Anxiety and Eye Care – Perspectives

By | Focus | One Comment

One might wonder why an ophthalmologist would venture out of his comfort zone and into the area of psychology. Fair enough, and it is therefore important to note that this post does not constitute an expert opinion or formal psychological or psychiatric advice, but one eye specialist’s perspective during these challenging times we currently find ourselves in.

The past few weeks in private practice have left me with a distinct sense that people in general are “over it” – COVID19 that is. However, we are far from determining the full impact of this global pandemic and even more so, the impact of humanity’s reaction to it. I mean this in a positive sense as well – we continue to play a part in COVID19’s full impact and the degree to which it will be positive and/or negative.

The Pandemic with its global lockdowns has had its obvious ups and downs:

Extra time at home with family VS domestic violence and loneliness.

Innovation and rapid startups VS the collapse of large industries.

DYI projects and home workouts VS boredom, injuries and loss of routine.

The moments of pause and unity VS the politics and the panic.

Unprecedented research turnover VS poor quality publications and fake news.

Funny new internet memes VS the tragic loss of lives and livelihoods.

Another facet of this pandemic season that continues to strike me in my daily practice is the level and pervasiveness of anxiety and the challenges it brings. Some, those that seem more emotional or in touch with their feelings are experiencing fear in a big, almost tangible way, while those that are less emotional or perhaps see themselves as more practically orientated might “feel” okay, but their bodies are showing the signs with flare-ups of auto-immune conditions, overeating, lack of sleep and tension headaches. Below are five perspective on this collateral epidemic which I hope will be of use.

1. According to the Ophthalmological Society of South Africa ophthalmology patients are experiencing increased anxiety when seeking healthcare. Our patients generally fall in the vulnerable categories of those above 60 and with co-morbidities and it is important that this patient anxiety be addressed when consulting with patients.

Three recommendations for eye care practitioners to address anxiety are:

Do not move patient appointments unnecessarily – This creates doubt about the urgency or need of seeing the ophthalmologist.

Communicate with patients – Have your staff call patients the day before appointments to determine whether patients have any COVID risk factors and also to explain the practice COVID safety procedures to the patient.

Ensure that your practice has visible safety measures in place, so that patients understand that their safety is important to you. This include patient information in visible places in the facility.

2. The flipside of the coin is of course the stress that comes with medical and optometry practice. Being a healthcare provider is an enormous privilege, but keeping up both technically and financially with the relentless advances in equipment, increasing litigation, healthcare funding and the politics of healthcare are but a few of the issues that add to the inherent load of being a practitioner. Occupational health and safety and emotional wellbeing of providers are significant concerns and of increased relevance during the COVID19 pandemic. It has never been more important for healthcare workers to be supportive of each other and reach out to ask for help when needed.

3. I have personally had to learn from others and figure out a way to remain strong in this environment. Two sets of five help me stay focused and positive in a world that sometimes seems to be on fire with negative hashtags. The first five and in this order, which I learned from a good friend and excellent biokineticist, Bertie Herbst, make up a kind of big picture compass:






The order is very important. I’m not going to discuss this in more detail here because I want to get to the second five, but when things seem out of control, this list helps me keep my priorities and my values aligned. The second five:






Pause – Perhaps the most difficult of them all, but I try to set aside as little as 15 minutes every day at a time during which interruptions are least likely to occur. (Before sunrise is usually the best!) I use noise-cancelling headphones, switch my phone to airplane mode, and make sure my visual scene is not too distracting.

Feel – Present day lifestyles are often a combination of information overload and never-ending to-do lists (which we need to deal with appropriately). When something eventually triggers our emotions, we tend to overreact. But as the cliché goes: We are human beings, not human doings. A daily pause is a good time to let emotions surface. Feel them. Name them. Then…

Think – Why do I feel this? Are my feelings based on reality? If they are, are they in proportion to reality or am I over-emphasizing something negative or selfish or preferred indifference? Are there realistic aspects in life that can help to counter negative feelings such as things to be grateful for or practical steps to address a bad situation? I think it is quite profound that we humans can almost stand outside of ourselves and evaluate what we are thinking and feeling. It is perhaps worth using this ability.

Acknowledge – This step adds significant time to the process, but there is little doubt in my mind that journaling or discussing thoughts and feelings with a spouse, trusted friend, counsellor or in prayer further add value to the routine.

Choose – Even more profound than our ability to assess our thoughts and feelings is our ability to choose our mental response to any situation, information, thought or feeling. As holocaust survivor Victor Frankl famously said, “Everything can be taken from a man but one thing: the last of human freedoms – the ability to choose one’s attitude in any given set of circumstances …” If making time to pause is not the most difficult, this step almost certainly is. And sadly, we often take the route of least resistance and surrender this freedom to choose and with it our self-control. Choose the positive, the practical, the best. Choose to be grateful. Choose to say sorry. Choose to forgive. Choose to be kind – to others AND to yourself. Choose today.

4. It is probably best to finish off with perspectives from two experts. Sandton counselling psychologist, Sacha Proctor recently commented on the importance of gratitude during difficult times (&6B).

“It is ok to allow yourself to feel the emotions you are dealing with right now: Sadness at the issues going on in the world. Loss and possible loneliness from not being able to see those you love during this time. Anxiety about loss of income or financial stress.

However in order to cope, we need to eventually focus on ways to remain hopeful.

Gratitude is one of the most powerful ways to cultivate joy in the midst of difficult times. It is also a buffer against anxiety and depression for many people.”

Her two images added to the post highlight the benefits of gratitude and how to incorporate it into our thinking.

5. Author and internationally renowned neuroscientist, Dr Caroline Leaf gave further practical tips for mentally dealing with toxic negativity:

“Emotions are highly contagious and can affect your mental and physical health so it’s important to create a healthy emotional environment…which can include some negativity! But how do you protect yourself from too much toxic negativity, especially during quarantine? Here are some tips I use and gave my patients:

  1. Recognize that emotions, moods, thought are contagious – check in with what is triggering you and why. Recognize what the negativity is doing to you mentally and physically.
  2. Remove yourself from that [triggering] person by putting up [healthy] boundaries if you feel like you are being affected negatively.
  3. Protect your mind by visualizing the negativity contained in a box far away from you.
  4. When the negativity reaches out to you, visualize a suit of armour on you deflecting the negativity off you.
  5. Boost your mental health “immune system” by focusing on something that makes you smile!
  6. At the right time (when emotions aren’t high) talk to the other person about how their negativity is hurting you, but be careful not to use harsh words. And remember to always stress that you could be misreading them. Don’t make assumptions! Often their negativity could be due to some internal conflict they are having and they are just projecting or trying to make sense. Ask them how you can perhaps help overcome the constant negativity. [Or perhaps it is time to confront your own negativity with kindness and positive perspectives…]
  7. Remember – focusing on the negative for a little bit with the intention of being proactive is good! Thinking about the worst case scenario can help prepare you if it ever happens (solution focused). However, ruminating without trying to find a solution is toxic. Negative thinking itself is not harmful – it’s how you do the thinking and for how long. Ideally you do not want to spend more than 10-15min and always try to end with a solution in place.

At the end of the day – you cannot control other people’s actions thoughts or words. You can only control what you think, say and do.”