AS EYE CARE professionals we often wear different “hats” – on any given workday we may be expected to be doctors, business owners, patient advocates, insurance experts, personal frame stylists and more. While these responsibilities can be incredibly rewarding, they can also be stressful at times.
Optometrists may often report higher job satisfaction and lower levels of anxiety than other healthcare professionals, but a recent survey of American Academy of Optometry Fellows found that 32% of respondents reported experiencing burnout. Many of our patients are feeling stressed as well. A recent Gallup poll found that 49% of Americans report feeling frequently stressed, and a 2023 survey by the American Psychological Association noted that 24% of Americans rated their stress level between 8 and 10 (on a scale of 1 to 10, with 10 being the highest).
As stress levels continue to rise in recent years, it is important for eye care professionals to understand the potential health effects of chronic stress to better diagnose and treat our patients and to ensure we are keeping ourselves healthy as well.
Effects of Stress on Systemic Health
The effects of stress on overall physical health are not fully known, but evidence suggests that chronic stress can potentially have long-term health impacts. Increased cortisol levels from long-term stress may lead to reduced immunity, increased levels of inflammation, higher rates of obesity and a higher risk of developing chronic illnesses such as high blood pressure and mental health conditions. Even temporary stressors can cause short-term health issues, such as poor sleep quality and quantity, digestive issues, a change in appetite and headaches.
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Stress & Eye Health
Increased stress levels can lead to new ocular symptoms or can exacerbate existing ocular conditions in our patients. Stress can cause a temporary increase in intraocular pressure, which may impact glaucoma management if a patient’s stress levels remain chronically elevated.
Dry eye is a commonly reported symptom in patients with elevated stress levels, and may be caused by poor sleep, increased screen usage during times of stress, changes in diet and hydration and hormonal changes. Patients with binocular vision or accommodative disorders often find their symptoms increase during times of stress, particularly if they tend to increase their near work or screen time during busy work periods. Myokymia can be caused by stress, and while a lid twitch is often harmless, it can be irritating for patients to deal with.
Conditions such as central serous chorioretinopathy and psychogenic vision loss can be caused by elevated levels of stress, though most patients with these conditions do not experience permanent vision reduction. Systemic health conditions that are exacerbated by stress can have impacts on ocular health, and it is common for treatments for these conditions to have ocular side effects as well.
General Tips for Managing Work-Related Stress
If high levels of stress and anxiety are impacting your ability to function day-to-day or if you feel overwhelmed by stress, consider seeking out professional mental health support services. Your mental health matters, and medication and therapy can be powerful tools to help manage stress for those that need it. It can be difficult to take care of our patients, staff and others if we are not prioritizing our own health and wellness.
Practicing mindfulness can be a helpful way to manage work-related stress. Mindfulness may include practices such as yoga, guided meditations and journaling, but can also be as simple as drawing attention to your breathing, taking a moment to notice each of your five senses or trying to notice one new thing about your environment each time you walk into a new room.
Taking time to take care of your physical health can also help reduce stress levels. Engaging in regular physical activity has been shown to help reduce anxiety and depression and can help combat the systemic health effects of chronic stress. It may feel difficult to find time for exercise, particularly when we are stressed about work, but even small amounts of physical activity such as short walks can be beneficial. Practicing good sleep hygiene by aiming for the same bedtime and wake up time each day, aiming for 7-9 hours of sleep per night and avoiding screens before bed can help with stress management as well.
Finding a support system or a network of friends or colleagues that understand your stressors may help you better manage your stress levels. A 2023 survey by the American Psychological Association found that most Americans did not feel that they could discuss their stressors with others, due to fearing being a burden on others. However, sharing your stressors or concerns with a trusted friend or colleague can help you manage the impact of stress in a healthier manner. If you do not feel that you have a trusted support system, discussing stressors with a therapist or writing your feelings down can be beneficial alternatives.
If your patients are experiencing stress, continue to encourage regular comprehensive eye examinations and regular visits with their primary care physician. Make sure to manage ocular sequelae of stress, including dry eye, binocular vision and accommodative issues and any ocular diseases exacerbated by stress. While eye care professionals are not mental health experts, it is appropriate to make recommendations for mental health treatment or stress management if a patient is experiencing ocular side effects of stress and anxiety.
Stress Management Tips for Eye Care Professionals
While the general stress management tips above can be helpful for anyone, there are specific techniques that optometrists and other eye care professionals can utilize to help manage work-related stress.
Whether you are a practice owner, an associate optometrist, an optician, a technician or are in another eyecare position, it can be difficult to maintain a healthy work-life balance when working in a patient-centric field. Oftentimes, we feel pressure to take our work home with us – either directly by finishing charts, submitting patient referrals, managing staff or patient issues from home or indirectly by worrying about our work or our patients during our downtime. While working from home may be unavoidable at times and can grant us a level of flexibility that may make it easier to manage our other life responsibilities, during times of elevated stress you may find it beneficial to set some boundaries regarding working from home. For example, some optometrists find it helpful to ensure all charts are signed for the day before they leave work to avoid remote charting. Maintaining work-life balance could also mean making sure you take a lunch break each day, taking your vacation and PTO if you have it, limiting walk-ins if you have the capability to do so or delegating tasks such as insurance authorizations, contacting other providers or filling out paperwork. It may not be realistic to implement all these suggestions – but even taking small steps can help decrease levels of stress and prevent burnout.
It can also be helpful to make sure you are taking care of your own eye health by following through with regular comprehensive eye examinations and by practicing the visual hygiene tips we give our patients all day. When was your last eye examination? No, self-refraction does not count. Are you taking frequent breaks when doing near work or following the 20-20-20 rule?
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If you are experiencing burnout and elevated levels of work-related stress, it may be worth considering whether making a career change (either big or small) could help reduce your stress or increase your job satisfaction. This could mean trying a change in practice modality, bringing in a specialty clinic or a new eye care service, implementing new management techniques or simply participating in a new educational experience. There are practitioners that find joy in adding dry eye treatment, specialty contact lenses or vision therapy into their practices. Other eye care professionals find that while one mode of practice is stressful for them, a change can help alleviate stress and help them achieve better work-life balance. Some doctors find that attending a seminar or conference inspires them to try new treatments or to change their approach to managing ocular conditions. While these changes may cause initial increases in stress and uncertainty, it is possible that they can lead to more long-term career satisfaction and reduced work-related stress.
Stress and the Eye Care Professional
It is difficult to avoid stress in today’s world, but an understanding of the potential health impacts of stress and how to reduce stress can help us take better care of our patients and of our own health. Making changes such as increasing physical activity, practicing healthy sleep habits and learning to utilize mindfulness resources and support systems can help reduce levels of stress for our patients and for ourselves. In specific cases, seeking out professional mental health services can be an important part of managing chronic stress. As eye care professionals, we can try to establish good work-life balance, ensure we are taking care of our own eye health and can make large or small career changes to help increase our job satisfaction and reduce work-related stress. It is important to note that it may not be realistic for us to incorporate all these changes, but any step in the direction of reducing stress may have a positive impact on our mental, physical and ocular health.
About the Author
Dr. Jillian Youngerman received her Bachelor of Science degree in Biology from the University of California, San Diego. She earned her Doctorate of Optometry from the Southern California College of Optometry at Marshall B. Ketchum University and completed her residency in Pediatric Optometry, Vision Therapy, and Neuro-Rehabilitation at the Center for Vision Development Optometry in Pasadena, CA. Following her residency, Dr. Youngerman began serving as a part-time clinical instructor in the Pediatric Vision Care Service and the Studt Center for Vision Therapy at the University Eye Center at Ketchum Health. She also joined a private practice that specializes in adult and pediatric primary eye care services, contact lens services, and vision therapy.
In 2020, Dr. Youngerman became a full-time Assistant Professor at the Southern California College of Optometry at Marshall B. Ketchum University, where she has laboratory and didactic teaching responsibilities and is a clinical instructor in Pediatrics and Vision Therapy at the University Eye Center at Ketchum Health.
