Mental stress as consequence and cause of vision loss: the dawn of psychosomatic ophthalmology for preventive and personalized medicine

Abstract

The loss of vision after damage to the retina, optic nerve, or brain has often grave consequences in everyday life such as problems with recognizing faces, reading, or mobility. Because vision loss is considered to be irreversible and often progressive, patients experience continuous mental stress due to worries, anxiety, or fear with secondary consequences such as depression and social isolation. While prolonged mental stress is clearly a of vision loss, it may also aggravate the situation. In fact, continuous stress and elevated cortisol levels negatively impact the eye and brain due to autonomous nervous system (sympathetic) imbalance and vascular dysregulation; hence stress may also be one of the major of visual system diseases such as glaucoma and optic neuropathy. Although stress is a known risk factor, its causal role in the development or progression of certain visual system disorders is not widely appreciated. This review of the literature discusses the relationship of stress and ophthalmological diseases. We conclude that stress is both and of vision loss. This creates a vicious cycle of a downward spiral, in which initial vision loss creates stress which further accelerates vision loss, creating even more stress and so forth. This new psychosomatic perspective has several implications for clinical practice. Firstly, stress reduction and relaxation techniques (e.g., meditation, autogenic training, stress management training, and psychotherapy to learn to cope) should be recommended not only as complementary to traditional treatments of vision loss but possibly as preventive means to reduce progression of vision loss. Secondly, doctors should try their best to inculcate positivity and optimism in their patients while giving them the information the patients are entitled to, especially regarding the important value of stress reduction. In this way, the vicious cycle could be interrupted. More clinical studies are now needed to confirm the causal role of stress in different low vision diseases to evaluate the efficacy of different anti-stress therapies for preventing progression and improving vision recovery and restoration in randomized trials as a foundation of psychosomatic ophthalmology.

Prevalence and new onset of depression and anxiety among participants with AMD in a European cohort

“…Results from a total of 11,834 participants were analyzed (5,876 men and 5,958 women; mean age 54.4 ± 11.0 years), of whom 1,089 (9.2%) were diagnosed as having AMD. Early AMD (stages 1-3) was present in 95.2% (1037) of the participants with AMD, stage 1a, 21.1% (230), stage 1b, 49.0% (534), stage 2a, 13.0% (142), stage 2b, 3% (39), stage 3, 8.5% (92), late AMD (stages 4a + 4b) was present in 4.8% (52) of the participants, stage 4a, 4.2% (46), stage 4b, 0.6% (6). Individuals in the AMD group were older than those in the control group (61.8 ± 9.9 years vs. 53.6 ± 10.8, respectively, p < 0.0001).…”

Vaccine development for glaucoma: From skepticism to certitude

“…One of our recently published papers gives a detailed account of how mental stress can initiate and exacerbate events leading to vision loss in glaucoma. [58] This includes elevation in IOP, vascular dysregulation, endothelial dysfunction, and neurodegenerative processes. [58,88,89] Stress reduction may, therefore, be thought to be as one of the promising non-invasive and relatively inexpensive techniques to delay the onset of glaucoma and to bring down the severity.…”

“…[58] This includes elevation in IOP, vascular dysregulation, endothelial dysfunction, and neurodegenerative processes. [58,88,89] Stress reduction may, therefore, be thought to be as one of the promising non-invasive and relatively inexpensive techniques to delay the onset of glaucoma and to bring down the severity. In a clinical trial, we recently reported that mindfulness/ meditation-based stress reduction techniques lead to lowering of IOP and improve quality of life in glaucoma patients.…”

“…[52][53][54] As an augmentation to this logic, our group also reported an increase in inflammatory and stress markers in glaucoma patients. [55][56][57][58] In addition, it is well established that peripheral blood leukocytic count increases as a defense mechanism for injury anywhere in the body. A noticeable example of such an observation would be myocardial infarction in which the number of macrophages substantially increases in the peripheral blood following myocardial injury.…”

Personality and stress influence vision restoration and recovery in glaucoma and optic neuropathy following alternating current stimulation: implications for personalized neuromodulation and rehabilitation

“…These psychological aspects can be interpreted as signs of excessive mental stress, with or without patients being aware of them. We recently argued that stress is not only the consequence but also a possible cause of vision loss [36]. It may be that patients with FS are overly burdened by excessive and long-term stress, and/or have lower stress resilience.…”