Beyond the Visual Field: Psychosocial Determinants of Psychological Distress in Primary Open-Angle Glaucoma

To identify psychosocial and clinical predictors of psychological distress in patients with primary open-angle glaucoma (POAG).

Prospective cross-sectional study.

300 patients with a diagnosis of POAG were recruited from the Duke Eye Center glaucoma clinics between September 2022 and August 2023.

Participants completed validated self-report questionnaires, including the Hospital Anxiety and Depression Scale (HADS, psychological distress), Self-Efficacy for Managing Chronic Disease Scale (SE-6, self-efficacy), Modified Medical Outcomes Study Social Support Survey Scale (MOS-8, social support), and the National Eye Institute Visual Function Questionnaire Scale (NEI VFQ-9, vision-related quality of life [QoL]). Clinical data were abstracted from electronic health records. Univariable and multivariable Poisson regression models assessed associations between distress and psychosocial / clinical variables, including interaction effects. Risk ratios (RRs) and p-values were reported.

Psychological distress measured by HADS.

The cohort had a mean age of 68.4 years (52% female), with 81% identifying as White and 15% as Black/African American. Mean total HADS score was 9.21 (SD = 6.28), with 55 participants (18%) reporting significant psychological distress (HADS > 14). Younger age, female sex, lower socioeconomic indicators (education, income, employment status), and clinical markers were also found to be significant predictors of distress in univariable analyses, with age remaining significant in multivariable analyses. In univariable models, poorer vision-related QoL (RR=0.78, p <0.001), weaker social support (RR=0.78, p <0.001), and lower self-efficacy (RR=0.74, p <0.001) were all associated with greater distress. In multivariable analyses, self-efficacy (RR=0.82, p < 0.001) and social support (RR=0.83, p < 0.001) remained independently associated. Significant interaction effects were estimated between vision-related QoL and social support (RR=0.91, p < 0.001), and low social support and low self-efficacy (RR=1.06, p = 0.005), indicating combinations of psychosocial strengths and vulnerabilities may shape distress risk.

Psychosocial variables are significant and interrelated predictors of distress in POAG, beyond what is captured by traditional clinical metrics. These findings underscore the critical role of modifiable psychosocial factors in shaping patients' emotional well-being. Integrated care models to address psychosocial needs represents an important opportunity to mitigate distress and improve glaucoma outcomes.