cross- sectional analyses of HEIJO-KYO Cohort Association between glaucomatous optic disc and symptoms of depression in elderly individuals: cross- sectional analyses of HEIJO-KYO Cohort Kimie Miyata1, Tadanobu Yoshikawa1, Kenji Obayashi2, Keigo Saeki2, Nahoko Ogata1 1Department of Ophthalmology,　Nara Medical University School of Medicine 2Department of Epidemiology and Preventive Medicine, Nara Medical University School of Medicine Background & Objective Glaucoma is associated with apoptosis of the photosensitive retinal ganglion cells which regulate the circadian biological rhythm through non-visual light information.1 An interference of the circadian rhythm is an inducible factor for depressive symptoms, and thus, glaucoma may be associated with depressive symptoms. However, the relationship between the presence of a glaucomatous optic disc and depressive symptoms has not been determined. Objective The purpose of this study was to determine whether there is a significant correlation between the presence of a glaucomatous optic disc and depressive symptoms. Participants & Methods Participants Seven hundred and eighty home-dwelling elderly individuals age ≥60 years who voluntarily enrolled in the HEIJO-KYO study were assessed for depressive symptoms and the presence of a glaucomatous optic disc . Assessments of depressive symptoms and glaucoma The presence of a glaucomatous optic disc was determined by examining the fundus photographs by a glaucoma specialist. The glaucomatous optic discs were classified as; without, unilateral, or bilateral glaucomatous optic disc. The depressive symptoms were determined by the short version of the Geriatric Depression Scale (GDS) questionnaire with a depressive state defined as a GDS score ≥6. Other measurements The best-corrected visual acuities of both eyes were measured with a Landolt ring chart at 5 m. The household income was self-reported. Statistical analysis The decimal BCVA was converted to the logarithm of the minimum angle of resolution (logMAR) units. Multivariable logistic regression analyses were used to determine the associations between the glaucomatous optic disc and the depressive state. The analyses included potential confounding factors such as age, sex, household income, and the BCVA. Results Table 1. Characteristics of 780 Participants by glaucomatous optic disc status No glaucomatous optic disc Unilateral glaucomatous optic disc Bilateral glaucomatous optic disc n = 715 n = 31 n = 34 P Age, mean (SD), years 71.0 (7.0) 71.0 (6.9) 73.1 (6.5) 0.2 Men, number (%) 370 (51.7) 13 (41.9) 26 (76.5) 0.009 Household income ≧4 milion/year, (%) 291 (43.4) 13 (43.3) 16 (51.6) 0.7 BCVA, logMAR units (SD) -0.05 (0.12) -0.06 (0.11) -0.06 (0.13) 0.09 BCVA, best-corrected visual acuity Figure 2. Incidence of depressive state as function of presence of glaucomatous optic disc Figure 3. Odds ratio for presence of depressed state in relation to presence of glaucomatous optic disc Unadjusted Fully adjusted (all variables in Table 1) Logistic regression models showing that the bilateral glaucomatous optic disc group had a significantly higher odds ratio (OR) for depressed mood than those without glaucomatous optic disc (OR, 2.64; P = 0.013; unadjusted model; OR, 2.73; P = 0.011; fully adjusted model), but not the group with unilateral glaucomatous optic disc. Discussion Our findings confirm earlier reports of a significant correlation between glaucoma and the depressive state.2-4 Mabuchi et al showed that the presence of severe glaucoma was a risk factor for depression.2 Diniz-Filho et al reported that a faster progression of the visual fields was associated with depressive symptoms in patients with glaucoma.3 Our results showed that bilateral glaucomatous optic disc was significantly associated with depressive symptoms. Although we did not examine the visual fields to determine the severity of the glaucoma, these findings suggest that severe visual field loss results in depressive symptoms. Popescu et al suggested other possible causes for the relationship between glaucoma and depressive symptoms.4 They showed that a decrease in the visual acuity including glaucoma, age-related degeneration, and Fuchs corneal dystrophy are associated with depression in older adults.4 These diseases cause not only visual acuity reduction but also the reduction of non-visual light information. Thus, the circadian biological rhythm disturbances through a reduction of non-visual light information may affect the depressive symptoms in glaucoma patients. Further studies are needed to determine the mechanism for this association. Conclusion The presence of a glaucomatous optic disc is significantly associated with a depressive state in the elderly. The association was independent of confounders including the visual acuity. References 1. Feigl B et al. Invest Ophthalmol Vis Sci. 2011;52:4362-7 2. Mabuchi F et al. Br J Ophthalmol. 2012;96:821-825. 3. Diniz-Filho A et al. Ophthalmology. 2016;123:754-759. 4. Popescu ML et al. Invest Ophthalmol Vis Sci. 2012;53:2308-2313. WGC 2017, Helsinki, Finland References