Eyeworld

70 | EYEWORLD | WINTER 2025 G UCOMA References 1. 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 something like what they've gone through," she said. "People feel like I intrinsically get it." As a therapist who has personally experi- enced 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 eye- sight.' That is called an implicit bias, whether it's conscious or unconscious. A lot of times that's what people are carrying when they in- teract 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 oph- thalmologist 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 counsel- ing 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 ophthalmolo- gists. "Care providers who are faced with hard stuff are going to develop modes of self-preser- vation. … 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 en- gagement 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 be- ing done in the lab." continued from page 69

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