Anxiety, Depression May Accelerate Glaucoma

Psychological distress associated with disc hemorrhage and decreased thickness of the retinal nerve fiber layer.

Anxiety and depression can increase the risk of a patient’s glaucoma progressing, according to a study published in Nature.

Researchers looked at 251 patients with primary open-angle glaucoma between December 2018 and February 2020. Only patients with at least 2 years of follow-up were eligible for the study. A single eye per patient was enrolled and if both eyes were eligible, only the right eye was selected.

Patients were assessed using the Beck Anxiety Inventory (BAI) and Beck Depressive Inventory-II (BDI-II), and classified into 4 groups: high anxiety, low anxiety, high depression, and low depression.

Overall, 209 (83.3%) patients were sorted into the low-anxiety group, while 44 (16.7%) were placed in the high-anxiety group. The incidence of disc hemorrhage was higher in the high-anxiety group than the low anxiety group (3.3% vs 11.9%, P =.018), as were mean intraocular pressure (13.76 mm Hg ± 3.00 mm Hg vs 14.76 mm Hg ± 3.02 mm Hg, P =.049) and peak pressure (17.43 mm Hg ± 4.12 mm Hg vs 18.86 mm Hg ± 4.32 mm Hg, P =.043). Also, researchers found that the rate of retinal nerve fiber layer (RNFL) thinning during follow-up in the high-anxiety group (−1.96±2.23 μm/year) was faster than in the low-anxiety one (−0.68 μm ± 1.39 μm/year, P =.021). 

Several studies examining anxiety and depression have reported that both are common in patients with glaucoma. Scientists have attributed this to the distress patients feel upon being diagnosed, including the fear of potential blindness and decreased daily activity.

However researchers have now also discovered that emotional distress can increase the progression of glaucoma. “In our study, anxiety was significantly associated with the rate of RNFL thickness decline in patients with glaucoma,” research shows. “Although the statistical significance was borderline (P =.074, independent t-test), the rate of RNFL thinning was faster in the HD-G [high-depression group] than the LD-G [low-depression group]. These results suggest that not only is glaucoma a risk factor for anxiety/depression, but also that anxiety/depression could be a risk factor for glaucoma.” 

Anxiety and depression are reactions to stress and are thought to surface in the amygdala. Emotional responses promote the secretion of neurotransmitters and stimulate the autonomic nervous system (ANS), which is also important in the development or progression of glaucoma. Psychological stress affects the variation of intraocular pressure — an important factor in the progression of glaucoma — and disturbs blood flow through the ANS.

The study is limited in that the questionnaire on anxiety or depression was given at the time of study inclusion and it wasn’t possible to confirm if the scores remained the same throughout the follow-up period. Also, glaucoma progression is slow, and the observation period might not have been long enough.

However, researchers feel the findings offer new insights into caring for patients with glaucoma and highlight that managing depression and anxiety might help manage glaucoma.


Shin D, Jung K, Park H and Park C. The effect of anxiety and depression on progression of glaucoma. Nature. Published online January 19, 2021. doi:10.1038/s41598-021-81512-0