Study: Early POAG Diagnosis Coincides with Lower Mental Health Scores

Many patients who are diagnosed early in the course of POAG may be at low risk of developing functional limitations during their lifetimes with adequate clinical management;  thus, it is important to empower these patients so their mental health does not suffer. Photo: James L. Fanelli, OD. Click image to enlarge. It’s intuitive that the news of a glaucoma diagnosis takes a mental toll on an individual, creating or exacerbating feelings of depression and anxiety. In a new JAMA Ophthalmology study, researchers investigated the nature of the relationship specifically as it relates to decreases in visual function or clinical vision measures.The prospective data included for analysis consisted of 50 patients who developed primary open-angle glaucoma (POAG; mean age 67.9; 42% female; 34% Black) who were a part of the Ocular Hypertension Treatment Study Phase I and II who had completed a Visual Function Questionnaire-25 (VFQ) within two years before and after POAG diagnosis. Also included were 100 matched controls from the same study who did not develop POAG (mean age 66.6; 37% female; 34% Black). Of those who did develop POAG, average pre- and post-POAG VFQ health scores were 94.5 and 88.0, respectively. In the control group, this change was much smaller, with pre- and post-period VFQ scores averaging 93.3 and 92.6.For those in the study who were newly diagnosed with POAG, only the mental health VFQ scale decreased substantively following diagnosis, while the control group did not exhibit this pattern. Since the decrease in these scores was assessed within two years of diagnosis, the study authors write that this “suggests the impact of diagnosis (diagnostic labeling) may not be transient. It is possible that persistent lower mental health scale scores might reflect repeated examinations and discussions of glaucoma at scheduled visits.”1They believe that the diagnosis may trigger fear of vision loss and blindness, but this may not reflect a patient’s true clinical risk, since advances in technology have allowed for earlier diagnoses and thus better management and treatment. They add that “a discussion at the time of diagnosis about prognosis and clinical management that includes the patient’s preferences, priorities, life expectancy and health status may be beneficial.”1Adding to this important finding, authors of an invited commentary also published in JAMA Ophthalmology discuss how clinicians need to understand the source of patients’ distress, anxiety and depression to optimize strategies to alleviate this.The commentators point to a few key factors at play. One is the importance of counseling patients to adhere to prescribed ocular hypotensive eye drops. This stems from nonadherence being a barrier, being reported anywhere from 5% to 80%, depending on population. The “Support, Educate, Empower” (SEE) program, devised at the University of Michigan, has improved medication adherence for patients by 21% on average by advocating for people to believe in themselves and their competency to change their behavior on their own volition. This is achieved via in-person, individualized motivational interviewing-based counseling based on use of medication reminders.Based on this, the commentators speculate that “broader use of behavioral interventions to facilitate medication adherence within the context of the glaucoma clinic could potentially lead to arresting or slowing the progression of glaucoma, thus reducing the negative mental health impact of having this condition.”2Another barrier to positive outcomes in nonadherence on the patient side to complete ophthalmic visits for routine assessment, monitoring and communication with their doctor. As they explain, inadequate adherence to visit attendance is a risk factor in poor glaucoma outcomes, which may compromise mental health.Finally, the commentators advise to help patients by improving written materials intended for them so they can understand them, like simplifying medical information; this could promote both medication and visit adherence. This is elucidated in their sentiment that “a more complete understanding of the critical regimens for managing glaucoma to prevent further vision loss is critical for mental health.”2Click here and here for the journal sources. 1. Gordon MO, Gao F, Burkland J, et al. Diagnosis of primary open-angle glaucoma and mental health status. JAMA Ophthalmol. June 5, 2025. [Epub ahead of print].2. McGwin G, Owsley C. Appreciating the role of mental health in glaucoma diagnosis and care. JAMA Ophthalmol. June 5, 2025. [Epub ahead of print].