Physiological stress has largely been disregarded rather than addressed by modern society. During my rigorous medical and surgical training, I often dismissed my own stress, convincing myself that what I felt wasn’t “real” and should be ignored. Today, the medical community understands that this mindset is not only inaccurate but also dangerous.
In times of stress, the human body releases a hormone called cortisol. This biological response, evolved over millions of years, prepares us to stay alert in the face of perceived danger. While cortisol is vital, prolonged exposure can lead to digestive issues, muscle tension and pain, cardiovascular problems, sleep disturbances and cognitive difficulties. Chronic stress can also contribute to immune system dysfunction, making individuals more susceptible to infections and inflammatory conditions. The cumulative effects of stress on the body extend beyond mere discomfort, impacting overall health and quality of life.
As an ophthalmologist and retina specialist, I diagnose and treat the ocular effects of chronic stress and elevated cortisol levels, known as Central Serous Retinopathy (CSR). Prolonged cortisol exposure causes leakage from small blood vessels at the back of the eye. This leads to abnormal fluid accumulation under the retina, disrupting photoreceptor function and causing painless blurring of central vision. The amount of fluid correlates directly with the degree of vision loss and the patient’s stress levels: the greater the stress, the higher the cortisol levels, the more fluid accumulates under the retina and the worse the vision becomes. If left untreated or unrecognized, recurrent episodes of CSR can lead to permanent retinal damage and long-term visual impairment.
Since March 2020, I have seen an average of five patients per week with this condition, spanning a wide range of demographics. Despite their differences, these patients share one commonality: overwhelming stress. What has been particularly striking over the past eight years is that many patients are unaware of their own stress levels. It is often only after careful discussion and self-reflection that they recognize how much chronic stress has impacted their health.
In early March 2020, a husband and wife visited my Los Angeles office. While discussing the husband’s diagnosis of Central Serous Retinopathy, he denied experiencing stress, much to his wife’s disbelief. She reminded him of his recent emergency room visit, where he had been diagnosed with a panic attack—a clear indication of stress overload. This scenario is not uncommon; many patients initially dismiss stress as a contributing factor, only to later acknowledge its pervasive influence on their well-being.
One of the most gratifying aspects of treating CSR is that, in 90% of cases, no medical or surgical intervention is necessary beyond stress reduction. As stress diminishes, cortisol levels decrease and the retinal fluid resolves. While researchers have yet to identify the most effective stress-reduction methods, I commonly recommend exercise, adequate sleep, meditation or even listening to music. Spending time in nature, engaging in creative activities and fostering social connections can also help alleviate stress. It is incredibly rewarding to see patients at follow-up appointments where I can show them, through advanced eye imaging, the resolution of retinal fluid as their stress levels decrease. Witnessing this tangible improvement reinforces the profound impact that stress management can have on both ocular and overall health.
CSR is frequently misdiagnosed as other retinal conditions, such as macular degeneration. I often see referred patients arrive in my office in tears, having been told they were going blind due to macular degeneration. It is profoundly uplifting to inform them that they do not have macular degeneration, and that stress reduction can resolve their vision problems. This highlights the importance of accurate diagnosis and increased awareness about CSR, ensuring that patients receive the appropriate guidance and reassurance.
We all lead stressful lives, and the global pandemic has only amplified this reality. Recognizing the toll stress takes on our bodies and relationships is crucial. While many people understand the connection between stress and conditions like heart disease, few realize that stress can also affect vision. I hope this piece has shed light on the importance of addressing stress for our overall well-being. By prioritizing stress management and self-care, we can take meaningful steps toward preserving both our vision and long-term health.
David Lazar, M.D., is a board-certified ophthalmologist with subspecialty training in medical and surgical diseases of the retina. Dr. Lazar completed fellowship training in vitreoretinal diseases and surgery at the Lahey Hospital and Beth Israel Deaconess Hospital in Boston, Massachusetts. While there, he also served as Clinical Associate at Tufts University School of Medicine and Harvard Medical School. Prior to his fellowship, he was Chief Resident at the LSU/Ochsner Clinic Foundation program in New Orleans, Louisiana. Dr. Lazar serves the Southern California community from his practice, Lazar Retina, in West Los Angeles.
