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Impact of anxiety and depression on progression to glaucoma among glaucoma suspects
  1. Samuel Berchuck1,2,
  2. Alessandro Jammal2,
  3. Sayan Mukherjee3,
  4. Tamara Somers4,
  5. Felipe A Medeiros2
  1. 1 Statistical Science and Forge, Duke University, Durham, North Carolina, USA
  2. 2 Ophthalmology, Duke University, Durham, North Carolina, USA
  3. 3 Statistical Science, Mathematics, Computer Science, Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
  4. 4 Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
  1. Correspondence to Felipe A Medeiros, Visual Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, 2310 Erwin Rd, Durham, NC 27710, USA; felipe.medeiros{at}


Aims To assess the impact of anxiety and depression in the risk of converting to glaucoma in a cohort of glaucoma suspects followed over time.

Methods The study included a retrospective cohort of subjects with diagnosis of glaucoma suspect at baseline, extracted from the Duke Glaucoma Registry. The presence of anxiety and depression was defined based on electronic health records billing codes, medical history and problem list. Univariable and multivariable Cox proportional hazards models were used to obtain HRs for the risk of converting to glaucoma over time. Multivariable models were adjusted for age, gender, race, intraocular pressure measurements over time and disease severity at baseline.

Results A total of 3259 glaucoma suspects followed for an average of 3.60 (2.05) years were included in our cohort, of which 911 (28%) were diagnosed with glaucoma during follow-up. Prevalence of anxiety and depression were 32% and 33%, respectively. Diagnoses of anxiety, or concomitant anxiety and depression were significantly associated with risk of converting to glaucoma over time, with adjusted HRs (95% CI) of 1.16 (1.01, 1.33) and 1.27 (1.07, 1.50), respectively.

Conclusion A history of anxiety or both anxiety and depression in glaucoma suspects was associated with developing glaucoma during follow-up.

  • Glaucoma
  • Epidemiology
  • Public health

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  • Contributors SB, SM and FAM conceived the research design. SB and AJ were involved in data acquisition and execution of the research. SB performed the data analysis and helped in interpreting the results by FAM and AJ. SB wrote and revised the manuscript in consultation with AJ, TS and FAM.

  • Funding Supported by the National Science Foundation grants CCF-193496, DEB-1840223 (SM), DMS 17-13012 (SM) and ABI 16-61396 (SM), National Institute of Health grants R01 DK116187-01 (SM) and R21AG055777-01A (SM), Human Frontier Science Program RGP0051/2017 (SM) and National Eye Institute grant EY029885 (FAM). The sponsor or funding organizations had no role in the design or conduct of this research.

  • Competing interests SB, AJ, SM and TS have nothing to disclose. FAM reports personal fees from Carl Zeiss Meditec, Heidelberg Engineering, Allergan, Reichert, Google, Aerie Pharmaceuticals, Novartis, Biogen, Galimedix, Annexon, Stealth Biotherapeutic, Biozeus and IDx and a patent from nGoggle.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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