Abstract
The prognosis of going blind is very stressful for patients diagnosed with “glaucoma”.
Worries and fear of losing independence is a constant mental burden, with secondary
risks of depression and social isolation. But stress is not only a result of glaucoma
but also a possible cause (risk factor). This should not be surprising, given that
chronic stress can trigger “psychosomatic” organ dysfunctions anywhere in the body.
Why should the organ “eye” be an exception? Indeed, glaucoma patients often suspect
that severe emotional stress caused their visual field loss or “foggy vision”. The
hypothesis that stress is a possible cause of glaucoma is supported by different observations:
(i) acute and chronic stress increases intraocular pressure and (ii) long-term stress
can lead to vascular dysregulation of the microcirculation in the eye and brain (“Flammerʼs
syndrome”), leading to partial hypoxia and hypoglycaemia (hypo-metabolism). Even if
nerve cells do not die, they may then
become inactive (“silent” neurons). (iii) Degenerative changes have been reported
in the brain of glaucoma patients, affecting not only anterograde or transsynaptic
areas of the central visual pathway, but degeneration is also found (iv) in brain
areas involved in emotional appraisal and the physiological regulation of stress hormones.
There are also psychological hints indicating that stress is a cause of glaucoma:
(v) Glaucoma patients with Flammerʼs syndrome show typical personality traits that
are associated with low stress resilience: they often have cold hands or feet, are
ambitious (professionally successful), perfectionistic, obsessive, brooding and worrying
a lot. (vi) If stress hormone levels and inflammation parameters are reduced in glaucoma
patients by relaxation with meditation, this correlates with normalisation of intraocular
pressure, and yet another clue is that (vii) visual field improvements after non-invasive
current stimulation therapy, that are
known to improve circulation and neuronal synchronisation, are much most effective
in patients with stress resilient personalities. An appreciation of stress as a “cause”
of glaucoma suggests that in addition to standard therapy (i) stress reduction through
relaxation techniques should be recommended (e.g. meditation), and (ii) self-medication
compliance should not be induced by kindling anxiety and worries with negative communication
(“You will go blind!”), but communication should be positive (“The prognosis is optimistic”).
Key words
glaucoma - low vision - mental stress - vascular dysregulation - personality - vision
restoration
