Living with a chronic disease like age-related macular degeneration (AMD) can be stressful. But when stress goes hand in hand with vision loss, you may wonder whether your anxiety is making your vision worse.

As one myAMDteam member noted, “I have dry AMD in both eyes, along with wet AMD in my right eye. I struggle with hand-eye coordination, and working with my hands has become very frustrating. Anxiety seems to affect my vision.”

Here’s what you need to know about anxiety and AMD, including whether stress can make macular degeneration worse.

How Stress and AMD May Be Connected

Age-related macular degeneration (AMD) is an eye condition that affects the macula (center of the retina). It causes a gradual loss of central vision over time. People with wet AMD — the less common type of AMD — may experience more abrupt vision loss.

So, how are macular degeneration and stress connected? According to recent research, by something called “allostatic load.”

What Is Allostatic Load?

Allostatic load refers to the cumulative wear and tear on the body that builds up when it’s exposed to repeated stress. A high allostatic load may increase your risk of developing eye conditions like AMD and glaucoma.

Different systems in the body, such as the cardiovascular and immune systems, work together to help the body respond to and adapt to stress. Chronic stress can overwork these systems.

Overworked body systems may not work as they should, leading to increased allostatic load. Over time, this overload can contribute to health problems.

AMD and Allostatic Load

A recent study found that people who developed AMD had higher allostatic load scores for up to 10 years prior to diagnosis compared to people who didn’t develop AMD. Moreover, higher allostatic load scores were linked to higher risks of developing AMD.

To calculate the load score, the study authors factored in:

• Body mass index (BMI)
• Blood pressure
• Kidney function
• Liver function
• Cholesterol levels
• Triglycerides (fat in the blood)
• C-reactive protein (an inflammation marker)
• Homocysteine (a cardiovascular risk marker)

A higher risk of developing AMD was linked to both a higher allostatic load and greater lifetime smoking exposure.

The researchers also found that some racial and ethnic groups had higher allostatic loads than others. Reducing chronic stress and health disparities may help lower the risk of AMD in these groups.

Can Stress Make AMD Worse?

Research on whether stress contributes to AMD progression is limited. It’s not yet clear whether stress worsens AMD. But the changes it can cause in the body may have indirect effects on macular degeneration.

When your body is stressed, it activates its stress response and releases cortisol and adrenaline. These hormones help your body respond to challenges, making your heart beat faster and increasing blood pressure. If you are often stressed, this response can occur over and over again.

Cortisol

Cortisol is a hormone that helps to control inflammation in your body — a process regulated by your immune system. Too much cortisol can impact how the immune system works. Inflammation plays a pivotal role in AMD, so cortisol’s effect on the immune system might be linked to disease progression.

Oxidative Stress

Stress can also contribute to oxidative stress. This is when too many free radical molecules exist in your body compared to antioxidants. Oxidative stress can contribute to inflammation as well as damage cells in the retina, directly impacting eye health.

Stress and Your Eye Health

One study evaluated a questionnaire called the Perceived Stress Scale (PSS) to measure stress levels in 137 people with AMD. The study authors noted that higher stress levels as rated on the PSS were linked to increased levels of cortisol and inflammation. High stress was also associated with other adverse health outcomes.

Although current research suggests that stress may play a role in AMD progression, more studies are needed to fully understand the link.

How Does AMD Cause Stress and Anxiety?

Being diagnosed with progressive vision loss can be scary. For many, knowing that already blurred vision is likely to get worse over time may be a constant source of stress.

Living with AMD can make you feel fearful and anxious about what the future holds. You may find you feel anxious about:

• Losing independence and needing help with everyday tasks
• Falling or getting injured because you can’t see clearly
• Not being able to read, drive, recognize faces, or participate in hobbies you enjoy
• Becoming socially isolated by avoiding activities due to vision changes
• Getting eye injections to manage your AMD
• Blurry vision and other AMD symptoms progressing to blindness

What myAMDteam Members Say About Stress

If you’re worried about how your condition will impact your life and your ability to take care of yourself, you’re not alone. Many myAMDteam members have expressed how their AMD diagnosis has been a cause of significant anxiety:

• “Still dealing with the constant anxiety I have from the diagnosis of dry AMD. I only have one functioning eye, so the diagnosis seems very serious and frightening … and hopeless.”
• “Very much [anxious] about the future of my vision.”
• “Does anyone have clinical anxiety or PTSD [from before] being diagnosed with AMD [that has now really increased with disease] progression and [vision] changes?”
• “Having anxiety about shots and [the] future since I have dry and wet AMD.”

Constant exposure to stress hormones, such as from worrying about an AMD diagnosis, can increase the risk of anxiety and depression. Research has shown that people with AMD tend to have high rates of both anxiety and depression.

For some people with AMD, anxiety about future vision loss can lead to depression. Plus, as someone’s AMD progresses, they have a higher risk of developing depression. In later stages of AMD, it’s especially common to feel lonely, vulnerable, and isolated due to vision loss.

Managing Stress When You Have AMD

Living with AMD may make you feel stressed, fearful, frustrated, or uncertain. Know that these emotions are common, and there’s no right or wrong way to feel. The good news is that there are steps you can take to support your emotional well-being.

Try Low-Vision Rehabilitation

Low-vision rehabilitation helps people with AMD adapt to vision loss and continue living as independently as possible. A low-vision specialist can help you learn practical ways to complete everyday tasks using your remaining vision.

Low-vision rehabilitation is unique to every person and designed to improve quality of life. Low vision therapy starts with a comprehensive eye exam and may also include:

• Assistive devices, such as magnifiers
• New prescription eyeglasses
• Home modifications to improve safety and mobility

Use Healthy Coping Strategies

If you’re feeling anxious about the future, it’s important to learn healthy coping skills. Often, these are used in combination with low-vision rehab.

Certain behavioral interventions may be helpful for teaching people with AMD how to cope with vision loss, light sensitivity, and other stressors. These may include:

• Cognitive behavioral therapy (CBT) — Can help you recognize unhealthy thought patterns related to your vision problems and teach you healthy, more useful strategies to cope with AMD
• Behavioral activation — Can aid you in breaking patterns of avoidance and getting back to doing the things you enjoy if you’ve withdrawn from activities or hobbies due to vision loss
• Self-management programs — Can teach you useful, healthy ways to solve problems, set goals, and regulate your emotions through techniques like deep breathing

These therapies are often offered in-person as well as by phone or video.

Stay Connected

Talking with trusted friends, family members, a spiritual advisor, or a therapist can provide support during difficult times. If you’re feeling isolated, consider joining a local or online AMD support group, like myAMDteam, to connect with others living with AMD.

Talk to Your Doctor

You don’t have to struggle with feelings of sadness, anxiety, or hopelessness. If your emotional well-being is affecting your daily life, talk with a healthcare provider.

Your ophthalmologist may suggest mental health counseling, medication, or other resources to help you cope with the emotional impact of AMD. You can also use organizations like the National Alliance for Mental Health (NAMI) to find emotional support as you navigate life with AMD.