Maladaptive coping strategies and glaucoma progression

Abstract

The identification of modifiable risk factors for glaucoma progression is needed. Our objective was to determine whether maladaptive coping styles are associated with recent glaucoma progression or worse visual field mean deviation.A hospital-based case–control study was conducted in the Glaucoma Service of Maisonneuve-Rosemont Hospital in Montreal, Canada. Patients with primary open angle glaucoma or normal tension glaucoma with ≥4 years of follow-up and ≥5 Humphrey visual fields were included. Cases had recent visual field progression as defined according to the Early Manifest Glaucoma Trial pattern change probability maps. Controls had stable visual fields. The Brief Cope questionnaire, a 28-item questionnaire about 14 different ways of coping with the stress of a chronic disease, was asked. Questions were also asked about demographic and medical factors, and the medical chart was examined. Outcomes included glaucoma progression (yes, no) and visual field mean deviation. Logistic and linear regressions were used.A total of 180 patients were included (82 progressors and 98 nonprogressors). Although none of the 14 coping scales were associated with glaucoma progression (P > 0.05), higher denial was correlated with worse visual field mean deviation (r = −0.173, P = 0.024). In a linear regression model including age, sex, education, depression, intraocular pressure, and family history of glaucoma, greater levels of denial (β = −1.37, 95% confidence interval [CI] −2.32, −0.41), Haitian ethnicity (β = −7.78, 95% CI −12.52, −3.04), and the number of glaucoma medications (β = −1.20, 95% CI −2.00, −0.38) were statistically significantly associated with visual field mean deviation.The maladaptive coping mechanism of denial was a risk factor for worse visual field mean deviation. Further prospective research will be required to verify the pathways by which denial may exert an effect on glaucomatous visual field loss.

Trends in and Predictors of Depression Among Participants in the Collaborative Initial Glaucoma Treatment Study (CIGTS)

“…However, there is evidence that poorer glaucoma control is associated with more depressive symptoms, while depressive symptoms are in turn related to non-adherence and possibly poorer glaucoma control. Diniz-Filho et al 27 reported that fast visual field progression was associated with a greater occurrence of depressive symptoms in 102 patients with glaucoma, and Freeman et al 28 found that a maladaptive coping strategy (denial) led to a higher risk of glaucomatous progression.…”

“…The association of such symptoms with lack of adherence to medications previously reported 13–15 and validated herein, may be due to maladaptive strategies of coping such as denial. 28 The possible consequence of faster glaucomatous progression 27 warrants attention to the glaucoma patient’s psychological status and better risk communication by eye care providers. Clinicians might consider using the VAQ or a single VAQ item to assess the patient’s glaucoma burden and possible related depression.…”

Mental stress as consequence and cause of vision loss: the dawn of psychosomatic ophthalmology for preventive and personalized medicine

“…If an individual is resilient or susceptible to stressors depends largely on their personality. Maladaptive coping strategies and specific personality patterns are found in patients with glaucoma [98][99][100]. Mabuchi [101] observed that PAOG patients have significantly higher mean neuroticism scores (N), and agreeableness (A) as well as conscientiousness (C) were significantly lower in male POAG patients.…”

“…The mean extraversion score (E) was significantly lower in female POAG patients. Freeman et al [98] observed that those patients that use denial when confronted with their first POAG diagnosis had a faster progression of the visual field loss.…”

The Impact of the Coronavirus Disease 2019 Pandemic on Adherence to Ocular Hypotensive Medication in Patients with Primary Open-Angle Glaucoma

“…We assessed the association between demographic, clinical, and psychosocial factors and adherence in the periods preceding and following the onset of the pandemic. Psychosocial factors included resilience, 10 coping styles, 11 illness perception 12 and self-efficacy, 13 which have been associated with adherence and visual function.…”