Prevalence and Predictors of Depression Among Participants With Glaucoma in a Nationally Representative Population Sample


      To investigate the prevalence of and risk factors for depression among participants with glaucoma and the predictive value of glaucoma for depression.


      Cross-sectional study.


      This study included 6760 participants in the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2008, aged ≥40 years, who reported a presence or absence of glaucoma. Demographic and disease-related information was obtained by interview. Self-reported measures of vision were ascertained via items from the Visual Function Questionnaire (VFQ-25). Participants underwent visual acuity examination, fundus photography, and visual field testing with screening frequency-doubling technology (FDT N-30-5). The main outcome was presence of depression, as determined by a score ≥10 on the Patient Health Questionnaire-9 (PHQ-9).


      Prevalence of depression among participants with and without glaucoma was 10.9% (SEM 2.2%) and 6.9% (SEM 0.62%), respectively. While the presence of glaucoma was significantly associated with depression after adjustment for demographic factors (OR 1.80, 95% CI 1.16–2.79), this association was not significant after adjustment for self-reported general health condition (OR 1.35, 95% CI 0.822–2.23). Among participants with glaucoma, objective measures of glaucoma severity were not significant predictors for depression. However, several self-reported measures of visual function were significantly associated with depression.


      Glaucoma is a significant predictor of depression after adjustment for demographic factors and multiple comorbidities, but not after adjustment for self-reported general health condition. Among participants with glaucoma, self-reported measures of vision were significant risk factors for depression, whereas objective measures of vision were not.
      To read this article in full you will need to make a payment


        • Gutierrez P.
        • Wilson M.R.
        • Johnson C.
        • et al.
        Influence of glaucomatous visual field loss on health-related quality of life.
        Arch Ophthalmol. 1997; 115: 777-784
        • van Gestel A.
        • Webers C.A.B.
        • Beckers H.J.M.
        • et al.
        The relationship between visual field loss in glaucoma and health-related quality-of-life.
        Eye (Lond). 2010; 24: 1759-1769
        • Glen F.C.
        • Crabb D.P.
        • Garway-Heath D.F.
        The direction of research into visual disability and quality of life in glaucoma.
        BMC Ophthalmol. 2011; 11: 19
        • Friedman D.S.
        • Okeke C.O.
        • Jampel H.D.
        • et al.
        Risk factors for poor adherence to eyedrops in electronically monitored patients with glaucoma.
        Ophthalmology. 2009; 116: 1097-1105
        • Holló G.
        • Kóthy P.
        • Géczy A.
        • Vargha P.
        Personality traits, depression, and objectively measured adherence to once-daily prostaglandin analog medication in glaucoma.
        J Glaucoma. 2009; 18: 288-292
        • Jayawant S.S.
        • Bhosle M.J.
        • Anderson R.T.
        • Balkrishnan R.
        Depressive symptomatology, medication persistence, and associated healthcare costs in older adults with glaucoma.
        J Glaucoma. 2007; 16: 513-520
        • Mabuchi F.
        • Yoshimura K.
        • Kashiwagi K.
        • et al.
        High prevalence of anxiety and depression in patients with primary open-angle glaucoma.
        J Glaucoma. 2008; 17: 552-557
        • Yochim B.P.
        • Mueller A.E.
        • Kane K.D.
        • Kahook M.Y.
        Prevalence of cognitive impairment, depression, and anxiety symptoms among older adults with glaucoma.
        J Glaucoma. 2012; 21: 250-254
        • Skalicky S.
        • Goldberg I.
        Depression and quality of life in patients with glaucoma: a cross-sectional analysis using the Geriatric Depression Scale-15, assessment of function related to vision, and the Glaucoma Quality of Life-15.
        J Glaucoma. 2008; 17: 546-551
        • Jampel H.D.
        • Frick K.D.
        • Janz N.K.
        • et al.
        Depression and mood indicators in newly diagnosed glaucoma patients.
        Am J Ophthalmol. 2007; 144: 238-244
        • Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS)
        National health and nutrition examination survey data.
        U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Hyattsville, MD2005 (Accessed: March 19, 2012)
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.W.
        The PHQ-9.
        J Gen Intern Med. 2001; 16: 606-613
        • Mangione C.M.
        • Lee P.P.
        • Gutierrez P.R.
        • et al.
        Development of the 25-item National Eye Institute Visual Function Questionnaire.
        Arch Ophthalmol. 2001; 119: 1050-1058
        • Terry A.L.
        • Paulose-Ram R.
        • Tilert T.J.
        • et al.
        The methodology of visual field testing with frequency doubling technology in the National Health and Nutrition Examination Survey, 2005-2006.
        Ophthalmic Epidemiol. 2010; 17: 411-421
        • Brusini P.
        • Tosoni C.
        Staging of functional damage in glaucoma using frequency doubling technology.
        J Glaucoma. 2003; 12: 417-426
        • Wilson M.R.
        • Coleman A.L.
        • Yu F.
        • et al.
        Depression in patients with glaucoma as measured by self-report surveys.
        Ophthalmology. 2002; 109: 1018-1022
        • Mathew R.S.
        • Delbaere K.
        • Lord S.R.
        • et al.
        Depressive symptoms and quality of life in people with age-related macular degeneration.
        Ophthalmic Physiol Opt. 2011; 31: 375-380
        • Lundmark P.O.
        • Trope G.E.
        • Shapiro C.M.
        • Flanagan J.G.
        Depressive symptomatology in tertiary-care glaucoma patients.
        Can J Ophthalmol. 2009; 44: 198-204
        • Kaiserman I.
        • Kaiserman N.
        • Elhayany A.
        • Vinker S.
        Topical beta-blockers are not associated with an increased risk of treatment for depression.
        Ophthalmology. 2006; 113: 1077-1080
        • Leske M.C.
        Open-angle glaucoma—an epidemiologic overview.
        Ophthalmic Epidemiol. 2007; 14: 166-172


      Shan Lin is Professor and Co-Director of Glaucoma Service at the University of California, San Francisco and Director of Glaucoma Service at San Francisco General Hospital. His research interests include angle closure glaucoma and glaucoma among Asians. His leadership positions include Chair of the Glaucoma Section of the Ophthalmic Technology Assessment Committee and Chair of the American Glaucoma Society Documents Subcommittee. His special honors include the American Glaucoma Society and The Glaucoma Foundation's Clinician-Scientist Awards.


      Sophia Wang is currently a Clinical and Translational Research Fellow at the University of California, San Francisco (UCSF). She is a trainee in the Advanced Training in Clinical Research program at the UCSF Department of Epidemiology and Biostatistics. She earned her A.B. in Biochemistry from Harvard University, and will complete her medical degree at UCSF. Her research interests include modifiable risk factors for ophthalmologic illness, including glaucoma, and health disparities research.