Psychological stress may cause vision loss

Berlin: Persistent psychological stress can be a major contributor to vision loss and its progression, scientists including those from India have found. Clinical practice implications of this finding include a recommendation to improve the clinician-patient relationship and provide stress-reduction treatments and psychological counselling to interrupt the vicious cycle of stress and progressive vision loss.

"The behaviour and words of the treating physician can have far-reaching consequences for the prognosis of vision loss. Many patients are told that the prognosis is poor and that they should be prepared to become blind one day," said Muneeb Faiq, All India Institute of Medical Sciences (AIIMS) New Delhi. "Even when this is far from certainty and full blindness almost never occurs, the ensuing fear and anxiety are a neurological and psychological double-burden with physiological consequences that often worsen the disease condition," said Faiq.

The study, published in the EPMA Journal, is based on a comprehensive analysis of hundreds of published research and clinical reports on the relationship of stress and ophthalmologic diseases.
"There is clear evidence of a psychosomatic component to vision loss, as stress is an important cause - not just a consequence - of progressive vision loss resulting from diseases such as glaucoma, optic neuropathy, diabetic retinopathy, and age-related macular degeneration," said Bernhard Sabel, from Magdeburg University in Germany. Some case reports are presented showing how stress induces vision loss and how reduction of stress contributes to vision restoration. "Continuous stress and elevated cortisol levels negatively impact the eye and brain due to autonomic nervous system (sympathetic) imbalance and vascular deregulation," said Sabel.

He emphasised that both the eye and the brain are involved in vision loss, a fact that is often overlooked by treating physicians and is not systematically documented in the medical literature.
Increased intraocular pressure, endothelial dysfunction (Flammer syndrome), and inflammation are some of the consequences of stress causing further damage. Adjunct therapies like brain stimulation, relaxation response, vision restoration, anxiety management, and social support counteract stress and induce a relaxation response by rebalancing the autonomic system of reducing sympathetic and activating parasympathetic activity.

They have been used successfully in tandem with therapies to increase blood flow to the eye, thereby opening the window of opportunity for vision restoration. The researchers believed this holistic approach can be used more widely in the clinical management of eye diseases. They advise that stress reduction and relaxation techniques (eg 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 measures to reduce progression of vision loss.