During my third year of medical school, I completed back-to-back rotations in ophthalmology and psychiatry. Whereas ophthalmology is procedure-driven, anatomy-heavy, and visual by nature, psychiatry is abstract, emotionally nuanced, and focused on what is invisible to the eye. But, when moving from retinal injections to psychiatric interviews, I noticed unexpected parallels, especially in the emotional weight patients carry when their vision begins to decline.

In ophthalmology, providers focus heavily on visual acuity and ocular anatomy but may sometimes overlook what vision means to a patient’s identity, independence, or quality of life. After spending a month in psychiatry, I began to view ophthalmic encounters differently. They weren’t just about sight; they were about fear, uncertainty, and grief. I began to wonder: What if we approached the emotional impact of vision loss with the same care we give to the eye itself?

THE EMOTIONAL TOLL OF VISION LOSS

One encounter during my ophthalmology elective in particular stuck with me. A middle-aged man presented with progressive blurry vision in his right eye that had gradually worsened over weeks. Upon presentation, with his family at his side, he was diagnosed with ischemic central retinal vein occlusion (CRVO). It was not the kind of dramatic, sudden loss you might associate with trauma or CRVO. It came on gradually, mistaken for aging or eye strain. But now, vision in his right eye had permanently deteriorated.

What struck me wasn’t the diagnosis but the silence that followed. His family shifted in their seats, and the patient sat still, trying to process how irreversible vision loss would impact the rest of his life. There was no emergency to treat, no sight to save—just the reality of living with visual impairment.

This emotional undercurrent became more noticeable to me, even in less urgent cases. In clinic, many patients presented with chronic dry eye disease. Although not life-threatening, for some patients, the condition causes constant discomfort. I could see their frustration as they tried to explain how something “minor” shaped their days, their sleep, and their mood. It is a fine line these patients walk, knowing their condition is not deadly but feeling like it is slowly chipping away at their well-being. Their experiences are echoed in the peer-reviewed literature: A study of more than 460,000 adult patients showed that those with dry eye disease had significantly higher odds of both anxiety (adjusted odds ratio [OR], 2.8; 95% CI, 2.6–3.0) and depression (adjusted OR, 2.9; 95% CI, 2.7–3.1) compared to those without the condition.¹

REFRAMING OPHTHALMIC CARE THROUGH A PSYCHIATRIC LENS

During my psychiatry rotation, I learned how to administer the Patient Health Questionnaire-9 (PHQ-9) and conduct full psychiatric interviews. As I questioned patients about their difficulty concentrating, fatigue, hopelessness, and daily functioning, I kept thinking about our ophthalmology patients—the man grieving lost vision after a CRVO diagnosis, a woman whose dry eyes kept her awake every night, a pilot whose career was temporarily paused by a retinal detachment. Patients’ concerns cannot simply be classified as ophthalmic conditions. They are lived experiences that profoundly affect their mental health.

What psychiatry taught me is that we don’t need to become mental health experts to offer emotional support; we just need to create space for it. That might mean taking an extra 30 seconds to ask, “How are you doing with all of this?” or recognizing when a patient needs more than a handout or a follow-up visit. They may need validation, empathy, or even a referral to counseling. In a specialty so focused on precision, we tend to forget that the important findings in a visit are not always those that show up on OCT imaging or fundus photography but rather what is left unsaid by patients.

ACTIONABLE TAKEAWAYS FOR STUDENTS AND PHYSICIANS

Whether you are a medical student or a practicing physician, the dual lens of mental health and medicine is a perspective you can begin weaving into patient encounters.

Below are a few ways to do so.

1. Practice reflective empathy. Instead of jumping straight to the plan, take a moment to ask how the diagnosis is affecting the patient. A simple “How are you managing with all this?” can open a door.
2. Notice emotional cues. If a patient seems unusually quiet, detached, or tense, that might be your cue to slow down and check in emotionally, not just medically.
3. Bring in help when needed. If your preceptor is open to it, suggest mental health screening tools like the PHQ-9 in appropriate cases, or simply flag a concern privately if you sense a patient might benefit from added support.
4. Take this mindset with you. Whether you proceed into ophthalmology or not, learning to tune in to how patients feel will make you a better physician.

1. Van der Vaart R, Weaver MA, Lefebvre C, Davis RM. The association between dry eye disease and depression and anxiety in a large population-based study. Am J Ophthalmol. 2015;159(3):470-474.