The prevalence of anxiety symptoms and disorders among ophthalmic disease patients

Author: Ulhaq ZS, Soraya GV, Dewi NA, Wulandari LR.

Geographical coverage: Germany; Japan; Turkey; Australia; Pakistan; Korea; China; Singapore; Philippines; United States of America; India; Brazil; Nigeria; France; Italy; Spain; United Kingdom; Portugal; Thailand; Netherlands; Poland; Congo; Lithuania; Taiwan

Sector: Burden of disease

Sub-sector: Epidemiology, prevalence

Equity focus: Not reported

Study population: Patients with ophthalmic diseases

Review type: Epidemiology review

Quantitative synthesis method: Meta-analysis

Qualitative synthesis method: Not applicable

Background

Anxiety disorders affect about 7.3 % of the general population and frequently co‑occur with other mental health conditions. People with chronic illnesses are at increased risk. Growing evidence links anxiety symptoms to ocular diseases, with potential adverse effects on eye health and overall well‑being. Timely identification and management of anxiety are therefore essential.

Objectives 

To estimate the prevalence of anxiety symptoms and anxiety disorders among patients with ophthalmic diseases.

Main findings

Anxiety is common in ophthalmic disease, particularly in paediatric populations and in conditions such as uveitis and thyroid eye disease.

Ninety‑five observational studies (81 assessing anxiety symptoms and 14 assessing anxiety disorders) were included. The pooled prevalence of anxiety symptoms was 31.2 % and of anxiety disorders 19.0 %. Paediatric patients had a significantly higher prevalence of anxiety symptoms (58.6 %, 95 % confidence interval [CI] 18.6 %–98.5 %) than adults (29.0 %, 95 % CI 25.8 %–32.3 %).

Anxiety symptoms were most prevalent in uveitis (53.5 %), followed by dry‑eye disease (37.2 %), retinitis pigmentosa (36.5 %), diabetic retinopathy (31.3 %), glaucoma (30.7 %), myopia (24.7 %), age‑related macular degeneration (21.6 %) and cataract (21.2 %). Anxiety disorders were most common in thyroid eye disease (28.9 %), glaucoma (22.2 %) and dry‑eye disease (11.4 %).

Compared with healthy controls, patients with ocular disease were nearly twice as likely to experience anxiety symptoms (odds ratio [OR] 1.91, 95 % CI 1.46–2.50) and anxiety disorders (OR 2.28, 95 % CI 1.17–4.45). Dry‑eye disease conferred a slightly higher risk of anxiety symptoms (OR 2.19) than glaucoma (OR 1.82) relative to controls.

Methodology 

MEDLINE, Scopus and Web of Science were searched in January 2022 for observational studies reporting anxiety symptoms or disorders in patients with eye disease.

Data were extracted into a standardised form and study quality was assessed with the Newcastle–Ottawa Scale. Random‑effects meta‑analysis generated pooled prevalence estimates. Subgroup analyses examined age group and specific ocular conditions. Secondary analyses compared anxiety prevalence with healthy controls. Heterogeneity was assessed with the I² statistic and publication bias with Begg’s funnel plot.

Applicability / external validity

Evidence for paediatric patients is limited, and further research in this group is warranted.

Geographic focus

Studies were conducted across 24 countries in Europe, Asia, Oceania, North and South America and Africa.

Summary of quality assessment 

Confidence in the conclusions is low. Reviewers did not contact study authors, screen reference lists, list excluded studies or specify reviewer numbers. Results were not stratified by risk of bias.