Does Stress Increase Eye Pressure For Everyone?

 I've written several articles about the very clear relationship between my eye pressure and my stress levels. As I pointed out (in the comments to that article), the standard medical opinion is that stress does not affect eye pressure (intraocular pressure). For example, see "Glaucoma - Frequently Asked Questions" at http://www.eyeinstitute.net/glau-faq.html. It states:

 

"As far as we know, stress does not affect eye pressure or the health of the optic nerve."

Another example of the prevailing medical opinion can be found at the following chat transcript on Stress and Glaucoma from July 20, 2005 available at http://www.wills-glaucoma.org/supportgroup/20050720.htm:

Patient:  Does being nervous or stressed increase the IOP (intraocular pressure) as it does blood pressure?

Dr. Elliot Werner:  Not as far as we know.

Therefore, my initial assumption (once I verified that my eye pressure measurements were accurate) was that my intraocular pressure responded to stress uniquely. Later, further research and discussions led to me form the opinion that many (maybe most) glaucoma patients will experience an increase in eye pressure in response to certain specific stressors. I presume the stressors that elevate intraocular pressure will be somewhat unique for each individual. However, there are well-understood mechanisms by which stress hormones and autonomic nervous system balance, for example, can increase intraocular pressure. This means that the connection between stress and elevated eye pressure has a theoretical foundation.

Until now I had assumed that extending my hypothesis (that stress increases eye pressure) from just me to most of the entire population of glaucoma patients was a big leap. However, I recently attended a conference and trade show where many of the major ophthalmology instrument manufacturers had booths with their equipment on display. I spent a lot of time talking with people at the event about tonometers. During one of these conversations, the manufacturer's representative (I'll call him Dale) measured my eye pressure with their latest tonometer. My eye pressure was elevated. I explained to Dale that my eye pressure was normally about 5 mm Hg lower. I explained that the stress of traveling together with the environment (the main floor of a busy, noisy, hectic trade show) would increase my eye pressure. I expected Dale to either disagree with me (because I was expressing an opinion in conflict with the prevailing medical opinion) or to question me further. However, I was very, very surprised when Dale responded that he had observed the same thing in himself and in many other people! He agreed with me so matter-of-factly that I was the one who had to question him further.

Dale does not have glaucoma. He has normal eye pressure and normal eye health. If stress and travel increase his eye pressure, then this effect could be a lot more widespread than even I had imagined.

Dale spends all of his working hours with tonometers. He demonstrates tonometers to medical doctors. He often spends full days at a doctor's practice performing eye pressure measurements on all the patients with the latest equipment. Dale is in a position to answer questions about tonometers for medical doctors. At trade shows, when he demonstrates tonometers, he measures eye pressure for attendees of all types: doctors, staff, other exhibitors, etc. These people are all part of the eye care industry. Many have normal vision, but those that do not can be expected to manage their condition at least as well as average, if not better - after all, they are either doctors or work in doctors' offices. Yet Dale still recognizes a connection between stress and eye pressure that extends well beyond the glaucoma population.

Informal observations like this are often the seed for good scientific research studies. I cannot think of any more important issue in glaucoma research than the connection between stress and eye pressure. I believe this issue has more importance in the near term even than understanding the precise details of glaucoma etiology and pathophysiology. Most current glaucoma research is such that the results are typically very narrow -- and if the results lead directly to treatment breakthroughs at all, the time lag can be measured in decades. I remain supportive of (and excited about) research aimed at discovering molecular mediators of the pathophysiology of glaucoma. However, I think current glaucoma patients would potentially benefit more if researchers answered the questions about how stress affects eye pressure.

If the connection between stress and elevated intraocular pressure were proven conclusively, the treatment and management of glaucoma could be revolutionized immediately. There are many excellent programs for reducing and managing stress. Elevated intraocular pressure remains the most important risk factor for glaucoma. Therefore, I see the potential for positively impacting the most important risk factor immediately. Upon the conclusion of successful research in this area, glaucoma patients would not have to wait decades for the development, testing and approval of new drugs. They could immediately take advantage of any number of low-cost and well-researched stress management programs. Unfortunately, the very fact that research focused on this question does not lead to potentially profitable new drugs or new surgical techniques and equipment means that there isn't as much interest in funding the research.

In the absence of conclusive scientific research about the connection between stress and elevated intraocular pressure, you could do one of two things:

• Read the articles on my blog about stress and eye pressure and form your own opinion;
• Do what I did and start carefully measuring your eye pressure at home, using a somewhat scientific or careful approach. After all, if you are a glaucoma patient, it really doesn't matter if the relationship holds for everyone. For your glaucoma treatment, it only matters if stress affects your eye pressure. I know it affects mine, based on more than 18,000 eye pressure measurements over more than 200 days. That knowledge is immediately useful to me. I think it would be useful for any other glaucoma patient too.