Effects of Visual Function Impairment on Depression in Patients With Glaucoma

Background: This study aimed to investigate the relationship between the degree of visual impairment and depressive symptoms in patients with glaucoma, and examine whether disease duration moderates this relationship. Methods: We enrolled 208 patients with glaucoma who received standardised treatment at The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University from February 2022 to February 2025. Clinical data and visual function indicators were collected. Patient-reported visual function was assessed using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), and depressive symptoms were assessed using the SelfRating Depression Scale (SDS). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) served as indicators of visual impairment. Statistical analyses, including descriptive statistics, correlation analysis, linear regression analysis and subgroup analysis with Fisher’s r-to-z transformation, were performed using SPSS 26.0 software. Results: The mean BCVA was 0.31 ± 0.12, and the mean CMT was 263.22 ± 29.01 µm. Depressive symptoms (SDS score ≥ 53) were present in 45.67% of patients. BCVA was negatively correlated with the SDS total score (r = −0.23, p < 0.001), whereas CMT was positively correlated with the SDS total score (r = 0.27, p < 0.001). The NEI-VFQ-25 total score was also negatively correlated with SDS scores (r = −0.22, p = 0.002). Linear regression showed that for every 0.1 increase in BCVA, SDS scores decreased by 1.53 points (p < 0.001); for every 10 µm increase in CMT, SDS scores increased by 0.74 points (p < 0.001). Subgroup analysis and formal interaction testing revealed that disease duration significantly moderated the associations of visual function with depression: the correlations between BCVA (r = −0.44 vs. −0.07, p < 0.010) and NEI-VFQ-25 (r = −0.49 vs. −0.03, p < 0.001) with SDS scores were significantly stronger in patients with longer disease duration (≥5 years), with significant interaction terms (both p < 0.010). Conclusions: The degree of visual impairment in patients with glaucoma was significantly associated with depressive symptoms. Objective measures (BCVA and CMT) and NEI-VFQ-25 were independently related to depression risk, and these relationships were more pronounced in patients with longer disease duration. Clinical practice should emphasize visual function protection and psychological treatments to improve patients’ mental health.