Abstract
Several studies have risen about mental health and the consequences it has on the body, however, few look into how these issues can affect the eye. This investigation seeks to answer the question, “How do anxiety and stress contribute the the occurrence of macular holes and/or degeneration within the eye.” Research that has been done in the past shows how prevalent mental health issues can cause negative effects on the macula, which when damaged can lead to both macular degeneration and macular holes. This question reveals a whole new world revolving around holistic healthcare– the approach to regard health as a whole, taking both the mind and body into consideration of their effects on each other. In the end, the investigation shows that mental issues cause the macula to thin, contributing to the occurrence of both ocular conditions.
Introduction to Mental and Ocular Health
In recent studies, the connection between psychological conditions and ocular (eyes) health has gained more public attention. Just this past year, organizations such as the Center for Disease Control and Prevention and The Australian and New Zealand Mental Health Association researched how mental health affects vision. As a result, people have become increasingly interested in how common psychological factors can contribute to retinal disease, particularly age-related macular degeneration, and macular holes. Age-related macular degeneration, commonly known as AMD, is a prevalent disease that causes older adults to lose or blur their vision. Ophthalmologists found that the macula (one of the parts of the retina) is damaged when AMD is present. The retina t helps us to participate in daily activities like reading, seeing fine details, and recognizing faces. Concerning this, a macular hole results from a gap within the macula. Both AMD and macular holes are conditions with multiple stages. When the macula is damaged in AMD, it often causes it often causes an irreversible stitch in one’s vision. However, when it is damaged and results in a Macular Hole the stages can lead to extreme results, such as a random “black patch” in your vision. To add to this severity, unlike AMD, only “7.8 out of 100,000 people in the general population get a macular hole”1.
Increasing beyond their basic implications, psychological conditions—such as stress and anxiety—play an important role when one obtains AMD or a Macular Hole. Although they are both emotional responses, Stress and Anxiety do not have the same denotation. Stress is defined as “the physical or mental response to an external cause” (What’s the difference between stress and anxiety?2. Stress often arises from short-term events such as having to do a last-minute project or getting sick. On the contrary, Anxiety, is defined as “your body’s reaction to stress and can occur even if there is no current threat”3. Unlike stress, anxiety doesn’t simply disappear, it gets in the way of engaging in daily activities and can even trigger health diseases. With this information comes the question, “How do anxiety and stress contribute to the occurrence of macular holes and/or degeneration within the eye”?
For one, studies, relating to ocular conditions, have shown that “Natural stress will result in overall poor health outcomes…”4. Conditions such as anxiety and stress have been shown to extend to the eye and affect blood flow, and pressure, and cause inflammation in the eyes. This shows that people experiencing these conditions along with others may be at risk for macular diseases. On these terms, the relevance of this topic is more crucial to comprehend than it may seem. In 2019, anxiety disorders affected 301 million people worldwide5. Knowing that these conditions affect numerous people, it’s important to become aware of how they came to be and how they can affect daily life. This not only ensures good mental health, but also good physical health, and specifically ocular health. Additionally, the topic provides more insight for future studies, not only from a psychological point of view but rather from the body as a whole. Instead of healthcare being approached in parts, the relationship between stress/anxiety and macular holes reflects a holistic point of view toward healthcare. In a fast-evolving world, where mental health is a predominant issue, it’s important to use studies such as this one to understand that topics such as ocular health are not separate, but included in this vast context. If we can recognize and find that these ideas are true, bringing forth new information, we can find ways to treat/limit mental conditions so that they do not lead to poor ocular health.
Nature of Scholarship
To bring forth new information for this purpose, institutions such as The American Institute of Stress and The National Library of Medicine have published many articles regarding this issue, written by multiple accredited scholars. Specifically, they wrote “Depression and anxiety are common in older adults and even more common in older adults with visual impairments”6. Through the nature of the scholarship, within such articles/studies, new perspectives have been uncovered about how big of a role mental health plays in ocular health. As we continue to learn more about this subject, writing, such as these, serves as the pillars of our knowledge.
With that in mind, different types of knowledge regarding this topic provide us with different interpretations of how mental health affects the eye. Today, some studies mention the relationships between these two factors, while others just state that there is a relationship. The common factor between all of them is that poor mental health takes a negative toll on ocular health through changes to the eye. With that being said, as our understanding of mental and ocular health evolves, we gain more insight into how these changes specifically affect the retina’s biochemical and structural properties. An example of this is the fact that “stress can cause the muscles in the eyes to become tense”7. This, in turn, compresses blood vessels, stops blood flow, and eventually leads to blurry vision, vision loss, and muscle spasms as seen in age-related macular degeneration. However, there have been different interpretations of this study, as there as to any other. Some say that the link between stress and macular conditions is about genetics, lifestyles, and other influences. These findings may have erupted from different demographic participants or the intensity and complexity of the ocular health. In the end, we can learn from these differences using them to uncover new information and recognize the high importance of researching in this field.
The complex relationship between mental health issues (like anxiety and stress) and ocular conditions (like macular holes and degeneration) is a topic that scholars still study, having many advances made to it. Nonetheless, the correlation between the two subjects is transparent through the supporting data and is also extremely relevant in our lives. This investigation will first consider the origin of this idea, presenting case studies that support the question raised through examples of how stress and anxiety weaken the retinal wall, thus directly affecting the macula leading to AMD and macular holes. Finally, the investigation will explain the anatomy of the eye and how it is specifically affected by stress. With this information, the investigation will then consider specifically the anatomy of the eye and how anxiety and stress can cause different physical stresses on its parts, increasing the risk of macular holes and degeneration, through the increase in stress hormones within the eye.
Analysis of Mental and Ocular Health Cases in Real Time
Because the eye is a fragile organ of the human body, there are few well-known case studies that mention both macular holes and macular degeneration concerning mental health. Nevertheless, those that do address people who suffered from poor mental health, display that as those conditions worsened, so this their ocular health. By doing this, these studies establish a relationship between the two. However, the theory that poor mental health affects ocular vision dates back over 3000 years ago and is not as recent as one may think. The book Susruta Samhita, written by the famous surgeon, Susruta addresses how mental health can affect the eye. This book, originating in India, was initially written in Sanskrit, one of the oldest languages in the world, but was translated into English for the use of medical professionals. Throughout this book, you can see how traditional Indian Ayurvedic Medicine plays a role in the different causes of vision loss. This type of medicine takes a more holistic approach to health care, its main goal being to restore not only the body but also the mind. Susruta Samhita starts by mentioning all the different causes of vision loss, of which almost half pertain to emotional stress and anxiety. These points include “improper sleeping habits, continuous weeping, excessive anger, grief, pain, and finally psychical and mental exhaustion”8. As a result, these are the same causes of macular holes, and the authors wrote, “We now wish to propose that psychological stress is not only a consequence or just a minor “risk factor.” Rather, it is one of the main causes of certain (but not all) cases of vision loss”9. The findings throughout this book play an important role in current studies as they provided my baseline for ophthalmology. “Dr. V.K Raju, Clinical Professor of Ophthalmology at West Virginia University, notes that the Samhita had eighteen chapters devoted to the eye and described seventy-six different ocular diseases, many of which required surgery”10.
Similarly, case studies have been conducted to show the same things Susruta did in his book. Within the last decade, scientists studied the ocular behavior of a woman named W.G. This 55-year-old woman, experienced eye problems such as macular degeneration, and blurred central vision, and difficulty reading. When she underwent surgery for this, the byproduct was counterproductive. Something had gone wrong in the operation with the amount of anesthesia tranquilizer she was given, and as a result, W.G. was left fully blind in her left eye the next morning. As an older woman, W.G. had other responsibilities than taking care of herself, as her husband at the time, was undergoing severe heart health problems. In the midst of this, her vision made it extremely strenuous for her to complete her job. As the years went on, her vision, and her husband’s health continued to deteriorate, so much that her husband passed away. The doctors who diagnosed W.G. concluded that she had undergone 3 continuous years of stress and that it was the main cause of her vision loss “Mental stress and worries in the past and at present were dominant”9. To accurately make this claim the doctors conducted a series of vision tests which measured her visual field index. In this case, the lower the percentage, the lower her vision is, and W.G. reported back with 43 and 59 percent. This meant that it was clear to ophthalmologists that her vision was egregious, she could only see course shapes, if lucky, and barely any fine details.In addition to this, many problems arose, within her body. W.G. had trouble sleeping at night, had low blood pressure, and was very pale. There was no dispute that her surgery caused the vision loss in her left eye, but the rapid deterioration in her right eye is said to be “in all probability, stress-related because of anxiety and worries…”9. W.G. worried about her vision loss in conjunction with her husband’s health/death and on top of that her own emotional needs. It is clear from this case study that this woman had a lot on her plate, exonerating both anxiety and stress, which in turn increased her probability of obtaining vision loss, specifically (along with glaucoma which she had prior), Age-Related Macular Degeneration.
Analysis of Effects on Ocular Structure
Since it is apparent that stress and anxiety do affect different parts of the eye, we need to understand the anatomy of the eye to fully grasp the topic. There are 7 general components of the eye many of which stress and anxiety affect—some in larger and smaller ways. These include the Cornea, Conjunctiva, Lens, Iris, Pupil, Optic Nerve, and more. This investigation’s central focus will be on the macula. The macula is a small specialized location within the center of the retina, the light-sensitive tissue in the back of the eye. It sits near the optic nerve head, which is described perfectly, as it is where the optic nerve exits the eye and sends visual information to the brain. The two conditions specifically highlighted, prior was Age-Related Macular Degeneration (AMD), and Macular Holes, both of which arise when there are defects in the macula. T Because the macula is only about 5.5 millimeters in diameter, conditions that directly affect it such as a macular hole are rare but can arise in the right setting11. Subsequently, in both AMD and macular holes, depending on whether it is dry or wet, the macula breaks down or is damaged by a leak in the blood (or fluid). This fluid is something we can link back to stress and anxiety as they cause a higher production of the hormone cortisol, which contributes to leakage and inflammation. When it is not disturbed, the macula helps us to see fine details, and read and recognize faces, as mentioned before. However, when it is damaged all of these skills are setback in addition to a significant loss in one central vision and negative effects on visual impairment, as seen in those affected by both AMD and macular holes.
Factors That Affect the Macula: Together, both stress and anxiety affect parts of the eye deteriorating it. deteriorating. Before diving into specifics on what each condition is affected by, there is one obvious change that stress and anxiety bring in the body: Psychological factors. When one experiences poor mental health, it is most likely that their visual perception and attention will be influenced. Individuals who experience high levels of stress and anxiety will perceive visual distortions and have increased difficulty focusing on tasks that require their detailed central vision to be involved, therefore, eventually disregarding it as a whole. To understand how stress and anxiety work hand in hand to deteriorate ocular vision we need to understand what factors affect in the eye as a whole. Firstly, stress and anxiety increase muscle tension, not only throughout the body but in this case, near the eyes. If these muscles continue to be tensed for long periods, it can result in eye strain, discomfort, and essentially blurs vision. This in turn can cause retinal damage through the macular getting thinner and dryer, increasing your chances of AMD. Secondly, the hormones in the body also get triggered through stress, as mentioned previously. “Stress can take a toll on your mental health and trigger anxiety…Stress causes increases in the hormone cortisol, the stress hormone. Increases in this hormone are related to anxiety”12. Concerning this, stress and anxiety are both causes of pupil dilation, through the hormones they release. Similar to eye strain, excessive or prolonged dilation can reduce one’s depth of focus and visual activity. As a result, anyone undergoing this is at a higher risk of having difficulty focusing on near objects, which is one of the symptoms of Age-Related Macular Degeneration (AMD). Another condition that anxiety and stress affect is selective attention. When someone experiences such emotions it can affect how they perceive and interpret visual information as well. Anxiety will trigger people undergoing this condition to pay attention to things that are imposed to act as a threat to them. In addition, they can increase one’s focus on visual disturbances, hazing the surroundings of their vision permanently if the emotions are prominent. Another condition that is commonly known for hazy vision is astigmatism, which works hand in hand with near-sightedness once again relating to both macular holes and AMD. Astigmatism, more scientifically known as refractive errors, can be exacerbated by stress and anxiety because it provides a perfect condition for mental issues to form. When someone undergoes stress, the stress-induced muscle tension around the eye affects the way light is focused on the retina, eventually changing the eye’s corneal curvature (The shape it has). All of these encompass what anxiety and stress do to the eye as a whole.
As mentioned previously, AMD and Macular holes are affected when the macula has deteriorated. To understand this impact, investigated a few of the things that the macula experiences when a person is influenced by anxiety and stress. The hormone cortisol is the main factor of AMD and Macular Holes, but also causes inflammation, oxidative stress, and, importantly vascular dysfunction in the retina. Vascular dysfunction is “blockage of blood flow, leakage of fluid, or rupture of a retinal vessel”13. Through this, hormones such as cortisol and adrenaline are released into the eyes, causing blood vessles within to constrict. Firstly, the blockage of blow flow, known as Vascontriction (the narrowing of blood cells), can compromise oxygen and nutrient delivery to the retinal cells, impairing their function, and essentially posing a threat to the macula. This extent of damage to the retina can lead to damage to the macula and in turn result in AMD and macular holes. Secondly the leakage of fluid, in the macula, is called Macular Edema. According to the National Eye Institute, “Macular Edema happens when blood vessels leak into the macula as a result of excess stress and anxiety while in this case widens the blood vessels. This makes the macula swell, causing blurry vision”14. In addition, these mental health issues can worsen other health issues that lead to macular edema such as diabetes through the damage of blood vessels. Another article mentions that “Macular Edema.. Is commonly linked to mental stress”15. Finally, Retinal Hemorrhage, or the rupture of the retinal vessel, can be caused by the stress or anxiety of your body. These conditions contritely trigger ones “fight or flight” response leading to high blood pressure which weakens blood vessel walls, thus making them more prone to rupture. Near the Macula they can cause visual impairment and even distortion since it t is essential for vision. Although the severity plays a role in this, they can often lead to more ocular vision problems. Through stress and anxiety, it’s possible that ocular problems can surface.
Conclusion
This investigation has sought to answer the question, how do anxiety and stress contribute to the occurrence of macular holes and/or degeneration within the eye?At the beginning of the investigation, the differences between Anxiety and Stress were made clear through their definitions. Understanding these definitions shaped the investigation as it showed how when proglonged mental stress is present it affects the eye. Combining both conditions is vital for the understanding of healthcare as a holistic study, where one negative condtion affects other parts of the body. The relation of stress and anxiety, although still being studied is very real and very alarming. Given these facts, large Institutions such as The National Library of Medicine are continuing to expand their knowledge on this matter. To highlight current knowledge that is used, the investigation highlighted 2 instances where mental health is affected by ocular health in real-time. First, through the introduction of ancient beliefs, in the book Susruta Samhita, it was apparent that this idea was prevalent even in the past. However, instead of simply staying an idea, an analysis of the W.G case studiy dealing with Age-Related Macular Degeneration proved Susruta’s ideas to be true. Both of these conditions become present when the macula is damaged, and the studys established that anxiety and stress played a big part. Furthermore, the size of the macula, along with an overview of the eye was provided, providing a mental image of what and how it becomes affected due to these mental conditions and the increase in the hormones they release. The investigation uncovered that with this stress and anxiety, the macula cannot do its job of recognizing faces, fine and details.
The evidence and arguments lead to the conclusion that anxiety and stress do increase the chances of expecting macular degeneration and/or macular Holes. Nevertheless, we can never say that there are no problems in reaching a final answer. As the idea of mental health affecting all processes of life continues to emerge more and more studies are being released about it. However, in terms of its relation to ocular health, There are currently few publicly accessible studies on this topic. As the eye is a small organ and rather fragile, many try to steer away from such knowledge. Regardless, as mentioned before, if we recognize that mental health is a holistic process that affects various different parts of the body, we can surely conclude, including those of the eye. In conclusion, Ocular Health, especially that of age-related macular degeneration and macular holes is greatly impacted by stress and anxiety through the hormones they release and issues they trigger within the human body.
References
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