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DOI: 10.1055/a-1303-8025
Ist Stress die primäre Ursache von Glaukom?
Article in several languages: English | deutsch![](https://www.thieme-connect.de/media/klimo/202102/lookinside/thumbnails/10-1055-a-1303-8025_kl2313_de-1.jpg)
Zusammenfassung
Die Prognose durch „Glaukom“ zu erblinden ist für Patienten psychisch extrem belastend, denn Sorgen und Ängste, die Selbstständigkeit zu verlieren, bedeutet Dauerstress mit dem Risiko von Depression und sozialer Isolation. Dass Stress nicht nur Folge, sondern auch Ursache (Risikofaktor) von Glaukom sein kann, sollte nicht überraschen, da chronischer Stress „psychosomatische“ Organschädigungen im ganzen Körper auslösen kann. Warum sollte das Organ „Auge“ da eine Ausnahme sein? In der Tat vermuten Glaukompatienten oft, starke emotionale Belastung sei Auslöser eines Gesichtsfeldverlusts oder „Nebelsehen“ gewesen. Diese Hypothese wird durch zahlreiche Beobachtungen unterstützt: (i) Stress erhöht akut und chronisch den Augeninnendruck und (ii) Dauerstress ist mit vaskulärer Dysregulation der Mikrozirkulation in Auge, Gehirn und anderen Organen assoziiert („Flammer-Syndrom“). Die Folgen sind partielle Hypoxie und Hypoglykämie (Hypometabolismus), die Neuronen nicht absterben lassen, sondern diese akut oder chronisch inaktivieren („stumme“ Neuronen). (iii) Bei Glaukompatienten wird von degenerativen Veränderungen im Gehirn berichtet, und zwar nicht nur in anterograden oder transsynaptischen Kerngebieten des zentralen Sehsystems, sondern auch (iv) in Kerngebieten, die an emotionaler Bewertung und physiologischer Stresshormonregulation beteiligt sind. Auch psychologische Beobachtungen unterstützen die Idee von Stress als Ursache: (v) Glaukompatienten mit Flammer-Syndrom zeigen typische Persönlichkeitsmerkmale, die mit geringer Stressresilienz assoziiert sind: Sie spüren oft kalte Hände oder kalte Füße, sind ambitioniert (beruflich erfolgreich), perfektionistisch, zwanghaft, grübeln viel und machen sich oft Sorgen. (vi) Wenn bei Glaukompatienten durch Meditation Stresshormonspiegel und Entzündungsparameter reduziert werden, korreliert dies mit einer Normalisierung des Augeninnendrucks und (vii) Gesichtsfeldverbesserungen nach einer Reizstromtherapie. Diese Art der Therapie, welche die Durchblutung und neuronale Synchronisation verbessert, ist bei Persönlichkeiten mit hoher Stressresilienz deutlich effektiver. Aus der Erkenntnis „Stress als Ursache von Glaukom“ folgt, dass ergänzend zur Standardtherapie (i) Stressreduktion durch Entspannungstechniken empfohlen werden sollte (z. B. Meditation) und (ii) zur Befolgung der Selbstmedikation keine Prognosen kommuniziert werden, die Angst und Sorgen erhöhen („Sie werden blind“), sondern solche, die Stress reduzieren („die Prognose ist optimistisch“).
Schlüsselwörter
Glaukom - Sehverlust - Stress - vaskuläre Dysregulation - Persönlichkeit - RestitutionPublication History
Received: 03 November 2020
Accepted: 18 January 2021
Article published online:
12 February 2021
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