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

Abstract

Purpose Identifying factors that affect recovery or restoration of neurological function is a key goal of rehabilitation in neurology and ophthalmology. One such factor can be prolonged mental stress, which may be not only the consequence of nervous system damage but also a major risk factor, or cause, of neural inactivation. Using the visual system as a model of neural injury, we wished to study how patients' stress and personality profiles correlate with vision recovery as induced by therapy with alternating current stimulation (ACS) in patients with optic nerve damage. Methods Personality and stress questionnaires were sent retrospectively to a clinical convenience sample of patients who suffer low vision due to optic nerve damage, which had previously been treated with ACS. The questionnaires included the NEO Five-Factor Inventory (NEO-FFI), the Trier Inventory of Chronic Stress (TICS), and the Flammer syndrome (FS) checklist, which probes signs of vascular dysregulation (VD). These scores were then correlated with the extent of ACS-induced vision restoration as recorded 1-3 years earlier by perimetric visual field tests. Results Two NEO-FFI personality factors (lower neuroticism, higher conscientiousness) and the presence of physiological Flammer signs were associated with greater recovery as were individual items of the factors openness and agreeableness. Single NEO-FFI item analysis revealed that recovery relates to greater extraversion (optimistic and happy), openness (less guided by authorities for decisions on moral issues), and agreeableness (argue less, like working with others, thoughtful, considerate) as well as the presence of FS signs (cold hands/feet, hypotension, slim body shapes, tinnitus). This suggests that patients with better recovery were more calm, peaceful and secure, hard-working, and reliable, and with high organizational skills. In contrast, patients with poor recovery had a tendency to be emotionally unstable, anxious, unhappy and prone to negative emotions, impulsive, careless, and unorganized. Chronic stress assessed with TICS did not correlate with recovery. Conclusion Vision restoration induced by ACS is greater in patients with less stress-prone personality traits and those who show signs of VD. Prospective studies are now needed to determine if personality has (i) a causal influence, i.e., patients with less stress-prone personalities and greater VD signs recover better, and/or (ii) if personality changes are an effect of the treatment, i.e., successful recovery induces personality changes. Though the cause-effect relationship is still open, we nevertheless propose that psychosocial factors and VD contribute to the highly variable outcome of vision restoration treatments in low vision rehabilitation. This has implications for preventive and personalized vision restoration and is of general value for our understanding of outcome variability in neuromodulation and neurological rehabilitation.

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“…Stress was identi ed as a signi cant negative predictor of HRQoL in this current study. Interestingly, it is speculated that stress can be not only a consequence of visual de cit, but also an aggravating factor as continuous stress and elevated cortisol levels might negatively impact the visual system due to sympathetic imbalance and vascular dysregulation (49,53).…”

Is Mental Stress the Primary Cause of Glaucoma?

“…Diese Unterschiede umfassen u. a. das Auftreten von Ungleichgewicht im autonomen Nervensystem, Magen-Darm-Störungen, Tachykardie und IOD-Anstieg [52]. Allgemein finden sich FS-Zeichen auf physiologischer (erhöhte Empfindlichkeit gegenüber Schmerzen und Medikamenten), hormoneller (erhöhtes Cortisol und Endothelin-1) und psychologischer Ebene [51]. Aus psychologischer Perspektive weisen FS + -Patienten eine charakteristische Persönlichkeitsdisposition auf, die durch Perfektionismus, Ehrgeiz, übermäßiges Grübeln und Sorgen auffällt.…”

“…Dies ist eine Quelle von dauerhaftem Stress, der eine Kaskade von erhöhten Stresshormonspiegeln in Verbindung mit endothelialer Dysfunktion auslöst und daraus resultierend zu einer vaskulären Dysregulation führt [48]. Diese hat wie-derum neuronale Inaktivierung aufgrund von unzureichender Sauerstoff-und Glukoseversorgung zur Folge [51].…”

Voice perturbations under the stress overload in young individuals: phenotyping and suboptimal health as predictors for cascading pathologies

“…Tinnitus Stress overload and vascular dysregulation of different origin plays the key role in pathogenesis of tinnitus [88].…”

“…Stress overload and vascular dysregulation of different origin plays the key role in pathogenesis of tinnitus [ 88 ]. Although corresponding pathomechanisms are still under-investigated, the evident relationship between vascular dysregulation and tinnitus is the reduced bioavailability of nitric oxide (NO) in vasospastic individuals.…”