Proliferative Diabetic Retinopathy Interventions Show Decreased Odds of Anxiety, Depression

Vikram Ponnusamy, MD

New research suggests both surgical and non-surgical interventions for proliferative diabetic retinopathy (PDR) have decreased odds of having comorbid anxiety and depression.

However, study data show retinal detachment repair was associated only with higher odds of anxiety, not depression.

“These findings emphasize the importance of multidisciplinary care in managing patients with diabetic retinal detachments,” wrote study author Vikram Ponnusamy, MD, University of North Carolina System.

These findings were presented at the Association for Research in Vision and Ophthalmology (ARVO) 2022 Meeting in Denver, Colorado.

As a leading cause of preventable blindness in working-age adults, diabetic retinopathy visual loss has a significant effect on social, economic, and emotional well-being. Both major depressive disorder and general anxiety disorder is prevalent in diabetics, especially in PDR patients.

The retrospective case-control study quantified the association between different interventions for the treatment of PDR, and anxiety and depression. Patients were identified over the age of 18 years with a diagnosis of PDR between January 2014 - December 2020 via ICD-9 and ICD-10 codes.

Additionally, comorbid anxiety and depression were determined via ICD-9 and ICD-10 diagnosis codes.

Further, CPT codes identified patients diagnosed with PDR that received treatment as follows:

• Intravitreal injection
• Panretinal photocoagulation (PRP)
• Pars plana vitrectomy (PPV)
• PPV with endolaser
• Retinal detachment repair (RDR)
• Complex RDR
• Silicone oil removal

Investigators used multiple logistic regression models to obtain estimated odds ratio (OR) and confidence intervals whilst stratifying and adjusting for sex and age.

From a total of 3572 patients with PDR, 648 had anxiety and 979 had depression. Patients who received intravitreal injection had lower odds of comorbid anxiety when compared to untreated PDR patients (OR, 0.835, 0.738 - 0.944; P <.001).

Additionally, investigators found reduced odds for comorbid depression when comparing between patients who received intravitreal injections (OR, 0.584, 0.525 - 0.650; P <.001), PPV with endolaser (OR, 0.725, 0.604 - 0.870; P <.001), or PRP (OR, 0.589, 0.512 - 0.678; P <.001) to patients who had no intervention for PDR.

Moreover, RDR (OR, 1.759, 1.044 - 2.966; P <.001) and complex RDR (OR, 1.451, 1.032 - 2.040, P <.001) were found to be associated with increased odds of comorbid anxiety, when compared to patients with untreated PDR.

“These findings further elucidate the relationship between mental health and diabetic retinopathy,” Ponnusamy concluded.

The study, “Anxiety and Depression in Patients Treated for Proliferative Diabetic Retinopathy,” was presented at ARVO 2022.