MENTAL HEALTH AND GLAUCOMA

 

Memory and cognitive impairment, as well as other mental health problems (e.g., depression and anxiety) are conditions which could significantly reduce a glaucoma patient's ability to adhere to the treatment regime. Poor adherence to treatment may lead to preventable vision loss.

Cognitive impairment may prevent one from adhering to treatment, regardless of the complexity of the treatment regimen. In a study, 12% of patients reported difficulty remembering to take their medications [Sleath B, Robin AL, Covert D, et al. Patient-reported behavior and problems in using glaucoma medications. Ophthalmology. 2006;113(suppl 3):431–436]

Another study has shown that the patients who were nonadherent to the treatment protocol had more frequent memory problems than participants classified as adherent. Such memory problems included forgetting when to take their medication and forgetting appointments. [Stryker JO, Beck AD, Primo SA, et al. An exploratory study of factors influencing glaucoma treatment adherence. J Glaucoma. 2010;19:66–72]

In a study by Yochim and colleagues, controlling for age, in subjects above 50 years of age, memory impairment was found in approximately 20% of the sample, and impaired executive functioning was found in approximately 22% of the sample. Mild-to-moderate depressive symptoms were found in 12.2% of participants, and 1 person reported clinically significant anxiety. [Yochim, Brian P. PhD, ABPP*; Mueller, Anne E. MA*; Kane, Katherine D. MA*; Kahook, Malik Y. MD†. Prevalence of Cognitive Impairment, Depression, and Anxiety Symptoms Among Older Adults With Glaucoma. Journal of Glaucoma 21(4):p 250-254, April/May 2012. | DOI: 10.1097/IJG.0b013e3182071b7e]

The results from Yochim’s study indicate that cognitive impairment may be common in older patients with glaucoma. This has implications for treatment adherence, as difficulties in remembering information may significantly impede the ability to follow instructions from a physician.

Care-givers for glaucoma patients are usually focused on compliance to treatment but overlook the mental health issues of the patients which could be driving the poor adherence to protocols.

Since these care-givers are often the first to interact with such patients, it is imperative that they are able to pick the signs and symptoms providing clues to the presence of mental health issues in these patients.

Appropriate interventions can achieve better quality of life in these patients in the long run.