Eyeworld

WINTER 2025 | EYEWORLD | 69 G OPENING DOORS by Liz Hillman Editorial Co-Director 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 Integrating mental health awareness into vision loss care F or patients, vision loss can feel like the closing of a door—to independence, con- fidence, and sometimes hope. Ophthal- mologists 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 oph- thalmology we talk about how to approach con- versations 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 pri- mary 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 avail- ability, 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 glauco- ma. "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 conversa- tion 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 de- pression 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 thera- pists for help with the emotions of vision loss are coming from ophthalmologists, but patients attending those appointments occurs less fre- quently. "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 start- ed 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 differ- ent 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 continued on page 70

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