Glaucoma: Opening doors
Winter 2025
by Liz Hillman
Editorial Co-Director
For patients, vision loss can feel like the closing of a door—to independence, confidence, and sometimes hope. Ophthalmologists often stand at the threshold of this life-altering moment, particularly when caring for patients with degenerative conditions such as glaucoma. Opening the door to mental healthcare, experts say, unlocks an important—and often overlooked—dimension of support.
“I don’t know that as a profession in ophthalmology we talk about how to approach conversations surrounding visual impairment with patients, how to explain it, name it, and help the patient feel the emotions that come with vision loss,” said Reena Garg, MD. “I think this was something I learned along the way because I noticed my patients suffering.”
A study published earlier this year found that patients, who were being monitored for ocular hypertension and went on to develop primary open-angle glaucoma, had reduced mental health scores on a questionnaire.1
From the therapist’s perspective, Kimberley Dobbs, LPC, NCC, CCTP, said that while systemic barriers to mental healthcare—limited availability, high cost, and lack of connection—affect many, patients with disabilities like vision loss often face additional, unique challenges.
An ophthalmologist’s approach
Dr. Garg said her approach to care from a mental health standpoint differs depending on whether she’s giving a new glaucoma diagnosis vs. caring for a patient with established glaucoma. “I get a lot of patients referred for glaucoma evaluation, and a lot of times … when I tell them they don’t have glaucoma, I get a big sigh of relief and, ‘Thank goodness, I haven’t slept for days,’” Dr. Garg said. “With that context, I always approach the conversation a little bit softly with those who I am diagnosing with glaucoma. I say, ‘I’m concerned that you may have glaucoma. These are the things pointing in that direction, and if we don’t do anything, the end result could be loss of vision.’ But I try to frame it by saying that there are things we can do and that it’s my job to partner with them so we can make sure the worst case doesn’t happen, that we will work together to engage in these treatments to make sure that we stay in the most likely scenario, which is that they will maintain good vision.”
When she is working with a patient who already knows of their glaucoma diagnosis and who is progressing, her approach is a little different. “They’ve already accepted that vision loss is a possibility in their life, so the conversation is framed a little differently.”
Dr. Garg said she brings up the mental health aspects of vision loss with her patients because even though it’s not proven that depression and anxiety can lead to progression of vision loss, stress can make pressure go up, and pressure is correlated with irreversible optic nerve damage.
Dr. Garg said she thinks referrals to therapists for help with the emotions of vision loss are coming from ophthalmologists, but patients attending those appointments occurs less frequently. “I think there’s a stigma associated with mental healthcare, even when the symptoms are associated with an actual physical diagnosis, like glaucoma,” Dr. Garg said.
Dr. Garg said she thinks more partnership between ophthalmologists caring for patients facing permanent vision loss and mental health specialists is needed so both can offer resources, peer-support groups, and one-on-one therapy to patients struggling with this reality. “If there were stronger partnerships, I think that could help patients on their journey,” Dr. Garg said.
A therapist’s perspective
Ms. Dobbs is a general mental health therapist, but when she lost her own eyesight and got involved with organizations and began meeting other people with visual impairments, she started to use her experience with vision loss and as a therapist to bridge the need for other people going through this.
“I started doing speaking events at different organizations and conferences and people started to reach out to me for therapy,” she said. While only some of her clients have vision loss, Ms. Dobbs said her personal experience opened the door in this area and for patients with other disabilities, not just sensory. “I think part of that is having a therapist who’s gone through something like what they’ve gone through,” she said. “People feel like I intrinsically get it.”
As a therapist who has personally experienced vision loss, Ms. Dobbs offered practical advice for ophthalmologists, particularly those caring for patients with degenerative conditions. One key recommendation: Avoid assuming that a patient’s mental health symptoms are solely a result of their ocular diagnosis. Instead, she emphasized the importance of viewing patients holistically and being mindful of implicit biases that may shape clinical assumptions.
“When you don’t have any kind of vision issues or when you interact with a person with visual impairment, there’s often this idea of, ‘I don’t know how I could live without my eyesight.’ That is called an implicit bias, whether it’s conscious or unconscious. A lot of times that’s what people are carrying when they interact with us, including therapists, and I think that can come out in therapy,” Ms. Dobbs said.
Ms. Dobbs said eyecare providers might have more awareness in this area, given that eyesight is their area of expertise, but unless they have experienced vision loss themselves, this is where their expertise stops. Recognizing that, she thinks, is important when considering the mental health impact of these conditions.
“They might have empathy, but they don’t understand it. Understanding is based on our own experiences,” she said. “I went to the ophthalmologist a couple of months ago, and there was a small step to get out of the chair. The ophthalmologist said, ‘Wait, hold on, why don’t you grab my hand?’ I said, ‘Why?’ The idea was that I didn’t know how to navigate through his office or I wouldn’t be able to ask for help when I needed it. I made it clear that I had just done a triathlon 3 days prior. I was like, this step down, I’ve got this. I said it smiling and laughing, but it was true.”
A good rule of thumb, Ms. Dobbs said, is to never assume. “Always lead with curiosity,” she said. “‘Would it be helpful if I offered you an arm? Would it be helpful if I provided you with a signature guide?’ Leading with curiosity is the way to go because your patients are the expert in themselves. You’re the expert in their eyes, but they’re the experts in knowing how to help themselves and knowing what works.”
Another missing piece to caring for patients who have degenerative, vision-threating eye conditions, Ms. Dobbs said, is a treatment team that includes a mental health counselor. While pamphlets and resources for support groups can be helpful, she said it can send the message that the patient has to figure it out alone. She also shared that having mental health counseling within the practice could help remove the stigma that exists when it comes to therapy. “Integrating mental health therapy into the treatment protocol could be such a value.”
Avoiding empathy burnout
Helping patients who face vision-threatening diagnoses on a regular basis can be emotionally taxing on the physician as well. Dr. Garg said there have been days when she’s wanted to stop treating glaucoma as a specialty and focus on general ophthalmology. “It’s hard to have these conversations. It’s hard sometimes to convince people to participate in their glaucoma care especially when they aren’t currently having any issues,” she said.
Ms. Dobbs acknowledged that absorbing the emotional experience of patients day in and day out can lead to burnout for ophthalmologists. “Care providers who are faced with hard stuff are going to develop modes of self-preservation. … We need to talk about net need, not just for patients but also the ophthalmologists who need the energy to continue to offer the care to each patient facing difficult diagnoses.”
Two things help Dr. Garg avoid empathy burnout and maintain a strong level of engagement with patients. One is she approaches glaucoma care as a partnership with the patient. Dr. Garg said she talks with the patient about how she’s not here to dictate what they do for their vision but that they’ll work together on the best options to maintain their vision and quality of life. “‘How are you feeling? How’s your vision? Are you having any issues?’ I’ve noticed that when I approach conversations in that way, it’s a lot easier to be empathetic because we’re having more of a conversation rather than me telling or talking at someone,” she said.
The second way is that she stays active with research, reading journals and watching videos. “It keeps the passion alive because there’s so many new and exciting things coming out in the field, and it gives me hope. Even though we may not have the tools to cure glaucoma right now, it feels not that far on the horizon when you look at all the amazing things that are being done in the lab.”
About the sources
Kimberley Dobbs, LPC, NCC, CCTP
Practice Owner/Therapist
Intuitive Counseling and Wellness
Philadelphia, Pennsylvania
Reena Garg, MD
Glaucoma Specialist
Visionary Eye Doctors
Rockville, Maryland
References
- Gordon MO, et al. Diagnosis of primary open-angle glaucoma and mental health status. JAMA Ophthalmol. 2025;143:608–611.
Relevant disclosures
Dobbs: None
Garg: None
Contact
Dobbs: dobbs.kimberley@gmail.com
Garg: ragarg927@gmail.com
