Anxiety, Depression and Pseudomyopia: A Bidirectional Relationship

Abstract

Purpose: This study aims to investigate the reciprocal relationship between anxiety, depression and pseudomyopia.

Methods: This was an analytical, multicentered, cross-sectional study conducted from July to November 2024. 30 subjects, aged 18–35years, including emmetrops and pseudomyopes (≥0.50 D reduction in spherical equivalent after cycloplegia) were included. The subjects underwent a comprehensive optometric evaluation that included cycloplegic and non-cycloplegic autorefraction. Anxiety and depression was measured using the Hospital Anxiety and Depression Scale (HADS). Group differences were investigated using Welch's t-test, Fisher's Exact and Chi-square tests for categorical associations and Pearson's coefficients for correlations. Bidirectional regression models were used to evaluate the expected interactions between anxiety, depression and pseudomyopia.

Results: When compared to emmetropes, pseudomyopes showed noticeably greater anxiety (11.81 ± 2.71 vs. 7.22 ± 1.30; p <.001) and depression (11.10 ± 2.49 vs 6.56 ± 0.88;p <.001) ratings. There was a positive correlation between pseudomyopic shift (mean 0.64 ± 0.35 D) and depression (r= 0.539,p=.002) as well as anxiety (r= 0.576,p=.001). The results of regression analyses showed a bidirectional relationship: pseudomyopic shift predicted higher anxiety (β =.576, p =.001; R² =.331) and depression (β=.539,p=.002; R² =.290), while anxiety (β=.417, p=.017) and depression (β =.349,p=.042) predicted greater pseudomyopic shift (R² =.428).

Conclusion: The findings suggest that there exists a reciprocal association between anxiety, depression and pseudomyopia, as well as a possible biopsychovisual feedback loop in which psychological symptoms and visual instability reinforce one another. These results demonstrate the importance of combining optometric and psychological tests in the diagnosis and treatment of pseudomyopia.