Lim Nigel C S, Fan Chara H J, Yong Michael K H, Wong Elizabeth P Y, Yip Leonard W Y
*Yong Loo Lin School of Medicine, National University of Singapore, National University Health System †Department of Psychological Medicine, Jurong Health, Alexandra Hospital ‡Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
J Glaucoma. 2016 Jul;25(7):605-12. doi: 10.1097/IJG.0000000000000393.
To determine the prevalence and risk factors for anxiety disorder and depression among glaucoma patients in Singapore, and to assess the relationship between quality of life (QOL) and depression/anxiety.
In this cross-sectional study, glaucoma patients aged 21 and above with a known diagnosis of primary open-angle glaucoma or primary angle-closure glaucoma were recruited from a tertiary care hospital. Patients with other types of glaucoma, and coexisting ocular or psychiatric disorders were excluded.Ophthalmic examination was carried out on all participants, which included best-corrected visual acuity (BCVA), intraocular pressure (IOP), gonioscopy, standard automated perimetry, and optic disc evaluation. Sociodemographic information and treatment histories were also collected.The Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Visual Function Questionnaire (VFQ25) were administered to evaluate for depression, anxiety, and impact on QOL, respectively.
A total of 100 patients were included in this study. The mean age was 67.1±12.0 years (range, 24 to 90 y). The frequency of depression and anxiety among our patients was 30% and 64%, respectively. The mean HAM-D score was 4.37±4.17 (range, 0 to 17), whereas the mean HAM-A score was 2.38±2.80 (range, 0 to 13). The mean VFQ25 score was 78.8±16.0 (range, 42.4 to 97.0). The poorest subscale on the VFQ25 was driving, with a mean score of 42.4±42.6 (range, 0.0 to 100.0).We did not find any significant difference between the presence of depression/anxiety between patients with primary open-angle glaucoma (P=0.263) and primary angle-closure glaucoma (P=0.830). Risk factors for depression included: female sex (P=0.020), higher logMAR BCVA in the worse eye (P=0.004), higher cup-disc ratio (P=0.016), lower MD in the better and worse eye (P=0.022 and 0.001, respectively), and lower mean VFQ25 score (P<0.001). Risk factors for anxiety included: lower MD in the worse eye (P=0.004) and lower mean VFQ25 score (P=0.004). There was also no significant association between the use of topical β-blockers/carbonic anhydrase inhibitors with depression (P=0.793) or anxiety (P=0.282).
There is a relatively high prevalence of depression (30%) and anxiety disorders (64%) among glaucoma patients in Singapore. Female glaucoma patients are more likely to suffer from depression. Other risk factors for depression include higher cup-disc ratio, higher logMAR BCVA, lower MD, and a lower mean VFQ25 score. Risk factors for anxiety disorder include lower MD and lower mean VFQ25 score. Ophthalmologists could consider use of the VFQ25 as an assessment for impairments in QOL in a glaucoma patient. If a glaucoma patient is at high risk of depression or anxiety disorder, a multidisciplinary management approach involving ophthalmology and psychiatry may be required.
确定新加坡青光眼患者中焦虑症和抑郁症的患病率及危险因素，并评估生活质量（QOL）与抑郁/焦虑之间的关系。
在这项横断面研究中，从一家三级护理医院招募了年龄在21岁及以上、已确诊为原发性开角型青光眼或原发性闭角型青光眼的青光眼患者。排除患有其他类型青光眼以及并存眼部或精神疾病的患者。对所有参与者进行眼科检查，包括最佳矫正视力（BCVA）、眼压（IOP）、前房角镜检查、标准自动视野检查和视盘评估。还收集了社会人口统计学信息和治疗史。分别使用汉密尔顿抑郁量表（HAM-D）、汉密尔顿焦虑量表（HAM-A）和视觉功能问卷（VFQ25）来评估抑郁、焦虑以及对生活质量的影响。
本研究共纳入100例患者。平均年龄为67.1±12.0岁（范围24至90岁）。我们的患者中抑郁症和焦虑症的发生率分别为30%和64%。HAM-D平均评分为4.37±4.17（范围0至17），而HAM-A平均评分为2.38±2.80（范围0至13）。VFQ25平均评分为78.8±16.0（范围42.4至97.0）。VFQ25中得分最低的子量表是驾驶，平均得分为42.4±42.6（范围0.0至100.0）。我们未发现原发性开角型青光眼患者（P=0.263）和原发性闭角型青光眼患者（P=0.830）在抑郁/焦虑存在情况上有任何显著差异。抑郁症的危险因素包括：女性（P=0.020）、较差眼更高的logMAR BCVA（P=0.004）、更高的杯盘比（P=0.016）、较好眼和较差眼更低的平均偏差（MD）（分别为P=0.022和0.001）以及更低的VFQ25平均评分（P<0.001）。焦虑症的危险因素包括：较差眼更低的MD（P=0.004）和更低的VFQ25平均评分（P=0.004）。使用局部β受体阻滞剂/碳酸酐酶抑制剂与抑郁（P=0.793）或焦虑（P=0.282）之间也无显著关联。
新加坡青光眼患者中抑郁症（30%）和焦虑症（64%）的患病率相对较高。女性青光眼患者更易患抑郁症。抑郁症的其他危险因素包括更高的杯盘比、更高的logMAR BCVA、更低的MD以及更低的VFQ25平均评分。焦虑症的危险因素包括更低的MD和更低的VFQ25平均评分。眼科医生可考虑将VFQ25用作评估青光眼患者生活质量受损情况的指标。如果青光眼患者有患抑郁症或焦虑症的高风险，可能需要采用涉及眼科和精神科的多学科管理方法。
