Mental health and ophthalmology

(Image credit: Adobe Stock/Africa Studio)

The mental health struggles that patients may be going through often can be missed by ophthalmologists, and they can play a big role in the ocular health issues they are facing.

Prem Subramanian, MD, PhD, the Clifford R. and Janice N. Merrill Endowed Chair in Ophthalmology and professor at the Sue Anschutz-Rogers Eye Center, picked up a tip during a career development course more than a decade ago that he has used ever since: Sit and listen to the patient for 2 minutes without saying anything.

“Two minutes in that circumstance seems really, really long, and patients sometimes run out of things to say,” he said in a Colorado University news release. “But if you do that, the patient often feels like you spent an hour with them.”

During these 2 minutes, Subramanian can learn a lot about the patient, their concerns, and their mental well-being, which is often deeply intertwined with the ocular condition they are facing.¹

According to a Mental Health in America study by KFF/CNN, mental health is a growing issue nationwide, with 90% of Americans viewing it as a crisis.

Facing the loss of what many people consider to be their most valuable sense, some patients may face severe depression, while others may struggle with changes to their facial appearance brought on by a condition thyroid eye disease (TED).

“It’s abundantly clear that ophthalmologists have a duty to acknowledge and talk about mental health, because it deeply affects the patient and their quality of life,” Subramanian said in the news release.

Connections between mental, ocular health

Ocular conditions – even those that are often classified as mild, like dry eye — can be much more than just irritating. They can have significant effects on self-confidence and can create or exacerbate mental health disorders.¹

Subramanian noted in the news release that when it comes to TED, young women, the population most prone to the disease, often feel a burden to maintain a specific appearance.

“If you look different than what society says you’re supposed to look like, that has a significant impact on your mental health,” he said in the news release. “I’ve seen patients who don’t want to go outside, associate with friends, or do anything where they’ll be seen.”

Mental illness can at times lead to eye injuries, Sophie Liao, MD, associate professor of ophthalmology and Robert H. Bell Endowed Chair in Ophthalmology, noted in the news release.

“In extreme cases, patients may end up in our clinic with self-induced trauma to their eyes because of an existing mental health condition, like paranoid schizophrenia,” Liao, who specializes in oculofacial plastic and reconstructive surgery said in the news release. In these cases, a person may engage in a practice called autoenucleation, where they don’t see the eye as part of themselves and damage it as a result.¹

“In these instances, an ophthalmologist has to think bigger than just ocular treatment,” Liao explained in the release. “You are assessing what can be salvaged and what next steps are necessary for medical care, but if you only treat the trauma and send them home, that doesn’t address the social and mental health struggles that brought them into your care in the first place.”

According to the UC news release, Liao pointed out that mental health resources and integrated care have been put in place across clinics in the UCHealth system. As a result, patients suffering from mental illness because of an eye condition or vice versa, ophthalmologists can better connect them with the appropriate experts and necessary treatment.1

Prepping trainees to reduce stress

The university noted in its news release that treating the confluence of ocular and mental health can also take its toll on ophthalmologists.

“Sometimes you encounter a scenario that isn’t a part of traditional training,” Liao says. “We can teach our trainees anatomy and how to get through a surgery fairly easily, but it’s sometimes those other factors that can be challenging to manage.”

The Department of Ophthalmology at the UC School of Medicine is now offering a resident wellness program to promote training on stress management.

With various assignments, instructors aim to boost confidence, built connections, and emphasize the importance of mental health.

Subramanian and Liao point out in the news release that even in busy clinics where time may be limited, communication between patients and their doctors about mental health concerns is important.

“I’ve gotten so much additional information out of conversations with patients, and it doesn’t always help me treat their eyes, but it tells me something about them and it makes a human connection,” Liao said in the news release. “These types of interactions are so important when it comes to the provider-patient relationship and building trust.”

Subramanian and Liao both concur that for patients, talking to an ophthalmologist about concerns that stem from an ocular issue can be beneficial for their overall health,

Subramanian pointed out in the news release that he would encourage patients to mention these feelings and say, “it's not just about my vision, it's about how I look” or “it's about how I feel about myself because my vision is not normal.”

“Patients should share these things with us because we’re doctors first and ophthalmologists second,” Subramanian concluded in the news release. “We want to know what our patients are thinking and feeling.”

Reference

1. Mason K. Mental Health’s Role in Ophthalmology. news.cuanschutz.edu. Published May 15, 2024. Accessed May 16, 2024. https://news.cuanschutz.edu/ophthalmology/mental-health-ophthalmology-liao-subramanian