Depression and anxiety in patients with pseudoexfoliative glaucoma Tongabay Cumurcu, M.D. a, 4 , Birgul Elbozan Cumurcu, M.D. b , Feryal Cam Celikel, M.D. b , Ilker Etikan, Ph.D. c a Department of Ophthalmology, Gaziosmanpasa University School of Medicine, Tokat 60100, Turkey b Department of Psychiatry, Gaziosmanpasa University School of Medicine, Tokat 60100, Turkey c Department of Biostatistics, Gaziosmanpasa University School of Medicine, Tokat 60100, Turkey Received 8 June 2006; accepted 14 September 2006 Abstract Objective: This study aimed to determine whether patients with pseudoexfoliative glaucoma (PXG), associated with vascular disorders, have more depressive and anxiety symptoms than patients with primary open-angle glaucoma (POAG) and controls without glaucoma. The vascular depression model was tested in this study. Method: The sample consisted of 41 PXG patients, 32 POAG patients and 40 controls. Each subject was diagnosed as having PXG or POAG or chosen as a control patient by an ophthalmologist and then evaluated by a psychiatrist. The Structured Clinical Interview for DSM-IV, Turkish version; Hamilton Depression Rating Scale (HDRS); Hamilton Anxiety Rating Scale (HARS); Mini Mental State Examination; and Montgomery–Asberg Depression Rating Scale (MADRS) were administered to all subjects. Results: The HDRS and MADRS scores of the PXG patients were significantly higher than those of the POAG and the control group (v 2 = 9.858, p = .007 and v 2 = 11.618, p = .003, respectively). The HARS scores did not show a significant difference between the patients with PXG or POAG and the control subjects (v 2 = 1.615, p = .446). In each of the three groups, there was no correlation between the HDRS, HARS or MADRS scores and any of the following parameters: duration of glaucoma, medical treatment, visual acuity, intraocular pressure, perimetric stage, cup–disc ratio and number of glaucoma operations ( p N .05). Conclusion: A relationship between PXG and severity of depressive symptoms was shown by our data. However, no significant difference could be found between the anxiety levels of the three groups. D 2006 Elsevier Inc. All rights reserved. Keywords: Depression; Anxiety; Pseudoexfoliative glaucoma; Vascular depression 1. Introduction Glaucoma is a chronic and progressive disease that is more prevalent among the elderly. Despite treatment, many patients continue to worsen and some lose vision [1]. Studies have shown that glaucoma is the second-leading cause of blindness in the United States as well as the second-leading cause of bilateral blindness in the world [2,3]. The number of people in the United States with primary open-angle glaucoma (POAG) in the year 2000 was estimated to be 2.47 million, of whom 1.84 million were White Americans and 619,000 were African Americans [4]. The pseudoexfoliative (PX) syndrome is an age-related disorder of the extracellular matrix characterized by the production and progressive accumulation of a fibrillar material in ocular tissues and the connective tissue sections of various visceral organs [5]. Overall, it is the most common identifiable cause of glaucoma, accounting for the majority of the cases in some countries [6]. PX glaucoma (PXG) is a special subgroup of POAG associated with the PX syndrome. Many studies have suggested an association between the PX syndrome and vascular diseases [7–11]. An association of exfoliative syndrome with branch and central retinal vein occlusion has been suggested [7,8]. In the Blue Mountain Eye Study, the exfoliation syndrome correlated positively with a history of hypertension, angina, myocardial infarction or stroke [9]. In addition, some studies have reported a higher frequency of exfoliation syndrome in patients with abdom- inal aortic aneurysm and transient ischemic attacks [10,11]. Previous studies investigated the extent of psychosomatic complaints in patients with glaucoma. Although several studies did not find any disturbance, most studies showed 0163-8343/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.genhosppsych.2006.09.004 4 Corresponding author. Tel.: +90 356 212 9500/1226; fax: +90 356 213 3179. E-mail addresses: tongabay@superonline.com, tcumurcu@gop.edu.tr (T. Cumurcu). General Hospital Psychiatry 28 (2006) 509 – 515