Persistent psychological stress, which is widely recognized as a consequence of vision loss, is also a major contributor to its development and progression, according to a study published in the EPMA Journal, the official journal of the European Association for Predictive, Preventive, and Personalized Medicine. Clinical practice implications of this finding include a recommendation to improve the clinician-patient relationship and provide stress-reduction treatments and psychological counseling to interrupt the vicious cycle of stress and progressive vision loss.
“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,” says Prof. Bernhard Sabel, PhD, Director of the Institute of Medical Psychology at Magdeburg University, Germany, lead investigator of the study. Prof. Sabel has pioneered a holistic treatment approach that combines stress management, patient education, and vision recovery and restoration techniques at the SAVIR-Center for Vision Restoration in Germany.
The study, which was presented at the 5th International Conference of “Low Vision and Brain” in Berlin, is based on a comprehensive analysis of hundreds of published research and clinical reports on the relationship of stress and ophthalmologic diseases. “Continuous stress and elevated cortisol levels negatively impact the eye and brain due to autonomic nervous system (sympathetic) imbalance and vascular deregulation,” Prof. Sabel explains, emphasizing 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. He notes that of the relatively few scientific reports in the field of psychosomatic ophthalmology available, even fewer explore the relationship of stress, vision loss, and vision restoration.
“The behavior 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. 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,” adds Dr. Muneeb Faiq, PhD, All India Institute of Medical Sciences, New Delhi, India, and Department of Ophthalmology, NYU Langone Health, New York University School of Medicine, USA, and a co-investigator on the study. 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 investigators believe this holistic approach can be used more widely in the clinical management of eye diseases. Stress management is also pertinent to the care givers/family members whose support and encouragement are important to maintain a stress-free state of mind, which in turn may keep the stress markers at bay.
Prof. Sabel and his colleagues note that, “future clinical studies are underway 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 restoration in randomized trials as a foundation of psychosomatic ophthalmology.”
The SAVIR-Center for Vision Restoration in Germany has successfully applied above protocol on hundreds of patients in the last few years. Most of the patients (94%) have been satisfied attending the SAVIR treatment program. And around 80% of the patients are getting clear and measurable benefits that include the following: increased visual acuity and reading, increased field of vision, reduced fogginess and/or preventing further vision loss.