mental health is an important area and influences health - related quality of life ( qol ) . depression , one of the most common mental diseases , is associated with worse qol and increased mortality . recently , depression has been found to be one of determinants for cardiovascular disease through alteration of the autonomic nervous system or inflammatory cytokines , which has been reported to have an association with glaucoma . patients with visual impairment have higher probability of being depressed than subjects without eye diseases . visual disability can aggravate qol through , for example , driving limitations and fear of falling , and it can be related to depression . glaucoma is a common , chronic , progressive optic nerve disease that can cause irreversible visual impairment . a 10% to 20% prevalence of depressive symptoms has been reported in subjects with glaucoma . despite the reported association between glaucoma and depression , no objective evaluation of vision , such as visual acuity ( va ) or visual field ( vf ) , the perception of disease itself could affect the sense of well - being in glaucoma patients through the fear of future vision loss , and the potential side effects of treatment might lead to mental health symptoms . evaluating mental health status or qol in undiagnosed glaucoma patients would remove the bias caused by acknowledgement of the disease itself , but no study has evaluated both psychological health and qol in undiagnosed glaucoma patients . the korea national health and nutrition examination survey ( knhanes ) is an ongoing , nationwide , population - based study that provides data on ophthalmologic examination , psychological health , and sociodemographic factors . therefore , we used data from the knhanes to investigate the association between mental health status and qol in undiagnosed glaucoma , along with the effects of va or vf damage . this cross - sectional study was based on data from the knhanes v ( 20102012 ) , a nationwide epidemiological survey conducted by the division of chronic disease and prevention , ministry of health and welfare , with the approval of the institutional review board . the survey follows the tenets of the declaration of helsinki for biomedical research involving humans . the knhanes uses a stratified , multistage , probability sampling method based on geographical area , age , and sex . this nationally representative study is composed of a health interview survey , health examination study , and a nutrition survey . among participants in the knhanes 20102012 v , subjects 40 years or older who underwent ophthalmological examination were included . participants who had previous retinal surgery , along with those whose fundus photograph displayed geographic atrophy or signs of wet age - related macular degeneration , such as retinal pigment epithelial ( rpe ) detachment , serous detachment of the sensory retina , subretinal or sub - rpe hemorrhage , or subretinal fibrous scars , were excluded . we excluded subjects with visually significant cataract ( best corrected visual acuity [ bcva ] of better eye worse than 0.5 ) and corneal opacity . cataract was defined as lens opacities ( locs iii score is 2 ) including nuclear , cortical , posterior subcapsular , anterior capsular , or combined type compared with standard photographs , similar to previous studies . individuals diagnosed with glaucoma by their doctor and those undergoing glaucoma treatment were also excluded . the knhanes includes questionnaires to assess psychological health , including depression , sleep duration , psychological stress , and suicidal ideations . to evaluate depression , has your life been disrupted by feelings of hopelessness or sadness for more than two weeks within the past year ?  participants who responded psychological stress was graded from responses , which reflect cognitive complaints on a 4-point likert scale : 1 ( low ) , 2 ( moderate ) , 3 ( severe ) , and 4 ( very severe ) . self - reported sleep duration was divided into 5 categories : 5 , 6 , 7 , 8 , and 9  hours / day . if participants replied  yes  to the question ,  during the past year , have you ever had a suicidal ideation ? the knhanes includes the euroqol , which is composed of a health - status descriptive system ( euroqol 5-dimension , eq-5d ) and the eq visual analog scale ( eq - vas ) . the eq-5d assesses the level of self - reported problems according to the 5 dimensions of mobility ( eq-1 ) , self - care ( eq-2 ) , usual activities ( eq-3 ) , pain / discomfort ( eq-4 ) , and anxiety / depression ( eq-5 ) . three answers for each dimension were possible ( no problems , some problems , severe problems ) . the subjects who answered  some or severe problem  were defined as having a problem in the associated eq 5-d dimension . using a combination of the 5 dimensions , a summary index ( eq-5d index ; range , 0.171 to 1 ) was calculated using the korea valuation set developed by the korean centers for disease control and prevention . the maximum score of 1 on the eq5-d index represents the best health state with no self - reported problem in any of the 5 dimensions . participants also expressed their subjective health status on a vas ranging from 0 ( the worst imaginable health state ) to 100 ( the best imaginable health state ) . the knhanes also collects data on anthropometrics and demographic characteristics , including socioeconomic status , education level , and physical activity . data on age , sex , educational level , and medical comorbidities such as diabetes mellitus and hypertension were also collected as potential confounding variables . diabetes was defined as a fasting blood glucose level > 126  mg / dl or current use of systemic antidiabetic treatment . systemic hypertension was defined as a systolic blood pressure > 160  mmhg , diastolic blood pressure > 90  mmhg , or current use of systemic antihypertensive medication . participants were divided into nondrinkers , light - to - moderate drinkers ( 130  g alcohol / day ) , and heavy drinkers ( > 30.0  g alcohol / day ) . moderate physical activity involved performance of moderate - intensity physical activity for > 20  minutes 3 or 4 times / week , with moderate intensity exercise defined as that inducing a mild elevation in breathing or heart rate for at least 10  minutes . ophthalmologists measured intraocular pressure ( iop ) using a goldmann applanation tonometer ( haag - streit , inc , bern , switzerland ) and used a topcon kr8800 autorefractor to obtain refractive error . participant va was measured at a distance of 4  m using an international standard vision chart ( jin vision chart based on the logmar scale ) based on decimal fractions . the bcva was obtained with full subjective refraction using an autorefractometer , with the pinhole applied if the bcva with autorefractometry did not improve to 0.8 . the bcva was classified into 4 categories : 0.8 to 1.0 , 0.5 to 0.63 , 0.25 to 0.4 , and no light perception to 0.2 . participants with elevated iop ( 22  mmhg ) or a glaucomatous optic disc were examined using frequency - doubling technology ( fdt , humphrey matrix ; carl zeiss meditec , inc , dublin , ca ) with the n-301 program . a glaucomatous optic disc refers to any of the following : a horizontal or vertical cup - to - disc ratio ( cdr ) 0.5 , presence of optic disc hemorrhage , presence of a retinal nerve fiber layer ( rnfl ) defect , or a violation of the is nt rule ( neuroretinal rim thickness in the order of inferior > superior > nasal > temporal ) . a glaucoma diagnosis was made based on the isgeo criteria : category 1 requires a glaucomatous vf defect with a cdr 0.7 , asymmetry of a vertical cdr 0.2 , or presence of an rnfl defect . when the vf was unavailable or unsatisfactory , subjects were included in category 2 if their vertical cdr was 0.9 , vertical cdr asymmetry was 0.3 , or if they had an rnfl defect with violation of the is nt rule . if examination of the optic disc and a vf test were not possible , category 3 required a va<3/60 and iop exceeding 21  mmhg . vf score was measured as follows : one point for vf defects of p  <  0.01 , 3 points for p  <  0.005 , and 5 points for vf defects indicated as  not seen at maximum  in 18 locations of 1 eye . abnormality score of vf was calculated providing greater weight on the location in the paracenteral vf , as brusini et al suggested . the sum of points in both eyes was used to determine glaucoma stage ( mild versus advanced ) based on the median value of the summed points . 9.2 ; sas institute , inc . ) was used for statistical analyses in order to reflect sampling weights and offer nationally representative prevalence estimates . demographic factors between subjects with and without glaucoma were compared using student t test for continuous parameters and the  test for categorical variables . continuous and categorical parameters are described as mean    standard error and percentage , respectively . factors that showed a difference between the 2 groups with p  <  0.05 were entered into a multivariate analysis , and odds ratios ( ors ) and 95% confidence intervals ( cis ) were calculated . a p value < 0.05 was considered to indicate statistical significance . this cross - sectional study was based on data from the knhanes v ( 20102012 ) , a nationwide epidemiological survey conducted by the division of chronic disease and prevention , ministry of health and welfare , with the approval of the institutional review board . the survey follows the tenets of the declaration of helsinki for biomedical research involving humans . the knhanes uses a stratified , multistage , probability sampling method based on geographical area , age , and sex . this nationally representative study is composed of a health interview survey , health examination study , and a nutrition survey . among participants in the knhanes 20102012 v , subjects 40 years or older who underwent ophthalmological examination were included . participants who had previous retinal surgery , along with those whose fundus photograph displayed geographic atrophy or signs of wet age - related macular degeneration , such as retinal pigment epithelial ( rpe ) detachment , serous detachment of the sensory retina , subretinal or sub - rpe hemorrhage , or subretinal fibrous scars , were excluded . we excluded subjects with visually significant cataract ( best corrected visual acuity [ bcva ] of better eye worse than 0.5 ) and corneal opacity . cataract was defined as lens opacities ( locs iii score is 2 ) including nuclear , cortical , posterior subcapsular , anterior capsular , or combined type compared with standard photographs , similar to previous studies . individuals diagnosed with glaucoma by their doctor and those undergoing glaucoma treatment were also excluded . the knhanes includes questionnaires to assess psychological health , including depression , sleep duration , psychological stress , and suicidal ideations . to evaluate depression , has your life been disrupted by feelings of hopelessness or sadness for more than two weeks within the past year ?  participants who responded psychological stress was graded from responses , which reflect cognitive complaints on a 4-point likert scale : 1 ( low ) , 2 ( moderate ) , 3 ( severe ) , and 4 ( very severe ) . self - reported sleep duration was divided into 5 categories : 5 , 6 , 7 , 8 , and 9  hours / day . if participants replied  yes  to the question ,  during the past year , have you ever had a suicidal ideation ? the knhanes includes the euroqol , which is composed of a health - status descriptive system ( euroqol 5-dimension , eq-5d ) and the eq visual analog scale ( eq - vas ) . the eq-5d assesses the level of self - reported problems according to the 5 dimensions of mobility ( eq-1 ) , self - care ( eq-2 ) , usual activities ( eq-3 ) , pain / discomfort ( eq-4 ) , and anxiety / depression ( eq-5 ) . three answers for each dimension were possible ( no problems , some problems , severe problems ) . the subjects who answered  some or severe problem  were defined as having a problem in the associated eq 5-d dimension . using a combination of the 5 dimensions , a summary index ( eq-5d index ; range , 0.171 to 1 ) was calculated using the korea valuation set developed by the korean centers for disease control and prevention . the maximum score of 1 on the eq5-d index represents the best health state with no self - reported problem in any of the 5 dimensions . participants also expressed their subjective health status on a vas ranging from 0 ( the worst imaginable health state ) to 100 ( the best imaginable health state ) . the knhanes also collects data on anthropometrics and demographic characteristics , including socioeconomic status , education level , and physical activity . data on age , sex , educational level , and medical comorbidities such as diabetes mellitus and hypertension were also collected as potential confounding variables . diabetes was defined as a fasting blood glucose level > 126  mg / dl or current use of systemic antidiabetic treatment . systemic hypertension was defined as a systolic blood pressure > 160  mmhg , diastolic blood pressure > 90  mmhg , or current use of systemic antihypertensive medication . participants were divided into nondrinkers , light - to - moderate drinkers ( 130  g alcohol / day ) , and heavy drinkers ( > 30.0  g alcohol / day ) . moderate physical activity involved performance of moderate - intensity physical activity for > 20  minutes 3 or 4 times / week , with moderate intensity exercise defined as that inducing a mild elevation in breathing or heart rate for at least 10  minutes . ophthalmologists measured intraocular pressure ( iop ) using a goldmann applanation tonometer ( haag - streit , inc , bern , switzerland ) and used a topcon kr8800 autorefractor to obtain refractive error . participant va was measured at a distance of 4  m using an international standard vision chart ( jin vision chart based on the logmar scale ) based on decimal fractions . the bcva was obtained with full subjective refraction using an autorefractometer , with the pinhole applied if the bcva with autorefractometry did not improve to 0.8 . the bcva was classified into 4 categories : 0.8 to 1.0 , 0.5 to 0.63 , 0.25 to 0.4 , and no light perception to 0.2 . participants with elevated iop ( 22  mmhg ) or a glaucomatous optic disc were examined using frequency - doubling technology ( fdt , humphrey matrix ; carl zeiss meditec , inc , dublin , ca ) with the n-301 program . a glaucomatous optic disc refers to any of the following : a horizontal or vertical cup - to - disc ratio ( cdr ) 0.5 , presence of optic disc hemorrhage , presence of a retinal nerve fiber layer ( rnfl ) defect , or a violation of the is nt rule ( neuroretinal rim thickness in the order of inferior > superior > nasal > temporal ) . a glaucoma diagnosis was made based on the isgeo criteria : category 1 requires a glaucomatous vf defect with a cdr 0.7 , asymmetry of a vertical cdr 0.2 , or presence of an rnfl defect . when the vf was unavailable or unsatisfactory , subjects were included in category 2 if their vertical cdr was 0.9 , vertical cdr asymmetry was 0.3 , or if they had an rnfl defect with violation of the is nt rule . if examination of the optic disc and a vf test were not possible , category 3 required a va<3/60 and iop exceeding 21  mmhg . vf score was measured as follows : one point for vf defects of p  <  0.01 , 3 points for p  <  0.005 , and 5 points for vf defects indicated as  not seen at maximum  in 18 locations of 1 eye . abnormality score of vf was calculated providing greater weight on the location in the paracenteral vf , as brusini et al suggested . the sum of points in both eyes was used to determine glaucoma stage ( mild versus advanced ) based on the median value of the summed points . sas software ( ver . 9.2 ; sas institute , inc . ) was used for statistical analyses in order to reflect sampling weights and offer nationally representative prevalence estimates . demographic factors between subjects with and without glaucoma were compared using student t test for continuous parameters and the  test for categorical variables . continuous and categorical parameters are described as mean    standard error and percentage , respectively . factors that showed a difference between the 2 groups with p  <  0.05 were entered into a multivariate analysis , and odds ratios ( ors ) and 95% confidence intervals ( cis ) were calculated . among the 25,534 participants in the knhanes 20102012 v , 12,976 subjects 40 years or older were included in the present study ( figure 1 ) . among them , 12,881 individuals who underwent ophthalmological examination were selected . of these , 155 participants who had previous retinal surgery , 89 subjects with a fundus photograph showing signs of wet age - related macular degeneration or geographic atrophy , and 18 individuals diagnosed with glaucoma or undergoing glaucoma treatment were excluded . in addition , 326 subjects were excluded because of incomplete medical data . ultimately , 12,079 participants ( 5235 males , 6844 females ) were included in this study . the prevalence of undiagnosed glaucoma was 4.27%    0.25% in the study population . the mean age    standard error of subjects with glaucoma was 61.47    0.70 years ( table 1 ) . participants with glaucoma were older and less educated , less likely to live with a spouse , and exercised less regularly than those without glaucoma . according to univariate analysis , male sex , lower body mass index , presence of chronic disease such as diabetes or hypertension , and lower income status baseline characteristics table 2 shows the univariate associations between glaucoma and psychological health and qol parameters . glaucoma is related to short ( 5  h ) or long ( 9  h ) sleep duration ( p  =  0.041 ) . suicidal ideation was greater in subjects with glaucoma than in those without glaucoma ( p  =  0.005 ) . depression diagnosed by a doctor did not differ significantly between individuals with and without glaucoma . however , glaucoma was associated with depressive mood ( 2 weeks in a row ) ( p  =  0.037 ) the proportion of anxiety / depression symptoms reported on the eq-5 was higher in subjects with glaucoma than in those without glaucoma ( p  <  0.001 ) . the glaucoma group also presented a higher proportion of those who reported  some or severe problems  in all 5 dimensions of the eq-5 in comparison with the non - glaucoma group . the eq-5d index and the subjective health status reported by the eq - vas were lower in the subjects with glaucoma than in those without glaucoma . association between glaucoma and psychological health , health - related quality of life table 3 presents the differences in psychological health and qol between the subjects with and without glaucoma after adjusting for age ( model 1 ) and age , sex , body mass index , diabetes , hypertension , income status , education level , marital status , and regular exercise ( model 2 : demographic factors with p value < 0.05 in univariate analyses ) . in both models 1 and 2 , glaucoma subjects were more likely than those without glaucoma to have some or severe problems with anxiety / depression ( model 1 : or , 1.71 ; 95% ci 1.232.39 , model 2 : or 1.77 ; 95% ci , 1.262.49 ) . the multivariate or for the lowest quartile of eq - vas in the glaucoma group versus the nonglaucoma group was 1.55 ( 95% ci 1.211.98 ) in model 1 and 1.52 ( 95% ci 1.191.96 ) in model 2 . adjusted odds on multivariate analysis of the association between glaucoma and psychological health , health - related quality of life table 4 shows the results of subgroup analysis in individuals with glaucoma with regard to psychological health and qol according to bcva . as bcva decreased , the eq-5d index score also decreased ( p  =  0.021 ) . subjects with lower bcva were more likely to have some or severe problems with anxiety / depression in the subgroup with glaucoma , but the relationship between them was not statistically significant ( p  =  0.154 ) . subjects with points 0 and those with > 0 did not differ significantly in eq - vas or eq-5d ( p  =  0.357 , 0.802 , respectively ) . eq-5 ( anxiety / depression ) was not significantly correlated with abnormality score of vf defects ( p  =  0.784 ) . relationship of visual acuity and visual field damage and health - related quality of life in subjects with undiagnosed glaucoma we present the first report regarding both psychological health and qol in people with undiagnosed glaucoma . subjects with glaucoma showed greater odds of having some or severe problems with anxiety / depression . in addition , glaucoma can lower qol in patients even when they are unaware they have the disease . one previous hospital - based study showed that the prevalence of depressive symptoms did not differ according to the presence of glaucoma . however , a growing body of evidence , including a population - based study , suggests that glaucoma patients are more likely to be depressed than subjects without glaucoma . the us national health and nutrition examination survey reported that glaucoma is significantly associated with depression after adjusting for demographic factors . no large , cross - sectional studies have investigated the association between glaucoma and depression in asian countries . in this study , we discovered no significant difference between subjects with and without glaucoma in depression diagnosed by a doctor . however , glaucoma subjects were more likely to have self - reported depressive mood for 2 weeks ( p  =  0.037 ) . a higher proportion of subjects with glaucoma ( 20.4% ) than without glaucoma ( 11.7% , p  <  0.001 ) reported symptoms of some or severe anxiety / depression on the eq-5 . in multivariate analysis , only eq-5d ( anxiety / depression ) remained a significant correlation with glaucoma . therefore , depressive mood was more common in subjects with glaucoma , but the degree or duration of depressive symptoms was not severe enough to diagnose a major depressive disorder . when previous studies analyzed the relationships between glaucoma and depressive symptoms , they used different criteria for depressive mood . wang et al found that the prevalence of depression diagnosed by the diagnostic and statistical manual of mental disorders ( dsm - iv ) was 10.9% in glaucoma patients and 6.9% in subjects without glaucoma ( p  =  0.02 ) . they used self - reported glaucoma to investigate the relationship between glaucoma and depression , which could explain the discrepancy with the results of our study . in our study , subjects with glaucoma undiagnosed by a doctor may have been free of the perception of the disease and the fear of the potential side effects of treatment . therefore , they might have experienced depressive symptoms that were not serious enough to warrant a depression diagnosis . the depressive symptoms were simply categorized for the subjects who answered  some or severe problem  for anxiety / depression ( eq-5 ) in this study . self - report instruments for common mental disorders include the patient health questionnaire , the center for epidemiological studies depression ( ces - d ) scale , beck depression inventory , and state - trait anxiety inventory . detailed grading for anxiety / depression such as  state - trait anxiety inventory  could not be performed in this study . in addition , it was not clear whether anxiety / depression is a temporary condition to symptom or a general tendency in subjects with undiagnosed glaucoma . it could be one of limitations that quantitative or qualitative evaluation for depression was not possible in this study , even though a brief screening questionnaire needed a shorter time . in addition , the information on mental health and qol came from self - reported questionnaires , so reporting bias is possible . for glaucoma patients , fear of blindness and the potential adverse effects of treatment can lead to depression . previous reports on the association of glaucoma with mental health status have concentrated on glaucoma patients with preexisting disease . jampel et al found that depressive mood was related to patient perceptions of worsening visual function but not to poor va or worse vf in newly diagnosed glaucoma patients . that study eliminated the effects of treatment itself because patients were not informed about their treatment at the time of the qol interview ; however , it could not adjust for the effects of perception of disease . our study , which excludes the effects of fear about the illness , corresponded to their study : the va and vf scores did not correlate with depressive symptoms . even without knowing about the disease itself , subjectively perceived poorer vision seems to be more closely related to depressive mood than the objective evaluation of vision . glaucoma influences qol in a degree similar to other chronic diseases such as dementia and diabetes . patients with glaucoma in a cross - sectional study acknowledged that their qol was decreased compared with subjects without glaucoma . in our study , subjects with glaucoma reported more problems with anxiety / depression on the eq-5d . to evaluate qol in glaucoma patients , general health - related , vision - specific , and glaucoma - specific instruments can be used . as general health - related questionnaires , eq-5d or short - form health surveys ( sf-36 ) have been widely used : as vision - specific measurements , national eye institute visual functioning questionnaire ( nei - vfq ) or activities of daily vision scale ( advs ) , visual function index ( vf-14 ) : as glaucoma - specific instruments , glaucoma quality of life ( gql)-15 , or symptom impact glaucoma ( sig ) . disease - specific instruments can focus on the issues of particular concern such as vision with more responsiveness ( sensitive to change ) . general qol instruments lack the responsiveness of the disease - specific instruments and the information focused on visual function . among glaucoma - specific instruments , gql-15 revealed that the most problematic activities for glaucoma patients were those associated with dark adaptation . those ocular dependent factors were not evaluated in general qol instruments such as the euro qol . that the euro qol does not assess vision - specific function was one of limitations of this study . however , valid and generic questionnaires may work even better with multidimensional evaluation of qol . combination of generic and disease - specific instruments may be a good approach to evaluate health - related qol in further studies . those results correspond with a previous hospital - based study that found that the eq-5d index was correlated with va in glaucoma patients . several studies reported that the severity of vf defects was linked to impaired qol or opposite results . the different study findings may result from dissimilar strategy used for grading qol or the proportion of individuals with advanced glaucoma , or the type of vf tests . in our study , fdt was used to evaluate vf damage , whereas other reports employed standard automated perimetry . using standard automated perimetry , visual field index was correlated with gql-15 , one of qol assessment tools , not corresponding to our findings . the visual field index is primarily based on the pattern deviation maps in eyes with a mean deviation better than 20  db with weighting toward the central areas of the vf , leading to be less affected by media opacities . n-301 program with a scoring algorithm in frequency doubling technology is not ideal for evaluating glaucoma stage and may be one of limitations of our study , even though that grading system has been found to be highly specific for glaucoma detection . a growing body of evidence shows that depression increases the risk of coronary artery disease to at least 1.5 times that of healthy subjects . depression is associated with autonomic dysfunction with increased sympathetic tone or endothelial dysfunction and inflammation . the relationship between undiagnosed glaucoma and depressive symptoms may also suggest a possibility that depression may increase the risk of glaucoma development . however , we can not confirm a cause and effect relationship from the present study because our cross - sectional study revealed only the association between glaucoma and depression . the strength of this study is that a population - based study is representative of individuals with undiagnosed glaucoma in the general population . the knhanes includes information on socioeconomic status and demographic factors that contribute to psychological health , such as income status , education level , marital status , and daily sun exposure . therefore , we could adjust all those factors to assess the association between glaucoma and mental health . in conclusion , individuals who had undiagnosed glaucoma might be more depressed than those without glaucoma , even though the degree of depression is not sufficient to diagnose depression . therefore , when initially diagnosing glaucoma , acknowledging that glaucoma patients might already have depressive symptoms could be helpful in treatment and follow - up .
abstractglaucoma is a leading cause of irreversible vision loss . mental health and quality of life ( qol ) are important issues for patients with glaucoma because visual impairment can be related to those . 
 analysis of mental health status or qol in undiagnosed glaucoma patients can be free of the bias caused by awareness of the disease itself . in this study , the association between mental health status or qol and undiagnosed glaucoma , along with the effects of visual acuity or visual field damage was investigated . among individuals in the korea national health and nutrition examination survey ( knhanes ) 
 v ( 20102012 ) , subjects 40 years or older were included . 
 knhanes is a cross - sectional study using a stratified , multistage , probability sampling survey . 
 the knhanes includes questionnaires to assess psychological health , including depression , sleep duration , psychological stress , and suicidal ideations . to evaluate qol , 
 the knhanes includes the euroqol , which is composed of a health - status descriptive system ( euroqol 5-dimension , eq-5d ) and the eq visual analog scale ( eq - vas ) . 
 the proportion of people reporting symptoms of  some or severe problems  in all 5 dimensions of the euroqol-5 instrument , including anxiety / depression , was higher in the glaucoma group than in the nonglaucoma group . 
 the subjective health status reported by the eq - vas was lower in the subjects with glaucoma than in those without glaucoma . 
 suicidal ideation was greater in subjects with glaucoma than in those without glaucoma ( p  =  0.005 ) . 
 after adjustment for demographic factors , glaucoma subjects were more likely than those without glaucoma to have some or severe problems with anxiety / depression ( odds ratio 1.77 ; 95% confidence interval , 1.262.49 ) . 
 worse best corrected visual acuity was associated with more problems with a lower eq-5d score in glaucoma subjects . 
 individuals who had undiagnosed glaucoma were more depressed than those without glaucoma . 
 qol can be affected by glaucoma , especially in patients with worse visual acuity .