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Editors Selection IGR 17-4

General aspects: Personality types

Comment by George Spaeth & Scott Fudemberg on:

20134 Personality type of the glaucoma patient, Lim MC; Shiba DR; Clark IJ et al., Journal of Glaucoma, 2007; 16: 649-654

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Assessment of personality types in glaucoma patients raises two fundamental considerations. Firstly, people of a particular personality may be predisposed to developing glaucoma. Secondly, the diagnosis, the disease process itself, and management of glaucoma may stimulate development or manifestation of particular personality types. This report by Lim et al. (1418) addresses the latter issue. In brief, their report shows a significant relationship between diagnosis of glaucoma and identification of hysteria, hypochondriasis, and health concerns by personality screening tools. This article provides scientific justification for being mindful of the profound psychological ramifications of caring for patients. The Hippocratic Oath binds physicians to 'first do no harm'. This study demonstrates that, unfortunately, even a successful effort to prevent vision loss from glaucoma may condemn us to cause emotional damage to our patients. Is this a Catch-22? Treating the patient and treating the disease are not mutually exclusive goals. Interventions have unintended consequences. If a patient taking a topical glaucoma medication encounters a side effect, we change the medication. Likewise, we must reframe our approach to glaucoma so that our actions do not negatively impact the mental health of our patients. It is critical to remain cognizant that important signs and symptoms of wellbeing are not detected by an eye exam. Awareness of the emotional side effects of glaucoma diagnosis should prompt simple screening for mental health disorders. Some glaucoma patients may require referral to an appropriate mental health provider.

Many patient interactions start with the question, 'How are you doing?' Demand a more complete answer than that which is limited to clarity of vision and ocular comfort. Given that this study's population had relatively little visual impairment, subjective indicators of wellbeing in these patients were more likely to be emotional than ophthalmic. Therefore, that introductory question could be the most important of the visit.

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