Stress and Repetitive Visual Field Assessment in Glaucoma Patients
Keywords:
Glaucoma, reliability, stress, visual field.Abstract
ÂGlaucoma is a chronic disease that could affect the quality of life and is a potential stressor for patients. Visual field assessment is important in monitoring disease progression among glaucoma patients. Stress could influence the performance of patients in visual field test that may affect the reliability of the test. Our objective in this study was to determine the association between stress score using Depression, Anxiety and Stress Scale (DASS) questionnaire and reliability indices of Humphrey visual field analysis (HFA). A total of 155 primary and secondary glaucoma patients were recruited in the study. Face to face interview using stress component of DASS questionnaire was conducted after automated HFA test. Reliability indices; i.e. fixation loss, false positive, and false negative error, were used to determine the accuracy of HFA result. Only 12 patients (7.7%) were found to have elevated stress score. No significant correlation was found between DASS stress score and the reliability indices of HFA. There was 0.2 folds (95% confidence interval (CI) [-2.35, -0.06], p = 0.039) reduction of fixation loss for every number of HFA done. For every one year increase in age, there was 0.2 folds (95% CI [-0.38, -0.07], p = 0.006) reduction in false positive error in HFA. Minimal stress may not affect the reliability of HFA assessment. Minimising stress among glaucoma patients is important not only for assessment of visual field but also for improvement of quality of life.
References
Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA. 2007;298(14):pp.1685-1687.
Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold. N Engl J Med. 1991;325(9):pp.606-612
Lupien SJ, Maheu F, Tu M, Fiocco A, Schramek TE. The effects of stress and stress hormones on human cognition: Implications for the field of brain and cognition. Brain Cogn. 2007;65(3):pp.209-237.
McEwen BS, Sapolsky RM. Stress and cognitive function. Curr Opin Neurobiol. 1995;5(2):pp.205-216.
McEwen BS, Stellar E. Stress and the individual: mechanisms leading to disease. Arch Intern Med. 1993;153(18):pp.2093-2101.
Shily BG. Psychophysiological stress, elevated intraocular pressure, and acute closed-angle glaucoma. Optom Vis Sci. 1987;64(11):pp.866-870.
Cukor D, Cohen SD, Peterson RA, Kimmel PL. Psychosocial aspects of chronic disease: ESRD as a paradigmatic illness. J Am Soc Nephrol. 2007;18(12):pp.3042-3055.
Kiecolt-Glaser JK, Glaser R, Shuttleworth EC, Dyer CS, Ogrocki P, Speicher CE. Chronic stress and immunity in family caregivers of Alzheimer's disease victims. Psychosom Med. 1987;49(5):pp.523-535.
Roder I, Boekaerts M. Stress, coping, and adjustment in children with a chronic disease: a review of the literature. Disabil Rehabil. 1999;21(7):pp.311-337.
Gupta N, Weinreb RN. New definitions of glaucoma. Curr Opin Ophthalmol. 1997;8(2):pp.38-41.
Janz NK, Wren PA, Guire KE, Musch DC, Gillespie BW, Lichter PR. Fear of Blindness in the Collaborative Initial Glaucoma Treatment Study: Patterns and Correlates over Time. Ophthalmology. 2007;114(12):pp.2213-2220.
Konstas AGP, Maskaleris G, Gratsonidis S, Sardelli C. Compliance and viewpoint of glaucoma patients in Greece. Eye. 2000;14(5):pp.752-756.
Parrish RK, Gedde SJ, Scott IU, Feuer WJ, Schiffman JC, Mangione CM, et al. Visual function and quality of life among patients with glaucoma. Arch Ophthalmol. 1997;115(11):pp.1447-1455.
Ramulu PY, West SK, Munoz B, Jampel HD, Friedman DS. Driving cessation and driving limitation in glaucoma: the Salisbury Eye Evaluation Project. Ophthalmology. 2009;116(10):pp.1846-1853.
Broadway DC. Visual field testing for glaucoma – a practical guide. Community Eye Health. 2012;25(79-80):pp.66-70.
Heijl A, Lindgren A, Lindgren G. Test-Retest Variability in Glaucomatous Visual Fields. Am J Ophthalmo. 1989;108(2):pp.130-135.
Birt CM, Shin DH, Samudrala V, Hughes BA, Kim C, Lee D. Analysis of reliability indices from Humphrey visual field tests in an urban glaucoma population. Ophthalmology. 1997;104(7):pp.1126-1130.
Kramer BC, Musch DC, Niziol LM, Weizer JS. Original article: Reliability of Simultaneous Visual Field Testing. Ophthalmology. 2012;119:pp.304-307.
Schwabe L, Wolf OT. Learning under stress impairs memory formation. Neurobiol Learn Mem. 2010;93(2):pp.183-188.
Noble CE, Hays JR. Discrimination Reaction Performance as a Function of Anxiety and Sex Parameters. Percept Mot Skills. 1966;23(3_suppl):pp.1267-1278.
Fasih U, Hamirani MM, Jafri AR, Riaz SU, Shaikh A. Assessment of anxiety and depression in primary open angle glaucoma patients (a study of 100 cases). Pakistan Journal of Ophthalmology. 2010;26(3):pp.143-147.
Parkitny L, McAuley J. The Depression Anxiety Stress Scale (DASS). J Physiother. 2010;56(3):p.204.
Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3): pp.335-343.
Contreras-Vidal JL, Teulings H, Stelmach G. Elderly subjects are impaired in spatial coordination in fine motor control. Acta Psychol. 1998;100(1):pp.25-35.
Fortin M, Lapointe L, Hudon C, Vanasse A, Ntetu AL, Maltais D. Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes. 2004;2:p.51.
Lipner M. Glaucoma patient on alert: comorbid control. Eye World. 2008.
U'Ren RC, Riddle MC, Lezak MD, Benningtonâ€Davis M. The mental efficiency of the elderly person with type II diabetes mellitus. J Am Geriatr Soc. 1990;38(5):pp.505-510.
Erb C, Batra A, Lietz A, Bayer AU, Flammer J, Thiel H-J. Psychological characteristics of patients with normal-tension glaucoma. Graefes Arch Clin Exp Ophthalmol. 1999;237(9):pp.753-757.
Brody S, Erb C, Veit R, Rau H. Intraocular pressure changes: the influence of psychological stress and the Valsalva maneuver. Biol Psychol. 1999;51(1):pp.43-57.
Kaluza G, Maurer H. Stress and intraocular pressure in open angle glaucoma. Psychol Health. 1997;12(5):pp.667-675.
Parikh RS, Parikh SR. Alternative therapy in glaucoma management: Is there any role? Indian J Ophthalmol. 2011;59(Suppl1): pp.S158-S160.
Fazio DT, Bateman JB, Christensen RE. Acute angle-closure glaucoma associated with surgical anesthesia. Arch Ophthalmol. 1985;103(3):pp.360-362.
Kirsch RE. A study of provocative tests for angle closure glaucoma. Arch Ophthalmol. 1965;74(6):pp.770-776.
Lowe RF. Primary angle-closure glaucoma. Inheritance and environment. Br J Ophthalmol. 1972;56(1):p.13.
Hölscher C. Stress impairs performance in spatial water maze learning tasks. Behav Brain Res. 1999;100(1):pp.225-235.
Jamal M. Relationship of job stress to job performance: A study of managers and blue-collar workers. Human Relations. 1985;38(5):pp.409-424.
Kanner AD, Coyne JC, Schaefer C, Lazarus RS. Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events. J Behav Med. 1981;4(1):pp.1-39.
Kutzko KE, Brito CF, Wall M. Effect of instructions on conventional automated perimetry. Invest Ophthalmol Vis Sci. 2000;41(7):pp.2006-2013.
Brown TA, Chorpita BF, Korotitsch W, Barlow DH. Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behav Res Ther. 1997;35(1):pp.79-89.
Johnson CA, Nelson-Quigg JM. A Prospective Three-year Study of Response Properties of Normal Subjects and Patients during Automated Perimetry. Ophthalmology. 1993;100(2):pp.269-274.
Downloads
Published
Issue
Section
License
JBCS Publication Ethics
JBCS is committed to ensure the publication process follows specific academic ethics. Hence, Authors, Reviewers and Editors are required to conform to standards of ethical guidelines.
Authors
Authors should discuss objectively the significance of research work, technical detail and relevant references to enable others to replicate the experiments. JBCS do not accept fraudulent or inaccurate statements that may constitute towards unethical conduct.
Authors should ensure the originality of their works. In cases where the work and/or words of others have been used, appropriate acknowledgements should be made. JBCS do not accept plagiarism in all forms that constitute towards unethical publishing of an article.
This includes simultaneous submission of the same manuscript to more than one journal. Corresponding author is responsible for the full consensus of all co-authors in approving the final version of the paper and its submission for publication.
Reviewers
Reviewers of JBCS treat manuscripts received for review as confidential documents. Therefore, Reviewers must ensure the confidentiality and should not use privileged information and/or ideas obtained through peer review for personal advantage.
Reviews should be conducted based on academic merit and observations should be formulated clearly with supporting arguments. In cases where selected Reviewer feels unqualified to review a manuscript, Reviewer should notify the editor and excuse himself from the review process in TWO (2) weeks time from the review offer is made.
In any reasonable circumstances, Reviewers should not consider to evaluate manuscripts if they have conflicts of interest (i.e: competitive, collaborative and/or other connections with any of the authors, companies, or institutions affiliated to the papers).
Editors 
Editors should evaluate manuscripts exclusively based on their academic merit. JBCS strictly do not allow editors to use unpublished information of authors  without the written consent of the author. Editors are required to take appropriate responsive actions if ethical complaints have been presented concerning a submitted manuscript or published paper.
CONFLICT OF INTEREST
Journal of Biomedical and Clinical Sciences requires authors to declare all competing interests in relation to their work. All submitted manuscripts must include a ‘competing interests section at the end of the manuscript listing all competing interests (financial and non-financial). Where authors have no competing interests, the statement should read ,The authors have declared that no competing interests exist. Editors may ask for further information relating to competing interests.
Editors and reviewers are also required to declare any competing interests and will be excluded from the peer review process if a competing interest exists. Competing interests may be financial or non-financial. A competing interest exists when the authors interpretation of data or presentation of information may be influenced by their personal or financial relationship with other people or organizations. Authors should disclose any financial competing interests but also any non-financial competing interests that may cause them embarrassment if they were to become public after the publication of the article.
HUMAN AND ANIMAL RIGHTS
All research must have been carried out within an appropriate ethical framework. If there is suspicion that work has not taken place within an appropriate ethical framework, Editors will follow the Misconduct policy and may reject the manuscript, and/or contact the author(s) institution or ethics committee. On rare occasions, if the Editor has serious concerns about the ethics of a study, the manuscript may be rejected on ethical grounds, even if approval from an ethics committee has been obtained.
Research involving human subjects, human material, or human data, must have been performed in accordance with the Declaration of Helsinki and must have been approved by an appropriate ethics committee. A statement detailing this, including the name of the ethics committee and the reference number where appropriate, must appear in all manuscripts reporting such research. Further information and documentation to support this should be made available to Editors on request.
Experimental research on vertebrates or any regulated invertebrates must comply with institutional, national, or international guidelines, and where available should have been approved by an appropriate ethics committee. The Basel Declaration outlines fundamental principles to adhere to when conducting research in animals and the International Council for Laboratory Animal Science (ICLAS) has also published ethical guidelines.
A statement detailing compliance with relevant guidelines (e.g. the revised Animals (Scientific Procedures) Act 1986 in the UK and Directive 2010/63/EU in Europe) and/or ethical approval (including the name of the ethics committee and the reference number where appropriate) must be included in the manuscript. The Editor will take account of animal welfare issues and reserves the right to reject a manuscript, especially if the research involves protocols that are inconsistent with commonly accepted norms of animal research. In rare cases, Editors may contact the ethics committee for further information.
INFORMED CONSENT 
For all research involving human subjects, informed consent to participate in the study should be obtained from participants (or their parent or guardian in the case of children under 16) and a statement to this effect should appear in the manuscript, this includes to all manuscripts that include details, images, or videos relating to individual participants.
DATA SHARING POLICY
JBCS strongly encourages that all datasets on which the conclusions of the paper rely should be available to readers. We encourage authors to ensure that their datasets are either deposited in publicly available repositories (where available and appropriate) or presented in the main manuscript or additional supporting files, in machine-readable format (such as spreadsheets rather than PDFs) whenever possible
Authors who do not wish to share their data must state that data will not be shared, and give the reason.
COPYRIGHT NOTICE
The JBCS retains the copyright of published manuscripts under the terms of the Copyright Transfer Agreement. However, the journal permits unrestricted use, distribution, and reproduction in any medium, provided permission to reuse, distribute and reproduce is obtained from the Journal's Editor and the original work is properly cited.
While the advice and information in this journal are believed to be true and accurate on the date of its going to press, neither the authors, the editors, nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Copyright (c) 2023 Journal of Biomedical and Clinical Sciences (JBCS)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.



