Beyond vision: The overlooked burden of depression in glaucoma patients

Figure 1 Risk factors for glaucoma and depression. Glaucoma and depression are linked by epidemiology (higher prevalence, bidirectional risk), psychosocial factors (fear of blindness, role loss, and social isolation), neurobiological mechanisms (hypothalamic-pituitary-adrenal-axis dysregulation, neuroinflammation, mitochondrial dysfunction, reduced brain-derived neurotrophic factor), and treatment burden. Clinicians see low adherence and inferior outcomes from these domains. Arrows show relationships, not causes. HPA: Hypothalamic-pituitary-adrenal; BDNF: Brain-derived neurotrophic factor.

Figure 2 Integrated glaucoma depression care. Workflow embedding mental-health care into glaucoma management: Screen at diagnosis and key milestones (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7), provide stepped interventions (psychoeducation, adherence coaching, cognitive-behavioral therapy, and antidepressants), and give ophthalmology and primary care regular feedback. Legend distinguishes screening points (dotted) and interventions (solid). PHQ-9: Patient Health Questionnaire-9; GAD-7: Generalized Anxiety Disorder-7; CBT: Cognitive-behavioral therapy; SSRIs: Selective serotonin reuptake inhibitors; SNRIs: Serotonin-norepinephrine reuptake inhibitors.