Influence of Psychological Stress on Intraocular Pressure Fluctuation in Normal and Glaucomatous Eyes in Young Adults

Abstract

Purpose : Cross-sectional studies reported an association between psychological stress, intraocular pressure (IOP) fluctuation, and glaucoma. This study investigates the impact of academic stress, a form of psychological stress, on IOP fluctuation in both healthy and glaucomatous eyes of adult tertiary students.

Methods : An examiner-blind pretest-posttest study design was conducted on a total of forty-eight adult university students (i.e., 96 eyes), half of whom were diagnosed with primary open-angle glaucoma (POAG). The eligibility criteria to participate required being disease-free and not using any topical or systemic medication, except for the glaucoma group, who were adhered to their topical ocular antihypertensive treatment regimen. The study measured perceived stress scale (PSS) scores and IOP at the beginning and end of the semester, representing periods of low and high academic stress, respectively. IOP was measured using Goldmann tonometry, with the average of three separate morning readings recorded for each semester time point.

Results : Baseline PSS scores were lower in both groups (14.13±1.87 in glaucoma vs. 13.50±2.38 in control) and significantly increased during follow-up (29.17±2.08 vs. 28.00±1.53), indicating increased psychological stress. Concurrently, IOP (in mmHg) rose from 22.01±5.87 to 25.08±5.84 in the glaucoma group and from 11.36±2.03 to 13.65±2.11 in the control group. A factorial analysis showed significant main effect for psychological stress, [F(1, 94)=730.87, p <0.001, partial η² =3.51; a significant main effect for glaucoma presence, [F(1, 94)=153.71, p < 0.001], partial η² =59.55; and a significant interaction between psychological stress and glaucoma presence, [F(1, 94)=15.94, p =0.001], partial η² =0.08. Sidak's multiple comparisons post hoc tests showed that higher psychological stress significantly elevated the IOP relative to the baseline in the glaucoma (p<0.001) and control (p<0.001) groups. Comparison between groups, however, showed that the magnitude of IOP increase in the glaucoma group was significantly greater [t(94) =4.457, p< 0.001] than that in the normal healthy group.

Conclusions : The study concludes that psychological stress significantly affects IOP in both healthy and glaucomatous eyes, with a more pronounced effect in the latter. This suggests that stress relief strategies could be beneficial for IOP control in glaucoma patients.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.