Prevalence of depression and anxiety disorders in patients with glaucoma: a systematic review and meta-analysis based on cross-sectional surveys

Author: Yin J, Li H, Guo N.

Geographical coverage: Germany, Japan, Turkey, Australia, China, Singapore, and the United States (US).

Sector: Prevalence

Sub–sector: Depression and anxiety

Equity focus: Not explicitly stated

Study population: Adult patients with glaucoma

Review type: Effectiveness review

Quantitative synthesis method: Meta-analysis

Qualitative synthesis method: Not applicable

Background

Glaucoma is a chronic optic neuropathy that progressively damages the optic nerve, leading to irreversible vision loss if untreated. Beyond visual impairment, glaucoma is linked to psychological distress, particularly depression and anxiety. Recent studies report higher rates of these disorders among people with glaucoma than in the general population: anxiety prevalence has been estimated at about 13.5 % in Turkey and Japan, while depression prevalence ranges from 10 % in the US and Japan to 57 % in Turkey. Despite growing awareness, evidence on the psychological burden of glaucoma remains limited. This systematic review and meta‑analysis therefore aimed to quantify the prevalence and severity of depression and anxiety in adults with glaucoma to support early recognition and management.

Objectives

To estimate the prevalence and severity of depression and anxiety in adults with glaucoma and to provide clinically useful information for healthcare professionals.

Main findings

Patients with glaucoma were significantly more prone to depression and anxiety than individuals without glaucoma.

• Included studies: fifteen cross‑sectional surveys comprising 24 334 individuals with glaucoma from seven countries (Germany = 2 studies; Japan = 5; Turkey = 1; Australia = 1; China = 2; Singapore = 1; United States = 3). Fourteen studies assessed depression and thirteen assessed anxiety, all using validated rating scales.
• Study quality: all studies were high quality; eight scored 9, four scored 8 and three scored 7 on the Newcastle‑Ottawa Scale (NOS).
• Depression: compared with controls, people with glaucoma had a markedly higher risk of depression (relative risk [RR] = 5.92, 95 % confidence interval [CI] 3.29 to 10.66; p < 0.01).
• Anxiety: the likelihood of anxiety was also greater (RR = 2.99, 95 % CI 1.93 to 4.64; p < 0.01).
• Heterogeneity and sensitivity analyses: sensitivity analyses identified individual studies that contributed to heterogeneity; excluding these studies reduced heterogeneity and did not materially alter the pooled estimates.

Methodology

Eligible studies were cross‑sectional surveys of adults (≥ 18 years) with glaucoma that employed a recognised assessment scale for depression and/or anxiety. The authors searched PubMed, Embase, ProQuest PsycINFO, CINAHL, Web of Science, the Cochrane Library, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang and China VIP from inception to December 2023. Two reviewers independently screened records, extracted data and assessed quality using the NOS. Weighted mean difference, standardised mean difference (SMD) and their 95 % CIs were calculated where appropriate. Heterogeneity was evaluated with the I² statistic and the Q test. A fixed‑effects model was applied when I² < 50 %; otherwise, a random‑effects model was used. Sensitivity analyses (subgroup and leave‑one‑out) explored sources of heterogeneity.

Applicability / external validity

Generalising the findings is limited by variation in healthcare systems, follow‑up durations, assessment scales and study populations across the included countries. Substantial heterogeneity further constrains external validity. Larger, multi‑centre studies with longer follow‑up are needed to strengthen the evidence base.

Geographic focus

Studies were conducted in Germany, Japan, Turkey, Australia, China, Singapore and the US.

Summary of quality assessment

The review did not report whether language restrictions were applied, whether reference lists were screened, or whether authors were contacted for additional information. A list of excluded studies was not provided.