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Professor David Mackey & Dr Samantha Sze-Yee Lee
August 2021

One of our body’s natural responses to stress, whether physical or psychological, is the release of cortisol – a steroid that is part of our fight or flight response. While steroid eye drops and oral steroid medications are known to increase intraocular pressure (IOP), and may even worsen glaucoma, increased levels in our own naturally produced cortisol usually won’t significantly increase IOP. 

Image of stressed looking man at computer desk

Recently, we measured the thicknesses of the retinal nerve layer, the layer of nerves that get damaged in glaucoma, and cortisol levels of over 800 young adults from Gen2 of the Raine Study. The participants undertook a laboratory-based test that evaluates how people react to psychological stress by measuring changes in cortisol and other stress hormones. The test consists of a 3-minute preparation time, a free speech interview in front of a non-responsive panel of 3 to 4 adults in office attire, and an arithmetic challenge. Blood samples were collected just before the start of the test (baseline; 0-minute), after completing the test (15-minute), and then the 25-, 35-, 45-,60-, 75-, and 105-minute time points. Individuals are classified as 1 of 3 groups of stress responders: 1) Anticipatory-, 2) Reactive-, or 3) Non-responders. 

  1. The anticipatory response pattern has been associated with chronic stress and post-traumatic stress disorder. 
  2. The reactive response is the most common response to acute stress. These individuals start with relatively lower levels of cortisol, which peak soon after the test starts, and then gradually return to baseline over the course of the test. 
  3. The non-response pattern is an abnormal response pattern where there is a blunted response to acute stress. These individuals have no clear hormonal response to the test, with little change in plasma cortisol over the study duration. The non-response pattern is associated with exposure to adverse early life events and other negative health outcomes, including panic disorders, obesity, depression, and poor cognitive function.

We compared eye measurements related to glaucoma in the three main subgroups of stress responders. We did not find any association between these measures and cortisol, suggesting that neither cortisol or stress significantly affects glaucoma severity.

So there is no need to worry that stress will impact your glaucoma.

Article by Professor David Mackey
Ophthalmologist
Genetics and Epidemiology Group at the Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia.
Article by Dr Samantha Sze-Yee Lee
Postdoctoral Research Fellow
Genetics and Epidemiology Group at the Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia.