Emotional and Caregiver Burden in Adults with Glaucoma-Related Blindness at a Chinese Tertiary Center

Zhonghua Luo,1,* Kojima Konatsu,1,* Yu Yang,1 Lu Cheng,1 Yuxian He,1 Yu Zhang,1 Ying Han,2 Jingjing Huang1 1Zhongshan Ophthalmic Center, Sun Yat-Sen University, WHO Collaborating Centre for Eye Care and Vision, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China; 2Department of Ophthalmology, University of California, San Francisco, CA, USA*These authors contributed equally to this workCorrespondence: Jingjing Huang, Zhongshan Ophthalmic Center, Sun Yat-Sen University, WHO Collaborating Centre for Eye Care and Vision, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, 7 Jinsui Road, Guangzhou, 510623, People’s Republic of China, Tel +86 13632333129, Email [email protected]: To investigate the psychological and functional burden of glaucoma-related blindness in adult patients and their primary caregivers, and to examine the interrelationships within the patient-caregiver dyad.Patients and Methods: A cross-sectional study enrolled 110 adult patients with glaucoma-related blindness and their caregivers. Depressive symptoms, vision-related quality of life, and caregiver burden were assessed using the Patient Health Questionnaire-9 (PHQ-9), the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), and the 22-item Zarit Burden Interview (ZBI-22), respectively. Logistic regression analyses were performed to identify factors associated with caregiver burden. A mediation analysis examined whether patients’ depressive symptoms mediated the association between visual impairment (VI) and caregiver burden.Results: As the severity of VI increased, patient PHQ-9 scores rose, while NEI-VFQ-25 scores declined correspondingly (all P < 0.05). Similarly, caregivers demonstrated higher PHQ-9 and ZBI-22 scores with rising levels of patient VI (all P < 0.05). Notably, patient and caregiver PHQ-9 scores were positively correlated (r = 0.336; P = 0.040). In multivariable logistic regression, higher caregivers’ depressive symptom scores (adjusted OR = 1.28; 95% CI: 1.09– 1.49; P = 0.002) and higher patient intraocular pressure (adjusted OR = 1.04; 95% CI: 1.01– 1.07; P = 0.044) remained independently associated with higher odds of caregiver burden. The indirect effect of VI on caregiver burden through the patients’ depressive symptoms was significant (P < 0.05).Conclusion: Glaucoma-related blindness imposes significant psychological and functional burdens on patients and caregivers, with evidence of emotional contagion. Effective control of intraocular pressure and mental health support for caregivers are critical to reducing caregiver burden.Keywords: glaucoma, blindness, adult patients, emotional contagion, caregiver burden