Managing mental health issues in glaucoma patients

Being diagnosed with glaucoma, or even being told you have a high risk of developing the condition, can cause anxiety and depression in many people. Much of the conversation around glaucoma focuses on treatment methods and screening, with mental health often being overlooked in patient management.

Statistics from the National Eye Institute reported that people over the age of 65 are at ‘particular risk’ of developing depression related to vision loss. They also state that 29 to 58% of people with vision loss go on to develop a depressive disorder one year on.  The risk of glaucoma increases with age – 88% of Americans with low vision are over 65 so the likelihood of feeling depressed or anxious as vision deteriorates is high.

Mental health awareness among ophthalmologists

Glaucoma specialists like Reay Brown of Atlanta Ophthalmology Associates believe that mental health is an area where ophthalmologists should ‘try a little harder’. Often they focus on the medical diagnosis and overlook mental health issues. Failures in communication about treatment and prognosis can further cause anxiety amongst patients who are worried about their future.

These failures in communication are typically a result of a lack of training and also a lack of time in the eye health profession. Ophthalmologists aren’t routinely equipped with the skills to tackle mental health issues, and they may have too many patients to deal with. This is an area that needs addressing because it impacts quality of life as well as making patients less likely to adhere to their treatment programme.

Dealing with mental health issues should start at medical school. This ensures that the ophthalmologists of the future are well-equipped to communicate with patients properly and spot the signs of mental health issues.

Four ways to help glaucoma patients cope

There are ways to alleviate depression or anxiety in glaucoma patients which practising eye health professionals can adopt:

1. Improving communication

Fear of the unknown can cause a great deal of anxiety – glaucoma is asymptomatic in the early stages so a patient won’t know when they will start to lose their vision or how quickly. Patients will also worry about treatment, how invasive or expensive it may be for example.

Ophthalmologists need to choose their words carefully when informing a patient of a diagnosis – giving them the facts in a way that is easy to understand without scaring the patient.

Douglas J. Rhee M.D. of the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston has some advice. He says that ophthalmologists should deliver a message of hope, rather than painting a bleak picture.

“I tell them that if they take their drops every day, it’s a reminder that this is a blinding, incurable disease but that it’s probably not going to be blinding for them”

Good communication is about choosing the right words, acknowledging the positives (treatments are very advanced in modern medicine) and carefully delivering bad news

2. Early engagement with patients

Knowledge is power for many patients, and everyone should be informed about the importance of taking care of their eye health from an early age. Ophthalmologists and optometrists should be involved in their community as much as possible. Though awareness campaigns they should encourage people to come for regular eye tests even if they don’t have problems with their vision.

Early engagement means early screening and earlier detection of glaucoma. If glaucoma is caught in the earliest stages then treatment is more likely to succeed, which will decrease the chance of depression or anxiety in patients.

3. Help plan their future

Giving the patient a plan of action can help to reduce anxiety about treatments and prognosis. The National Eye Institute reports that those with vision loss are three times more likely to report difficulty in walking, managing medications and preparing meals. This is likely to be a source of worry among those with glaucoma, with or without symptoms, so it’s important to address these concerns early on.

Ophthalmologists should give the patient accurate information about how to administer their treatment, how to access support services and how they can adapt their homes and lives. This can be daunting for a patient but addressing a problem often yields a better long-term outcome than being in denial. Read more about quality of life and glaucoma in our related blog post

4. Collaborate with mental health services

We have established that mental health is not isolated from eye health, so this means that professionals in both fields could work together productively. As an eye health professional, you familiarise yourself with the pathways to refer a patient for specialist mental health treatment. Cognitive behavioural therapy or drug therapy can help a patient deal with their negative thoughts and allow them to enjoy a good quality of life.

Those diagnosed with glaucoma rely upon their ophthalmologists for clarity on their future, and when this fails it can cause depression or anxiety to develop.

Better communication and an understanding of mental health can protect a patient, improve treatment outcomes and even help to preserve sight. Denial and worry can cause patients to ignore advice about how to take their eye drops and even miss important screening tests.

Want to learn more? Read about glaucoma and quality of life or about the impact of stress on AMD patients.