Relationship Between Visual Field, Intraocular Pressure, and Retinal Nerve Fiber Layer in Patients with Open-Angle Glaucoma and Depression Level

Abstract

Objective: The aim of this study was to investigate the relationship between depression levels and parameters such as intraocular pressure variability, visual field scores, and retinal nerve fiber layer (RNFL) thickness in patients with primary open-angle glaucoma (POAG). Method: A total of 50 patients diagnosed with POAG were included in this study. All participants underwent a comprehensive ophthalmological evaluation including intraocular pressure measurements and retinal nerve fiber layer (RNFL) thickness measurements using standard automated perimetry for visual field analysis and optical coherence tomography to assess the functional and structural damage caused by glaucoma. The Beck Depression Inventory (BDI) was administered to all participants to assess their depression levels. Results: There were no significant relationship between BDI scores and intraocular pressure, visual field, retinal nerve fiber analysis, or number of medications used in glaucoma patients. In the multiple linear regression analysis, the model was found to be statistically significant (F=3.805) and explained 25.3% of the variance in BDI scores. Conclusion: Patients with primary open-angle glaucoma exhibit mild depressive symptoms regardless of the severity of the disease’s impact on the eye, and that the level of depressive symptoms increases with age. This finding suggests that the development of depression in glaucoma may be associated not only with objective parameters of the disease but also with age and other personal factors.

Keywords

• Primary open-angle glaucoma
• visual field
• retinal nerve fiber analysis
• depression

Açık Açılı Glokom Hastalarında Görme Alanı, Göz İçi Basıncı ve Retina Sinir Lifi Tabakası ile Depresyon Düzeyi Arasındaki İlişki

Abstract

Amaç: Bu çalışmanın amacı, primer açık açılı glokom (PAAG) hastalarında göz içi basıncı düzensizliği, görme alanı skorları ve retina sinir lifi (RNFL) kalınlığı gibi parametrelerle depresyon düzeyi arasındaki ilişkinin incelenmesidir. Yöntem: Bu çalışmaya PAAG tanısı almış toplam 50 hasta dahil edildi. Tüm katılımcılara kapsamlı oftalmolojik değerlendirme yapıldı. Bu kapsamda göz içi basıncı ölçümleri, glokomun fonksiyonel ve yapısal hasarını değerlendirmek amacıyla standart otomatik perimetri ve görme alanı analizi ile optik koherens tomografi kullanılarak RNFL kalınlık ölçümleri yapıldı. Depresyon düzeyleri Beck Depresyon Ölçeği (BDÖ) ile değerlendirildi. Bulgular: Glokom hastalarında göz içi basıncı, görme alanı, retina sinir lifi analizi ve kullanılan ilaç sayısı ile BDÖ puanları arasında anlamlı ilişki saptanmamıştır. Çoklu doğrusal regresyon analizi model istatistiksel olarak anlamlı bulundu (F=3,805) ve BDÖ puanlarındaki varyansın %25,3'ünü açıklamıdı. Sonuç: Primer açık açılı glokom hastalarının glokomun gözü etkileme şiddetinden bağımsız olarak hafif düzeyde depresif belirti gösterdiklerini, yaş arttıkça depresif belirti düzeylerinin arttığı saptanmıştır. Bu bulgu, glokomda depresyon gelişiminin yalnızca glokom hastalığının objektif parametreleriyle değil, yaş ve diğer kişisel faktörlerle de ilişkili olabileceğini göstermektedir.

Keywords

• Primer açık açılı glokom
• görme alanı
• retina sinir lifi analizi
• depresyon

References

1. Ahmed OM, Waisbourd M, Spaeth GL, Katz LJ (2021) Improvement in structure and visual function in patients with glaucoma: the possible key to better treatment? Surv Ophthalmol, 66:644-652.
2. Altay Y (2025) Which factor have more adverse effect on ocular surface of patients treated with antiglaucoma drops; drug type, number of drugs or drug intensity? Cutan Ocul Toxicol, 44:141-146.
3. Asrani SG, McGlumphy EJ, Al-Aswad LA, Chaya CJ, Lin S, Musch DC et al. (2024) The relationship between intraocular pressure and glaucoma: An evolving concept. Prog Retin Eye Res, 103:101303.
4. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry, 4:561-571.
5. Chang RT, Singh K (2016) Glaucoma suspect: diagnosis and management. Asia Pac J Ophthalmol, 5:32-37.
6. Chen YY, Lai YJ, Wang JP, Shen YC, Wang CY, Chen HH et al. (2018) The association between glaucoma and risk of depression: a nationwide population-based cohort study. BMC Ophthalmol, 18:146.
7. Chuangsuwanich T, Tun TA, Braeu FA, Wang X, Chin ZY, Panda SK et al. (2023) Differing associations between optic nerve head strains and visual field loss in patients with normal- and high-tension glaucoma. Ophthalmology, 130:99-110.
8. Cohen J (1988) Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hoboken, NJ, Lawrence Erlbaum.

9. Deng J, Qin Y (2024) From meta-analysis to Mendelian randomization: Unidirectional perspectives on the association of glaucoma with depression and anxiety. PLoS One, 19:e0310985.
10. Dietze J, Blair K, Zeppieri M, Havens SJ, Adams M (2024) Glaucoma (Nursing). In: StatPearls. Treasure Island (FL): StatPearls Publishing.
11. Dogan S, Yildiz S, Kilicaslan AK, Emir BS, Kurt O, Sehlikoğlu S (2024) Does anxiety, depression, and sleep levels affect the quality of life in patients diagnosed with multiple sclerosis? Eur Rev Med Pharmacol Sci, 28:1306-1313.
12. Fernandez-Lazaro CI, García-González JM, Adams DP, Fernandez-Lazaro D, Mielgo-Ayuso J, Caballero-Garcia A et al. (2019) Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study. BMC Fam Pract, 20:132.
13. Filatova EV, Shadrina MI, Slominsky PA (2021) Major depression: one brain, one disease, one set of intertwined processes. Cells, 10:1283.
14. Giacometti HHAR, Coelho LF, Iankilevich LG, Valentin LSS, Ferreira LA, Balbino M et al (2024) Prevalence of anxiety and depression among patients with glaucoma. Front Psychol, 15:1410890.
15. Groff ML, Choi B, Lin T, McIlraith I, Hutnik C, Malvankar-Mehta MS (2023) Anxiety, depression, and sleep-related outcomes of glaucoma patients: systematic review and meta-analysis Can J Ophthalmol, 58:346-355.
16. Gupta A, Bansal R, Sharma A, Kapil A (2024) Optic disc signs—cupping, swelling, inflammation, and pallor. In Ophthalmic Signs in Practice of Medicine. Singapore, Springer Nature, 423-472.
17. Gürok MG, Balgetir F, Yildiz S, Tabara MF (2024) Huzursuz bacak sendromu olan hastalarda aleksitimi ve diğer ruhsal semptomlar. Fırat Üniversitesi Sağlık Bilimleri Dergisi, 38:185-189.
18. Hisli N (1989) Beck Depresyon Envanteri’nin üniversite öğrencileri için geçerliği ve güvenirliği. Psikoloji Dergisi, 6:3-13.
19. Inayat H, Abdul-Nabi M, Leung B, Jiang J, Robertson S, Malvankar-Mehta MS (2024) Detrimental impact on work productivity in patients with glaucoma: a systematic review. JFO Open Ophthalmol, 8:100142.
20. Jayaram H, Kolko M, Friedman DS, Gazzard G (2023) Glaucoma: now and beyond. Lancet, 402:1788-1801.
21. Jesus J, Ambrósio J, Meira D, Rodriguez-Uña I, Beirão JM (2025) Blinded by the Mind: Exploring the Hidden Psychiatric Burden in Glaucoma Patients. Biomedicines, 13:116.
22. Onwubiko SN, Nwachukwu NZ, Muomah RC, Okoloagu NM, Ngwegu OM, Nwachukwu DC (2020) Factors associated with depression and anxiety among glaucoma patients. Niger J Clin Pract, 23:315-321.
23. Pradhan LK, Das SK (2021) The regulatory role of reticulons in neurodegeneration: insights underpinning therapeutic potential for neurodegenerative diseases. Cell Mol Neurobiol, 41:1157-1174.
24. Quaranta L, Riva I, Gerardi C, Oddone F, Floriani I, Konstas AG (2016) Quality of life in glaucoma: a review of the literature. Adv Ther, 33:959-981.
25. Rovelt J, Freiberg J, Azuara-Blanco A, Virgili G, Kolko M (2024) The multifaceted non-genetic risk factors for primary open-angle glaucoma: An overview of systematic reviews. Ophthalmol Glaucoma, 8:188-198.
26. Saccà SC, Cutolo CA, Rossi T (2019) Glaucoma: an overview. In: Handbook of Nutrition, Diet, and the Eye (Eds VR Preedy, RR Watson): 167-187. Cambridege, MA, Academic Press.
27. Schmidl D, Schmetterer L, Garhöfer G, Popa-Cherecheanu A (2015) Pharmacotherapy of glaucoma. J Ocul Pharmacol Ther, 31:63-77.
28. Shin DY, Jung KI, Park HYL, Park CK (2021) The effect of anxiety and depression on progression of glaucoma. Sci Rep, 11:1769.
29. Stamatiou ME, Kazantzis D, Theodossiadis P, Chatziralli I (2022) Depression in glaucoma patients: a review of the literature. Semin Ophthalmol, 37:29-35.
30. Takao E, Ichitani A, Tanito M (2024). Estimation of topical glaucoma medication over-prescription and its associated factors. J Clin Med, 13:184.
31. Tharmathurai S, Muhammad-Ikmal MK, Razak AA, Che-Hamzah J, Azhany Y, Fazilawati Q et al. (2021) Depression and severity of glaucoma among older adults in urban and suburban areas. J Glaucoma, 30:205-212.
32. Waisberg E, Micieli JA (2021) Neuro-ophthalmological optic nerve cupping: an overview. Eye Brain, 13:255-268.
33. Wang SM, Jung Y, Han K, Ohn K, Park HYL, Park CK et al (2025) Risk of depression in glaucoma patients with vision impairment: A nationwide cohort study. Heliyon, 11:e40617.
34. Wang Y, Guo Y, Zhang Y, Huang S, Zhong Y (2024) Differences and similarities between primary open-angle glaucoma and primary angle-closure glaucoma. Eye Brain, 16:39-54.
35. Wu A, Khawaja AP, Pasquale LR, Stein JD (2020) A review of systemic medications that may modulate the risk of glaucoma. Eye (Lond), 34:12-28.
36. Xu Y, Ye Y, Chen Z, Xu J, Yang Y, Zhang Y et al (2025) The impact of intraocular pressure changes on corneal biomechanics in primary open-angle glaucoma. Am J Ophthalmol, 269:216-225.
37. Zeppieri M, Marsili S, Enaholo ES, Shuaibu AO, Uwagboe N, Salati C et al. (2023) Optical coherence tomography (OCT): a brief look at the uses and technological evolution of ophthalmology. Medicina, 59:2114.
38. Zhou C, Qian S, Wu P, Qiu C (2013) Anxiety and depression in Chinese patients with glaucoma: sociodemographic, clinical, and self-reported correlates. J Psychosom Res, 75:75-82.