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 consequence 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 causes 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 consequence and cause 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.

Keywords: Low vision; Personalized medicine; Predictive; Preventive; Psychology; Psychosomatic medicine; Relaxation; Restoration; Stress.

Fig. 1

Causes of vision loss taken from “SUSRUTA SAMHITA“[10], first chapter of “BASICS OF EYE DISEASES.” The figure shows the original Sanskrit text passage with its transformation to Roman lettering and the respective English translation. Six causes of vision loss (printed here in bold) are related to emotional stress: 1. USNABHITAPTASYA JALAPRAVESHATH—Drinking or exposing to cool water after exposing to heat. 2. DOOREKSHANATH—Looking at the very distant objects regularly for a long time, may be without blinking. 3. SWAPNA VIPARYAASCHA— Improper sleeping habits like daytime sleeping, awakening at night etc. 4. PRASAKTA SAMRODHANA— Continuous weeping. 5. KOPA— Excessive anger. 6. SHOKA—Grief. 7. KLESHA— Stress: suffering pain, physical, and mental exhaustion. 8. ABIGHAATA—Minute irritative injuries or contusion injuries or perforating injuries. 9. ATI MAITHUNNA—Indulgence in excessive sexual intercourse. 10. SHUKTHA ARANALA AMLA—Vinegar and alcoholic beverages. 11. KULUTTA—Intake of horse gram excessively. 12. MASHA—Intake of black gram excessively. 13. ATISWEDA—Excessive sweating. 14. DHOOMA NISEVANATH—Exposing to smoke or tobacco smoking. 15. CHARDHIR VIGHATATH—Suppressing the vomit. 16. VAMANATHI YOGATH—Excessively indulging in inducing vomiting. 17. BHASHPA GRAHATH—Suppressing tears. 18. SUKSHMA NIREEKSHANATH—Observing the minute things or seeing too tiny objects

Fig. 2

Diagram of stressors (chronic or acute) and their effects showing the vicious cycle of mental stress and vision loss and the cause-effect relationship of stress and vision loss. According to this concept, low vision is both cause and consequence of vision loss. Note: the disease is involving different levels of analysis, psychological, biological, and pathological (ophthalmological)

Fig. 3

Humphrey visual fields of a 78-year-old woman with stress-induced vision loss OD before vs. after a 10-day treatment. Treatment included alternating current stimulation plus relaxation exercises and psychological consulting. In both tests, she had neither any fixation loss nor any false positive responses. Visual field index improved from 12 to 21% (pre/post mean deviation: − 25.97/− 22.44 dB). Subjectively, the patients reported improvement from “gray” to “white” vision with noticeably better acuity. She did not notice any changes in the central visual field but could better recognize faces and street signs, and she was able to see her hair in the mirror again, with her upper visual field. The second case is also a woman who was treated for her glaucoma with current stimulation and various anti-stress methods such as psychological consulting and relaxation (see text for further details)

Fig. 4

Cartoon displaying how the patient feels when confronted with a negative prognosis