Doctors of optometry ‘critical’ to helping patients with mental illness

More than one in five Americans live with a mental illness and only half of people with mental illness receive treatment. Fortunately, doctors of optometry are uniquely qualified to help, according to a new AOA report. 

The report, “Visual Quality of Life and Mental Health,” was written by the AOA Health Policy Institute (HPI), the thought leader in public policy research and analysis focused on eye health and vision care. It outlines how doctors of optometry can recognize mental illness, understand how mental illness and medications can impact ocular conditions, and identify key referrals for patients.

Mental health is a growing concern in the United States, says Melissa Richard, O.D., who contributed to the paper. “The suicide of a meteorologist in December 2018, two months after her [laser eye] procedure, and more recently, a 26-year-old police officer in Pennsylvania, brought attention to the topic of vision complications and mental illness,” Dr. Richard says. “As primary care providers, optometrists need to be able to understand the relationship between ocular conditions, mental illness and the medications to treat it.” 

Vision problems and mental illness 

Certain ocular issues—including those optometrists are trained to diagnose in patients—can be associated with mental illness, the report states. Anxiety and depression, for instance, are sometimes linked to pupil abnormalities and abnormal pupal dilation, respectively. Some patients with bipolar disorder have thinner retinal ganglion cell layers than patients without the disorder. 

“Since this article was written, Neurolens developed a portable test for ocular misalignment,” Dr. Richard says. “This allows optometrists to easily measure every patient and prescribe prism when necessary.”  

While mental illness can be successfully treated with psychiatric medications, such as serotonin reuptake inhibitors (SSRIs), benzodiazepines and antipsychotics, these drugs can cause ocular-related side effects. Doctors of optometry can help patients with some of the common side effects, including accommodation interference, ocular dystonias, and eyelid and keratoconjunctival disorders. 

How doctors of optometry can help 

“As primary care providers,” the report states, “doctors of optometry are sometimes one of the only health care professionals that individuals engage with on an annual basis.” 

Here’s how optometrists can help patients with mental illness: 

1. Use patient history forms to inquire about mental health conditions and medications. 
2. Refer patients who are newly diagnosed with a sight-threatening disease to an optometrist who provides low-vision services (if you don’t), occupational therapists or support groups. Offer education and resources. 
3. Provide testing for patients with suspected binocular vision dysfunction, or refer to a doctor of optometry who provides testing.  
4. Develop a two-way referral system with mental health practitioners.