Glaucoma is a leading cause of irreversible blindness worldwide. Presently, elevated intraocular pressure (IOP) is the only approved modifiable risk factor. A consensus of the current literature suggests that both physiological and psychological stress may also impact the lifelong course of glaucoma. Specifically, stress is known to influence sympathetic nervous system activity. An increase in sympathetic nervous system activity may elevate a person’s blood pressure (BP) and IOP, and both are strongly associated with glaucomatous disease. Anxiety and depression have more conflicting evidence in relation to glaucoma. Socioeconomic and environmental stress may worsen adherence to therapy and disease outcomes due to a lack of financial resources and related access to healthcare. Neighborhood quality and environmental conditions, particularly urban environments, have been associated with glaucoma risk factors, higher glaucoma prevalence, and delayed surgical interventions. Racial differences have also been identified, with Black patients being more stressed and likely to present with increased glaucoma severity and faster disease progression than White patients. Mindfulness, meditation, and other forms of psychological relaxation have been shown to reduce IOP and stress biomarkers and result in improved quality of life (QOL). Larger studies in more diverse populations are needed to clarify risk and identify the best therapeutic approaches to reduce stress as a method to improve clinical outcomes and QOL for glaucoma patients.

Purpose: We aimed to analyze the effects of age on human tear film (TF) using a novel nanometer resolution TF imaging device (Tear Film Imager, TFI, AdOM, Israel). Methods: 44 healthy adult subjects (≥18 years of age) without ocular or systemic diseases or prior eye treatments with ages spanning seven decades were enrolled in this prospective cross-sectional study. Subjects underwent a comprehensive ophthalmic examination and completed the Ocular Surface Disease Index questionnaire (OSDI). All study participants underwent TF imaging using the TFI, including assessment of muco-aqueous layer thickness (MALT), lipid-layer thickness (LLT), inter-blink interval, and lipid map uniformity. Associations between TFI parameters and age were tested using linear regression (accounting for multiple eyes). Results: A total of 80 eyes (44 subjects) were imaged: 19 eyes from 10 subjects in the 3rd decade of life (aged 20–29); 10 eyes from 5 subjects in the 4th decade of life (aged 30–39); 5 eyes from 3 subjects in the 5th decade of life (40–49); 12 eyes from 7 subjects in the 6th decade of life (50–59), 19 eyes from 11 subjects in the 7th decade of life (60–69); 11 eyes from 6 subjects in the 8th decade of life (70–79); and 4 eyes from 2 subjects in the 9th decade of life (80–89). With increasing age, MALT significantly decreased (p = 0.024), and LLT significantly increased (p = 0.001). No statistically significant linear age effects were found for the other TFI parameters (p > 0.05) or the OSDI scores of study participants of different ages (p = 0.786). Conclusions: Quantitative TF biomarkers varied significantly with advancing age in healthy individuals, highlighting the importance of accounting for age in TF assessments.