Independent associations of physical activity and depression with open-angle glaucoma in a population-based analysis

Patients with open-angle glaucoma (OAG), a chronic visual impairment, are at elevated risk of developing depression. Physical activity (PA) has been associated with benefits for mental health, but evidence is limited regarding its impact on depression risk in individuals with OAG. This study aimed to assess the association between PA and incident depression in a nationwide cohort of patients newly diagnosed with OAG. We conducted a retrospective cohort study using customized data from the Korean National Health Insurance Service (KNHIS). The cohort included 97,617 individuals newly diagnosed with OAG between 2011 and 2015, with follow-up until depression onset, death, or study end in 2023. Age- and sex-matched controls without OAG were selected at a 1:2 ratio. PA levels were classified as low or high, based on validated self-report, and categorized into four patterns according to change before and after OAG diagnosis: consistently low, consistently high, increased (low to high), and decreased (high to low). The primary outcome was incident depression identified using ICD-10 diagnostic codes. Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for depression risk according to PA patterns. Among patients with OAG (mean [SD] age, 59.7 [12.5] years; 42.5% female), those maintaining high PA levels after diagnosis had a lower risk of developing depression compared with those with low PA (HR, 0.877; 95% CI, 0.856-0.900). The most favorable outcomes was observed in patients with consistently high PA (HR, 0.855; 95% CI, 0.829-0.883), followed by those who increased their PA post-diagnosis (HR, 0.912; 95% CI, 0.879-0.947). Patients who decreased PA or remained inactive showed no significant reduction in depression risk. Overall, Higher or increasing physical activity after OAG diagnosis was associated with a modest but meaningful reduction in depression risk. These findings suggest that encouraging PA may help mitigate depression risk and should be considered as part of comprehensive glaucoma care.