indicates that a history of anxiety upon a glaucoma suspect diagnosis is significantly associated with a future diagnosis of glaucoma,” investigators said. “While depression was associated with an increased risk of glaucoma in univariable models, this association was no longer significant when controlling for baseline clinical measures.”1

The researchers have pointed to prior investigations that show anxiety and stress may have an impact on intraocular pressure (IOP). “Several studies have indicated that psychiatric stress is associated with elevation of IOP, and this has been confirmed recently in a study of non-human primates.”2-5 

However, the researchers qualify these references saying they mostly focus on acute stress, which is likely different than stress attributed to chronic anxiety disorders. “Nonetheless, the impact of stress on IOP is a likely biological pathway that may explain the significant association found in our study,” the researchers concluded.1


1. Berchuck S, Jammal A, Mukherjee S, Somers T, Medeiros F. Impact of anxiety and depression on progression to glaucoma among glaucoma suspects. Br J Ophthalmol. Published online August 29, 2020. Accessed October 2, 2020. doi: 10.1136/bjophthalmol-2020-316617

2. Grignolo F, Bongioanni C, Carenini B. Variations of intraocular pressure induced by psychological stress (author’s transl). Klin Monbl Augenheilkd. 1977;170:562–9.

3. Kaluza G, Maurer H. Stress and intraocular pressure in open angle glaucoma. Psychol Health. 1997;12:667–75.

4. Abe R, Silva T, Dantas I, et al. Can psychological stress elevate intraocular pressure in healthy individuals? Ophthalmol Glaucoma. Published online July 3, 2020. Accessed October 6, 2020. doi: 10.1016/j.ogla.2020.06.011  

5. Jasien J, Girkin C, Downs J. Effect of anesthesia on intraocular pressure measured with continuous wireless telemetry in nonhuman primates. Invest Ophthalmol Vis Sci. 2019;60:3830. doi: 10.1016/j.ogla.2020.06.011