Depression and Eye Disease-A Narrative Review of Common Underlying Pathophysiological Mechanisms and their Potential Applications.

Background: Depression has been shown to be associated with eye diseases, including dry eye disease (DED), cataracts, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR). This narrative review explores potential pathophysiological connections between depression and eye disease, as well as its potential correlations with ocular parameters. Methods: A literature search was conducted in August 2022 in PUBMED, EMBASE, and PsycINFO. Published articles related to the subject were consolidated and classified according to respective eye diseases and pathophysiological mechanisms. Results: The literature reviewed suggests that common pathophysiological states like inflammation and neurodegeneration may contribute to both depression and certain eye diseases, while somatic symptoms and altered physiology, such as disruptions in circadian rhythm due to eye diseases, can also influence patients' mood states. Grounded in the shared embryological, anatomical, and physiological features between the eye and the brain, depression is also correlated to changes observed in non-invasive ophthalmological imaging modalities, such as changes in the retinal nerve fibre layer and retinal microvasculature. Conclusions: There is substantial evidence of a close association between depression and eye diseases. Understanding the underlying concepts can inform further research on treatment options and monitoring of depression based on ocular parameters.

Structural Differences in the Optic Nerve Head of Glaucoma Patients With and Without Disc Hemorrhages.

PURPOSE: The aim of the study was to evaluate differences in planimetry, optic nerve parameters, and visual field (VF) indices in glaucomatous eyes with a disc hemorrhage (DH), their contralateral counterparts without DH, and normal controls. PATIENTS AND METHODS: We retrospectively reviewed the records (from 1995 to 2013) of 44 glaucoma subjects with unilateral DH and 50 normal controls. In the DH group, 33 had bilateral fundus photos for planimetric analysis (Cyoptique GL), 15 had spectral domain-optical coherence tomography (SD-OCT), 15 had VF indices (Humphrey Visual Field Analyser), and 39 had ≥ 5 perimetry outputs for progression analysis (Progressor). RESULTS: Structurally, planimetric analysis revealed that the eye with DH had a larger cup-disc ratio, more significantly in the vertical aspect (P<0.001), and a thinner rim (P=0.010), compared with the contralateral eye without DH. SD-OCT analysis also showed a thinner rim area (P<0.001), most significantly in 2, 3, and 9 clock hours and the inferior and superior quadrants (P<0.001) compared with the contralateral eye without DH and normal controls. Also, the vertical cup-disc ratio was larger (P<0.001). Functionally, VF deterioration was demonstrated by VF indices in eyes with DH-mean deviation: -10.69 versus -0.97, P<0.001 and pattern standard deviation: 6.60 versus 1.59, P<0.001, compared with normal controls. CONCLUSIONS: Eyes with DH consistently displayed both structural features of more advanced glaucoma confirmed simultaneously on planimetry and SD-OCT, with concurrent VF deterioration.

Bleb related infections: clinical characteristics, risk factors, and outcomes in an Asian population.

PURPOSE: Comparison of the demographic, ocular, systemic and microbiological characteristics of eyes with bleb related infection (BRI) and bleb related endophthalmitis (BRE). METHODS: Retrospective chart review of patients with BRI from January 1996-July 2013. Identification done via the center's longstanding endophthalmitis audit, BRI audit and laboratory database identifying all conjunctival swabs from blebs. Blebitis was defined as anterior segment inflammation with mucopurulent material in or around the bleb, with anterior chamber cells but no hypopyon. BRE was defined by the presence of hypopyon or vitreous inflammation. RESULTS: Twenty-nine patients with blebitis and 10 with BRE were identified. Mean age of subjects (n=39) was 68.4 (±13.3) with a preponderance of men (74.4%) and Chinese ethnicity (74.4%). BRE patients were 10.7 years older than blebitis patients (P=0.026). 28 (71.8%) subjects had primary open angle glaucoma. The presenting intraocular pressure (IOP) dropped in blebitis but almost doubled in BRE (P=0.011) compared to average preinfective IOP. Two weeks after treatment, IOPs in both groups returned to close to preinfective levels. Subjects with blebitis more often had an avascular bleb (88.0%) while those with BRE trended toward a moderately vascular bleb (50%). The distribution of causative microorganisms between the groups was similar. CONCLUSION: Our study indicates that risk factors are similar in both groups even though the visual outcome and clinical course, in the form of IOP findings and bleb vascularity, can diverge significantly. The decreased IOP in blebitis subjects represents objective evidence of subclinical leaks or bleb sweating.

A follow-up survey on the knowledge of age-related macular degeneration and its risk factors among Singapore residents after 5 years of nation-wide awareness campaigns.

PURPOSE: To re-evaluate the awareness of age-related macular degeneration (AMD) and knowledge of its risk factors among Singapore residents after 5 years of awareness campaigns. METHODS: Cross-sectional, questionnaire-based telephone survey (modified from the AMD Alliance International Global Report), conducted in Singapore in 2011. Participants were randomly selected using the Global Yellow Pages Singapore residential listings 2009/2010. Awareness of AMD and its risk factors was assessed among participants. RESULTS: Of 1773 Singapore residents contacted over the telephone, 559 participated (31.5% response rate). The mean age of participants was 43.1 years (range 21-85 years). A total of 157 participants (28.1%) were familiar with AMD. Among these, the number who correctly identified the risk factors were: smoking, n = 132 (84.1%); ageing, n = 123 (78.3%); lack of vitamins/nutrients, n = 121 (77.1%); genetics, n = 101 (64.3%); unprotected light exposure, n = 100 (63.7%) and; sex, n = 62 (39.5%). Participants aged >50 years (prevalence rate ratio, PRR 2.23, confidence interval, CI, 1.31-3.81) or who had undergone an eye test within the previous year (PRR 2.61, 95% CI 1.79-3.82) were more familiar with AMD, while females (PRR 0.68, 95% CI 0.47-0.98) were less familiar. CONCLUSION: Self-reported awareness of AMD among Singapore residents increased four-fold from 7.3% in 2006 to 28.1% in 2011 following 5 years of awareness campaigns. Participants who were >50 years or had undergone an eye test within the previous year were more aware of AMD while female participants were less aware of AMD.

Retinal vascular caliber and age-related macular degeneration in an Indian population from Singapore.

PURPOSE: To examine the association between retinal vascular caliber and early age-related macular degeneration (AMD) in an Indian population. METHODS: A total of 3112 Indian participants aged ≥40 years from the population-based Singapore Indian Eye Study who had data available on retinal vascular caliber measurements and AMD status were included. Retinal arteriolar and venular calibers were measured from digital photographs using computer-assisted software according to a standardized protocol. Images of the macular region were graded according to the modified Wisconsin age-related maculopathy grading system. Right eyes were selected for analyses. Binary logistic regression models were used to assess the association, adjusting for age, sex, systolic blood pressure, total cholesterol, random blood glucose, body mass index, and the companion retinal vascular caliber. RESULTS: A total of 107 participants (3.4%) were diagnosed with early AMD. Neither arteriolar nor venular caliber was related to AMD. For early AMD, the age-, sex-, and companion retinal vascular caliber-adjusted odds ratio (OR) per standard deviation (SD) decrease in arteriolar caliber was 0.95 (95% CI 0.84-1.31; p = 0.671), and per SD increase in venular caliber was OR: 0.96 (95% CI: 0.77-1.20); p = 0.714. No trend was found after categorizing retinal vascular calibers into quartiles. Multivariate adjustment and stratified analyses did not alter these results. CONCLUSION: Retinal vascular calibers were not related to early AMD among Indian participants. These findings differ from those of several previous studies performed in Caucasian and Asian populations.