Flammer Syndrome: Psychological Causes and Consequences of Visual Impairment

About 285 million people are estimated to be visually impaired worldwide, amongst them 39 million are blind. In contrast to refractive deficits caused by diseases of the cornea or lens which can be corrected by optic means or surgery, diseases affecting the visual nervous system (retina, optic nerve, brain) are widely assumed to be irreversible. If patients are informed of such a grim diagnosis and poor prognosis, they typically experience anxiety and fear of becoming blind. This creates a psychological double-burden: Not only do they experience fear-inducing difficulties in daily life with reading, orienting or mobility, but a negative prognosis typically has a severe emotional impact, leading to worries, anxiety, fear, depression, and social isolation. Therefore, vision loss and emotional responses go hand-in-hand, creating a long lasting psychosocial and socioeconomic burden to the affected individuals and society at large. The aim of this chapter is to summarize the literature with the goal to untangle the relationship between vision loss and psychological factors related to the Flammer Syndrome phenotype – both in research and in the clinical context from a holistic point of view. We conclude that stress is both consequence and cause of vision loss. This creates a vicious cycle of a downward spiral, in which initial vision loss creates stress which further accelerates vision loss, creating even more stress and so forth. We propose that optimized stress management in Flammer Syndrome affected individuals can help activate residual vision and restoration, augmenting current approaches to prevent further vision loss and to enhance rehabilitative efforts such as vision training and brain stimulation.