Optometry & Visual Performance 171 Volume 14 | Issue 2 | June 2026 survival mechanisms are thrown into overdrive. The hypothalamic-pituitary-adrenal (HPA) axis, our central stress response system, floods the body with glucocorticoids, most notably cortisol.3 While essential for short-term survival, sustained high levels of cortisol can be profoundly damaging to the delicate and highly vascularized structures of the eye. This stress-induced hormonal cascade can impair blood flow to the retina and optic nerve, increase inflammation, and disrupt the function of the bloodretinal barrier, a critical structure that protects the eye’s sensitive neural tissue.1 This process is a key suspect in the progression of several sight-threatening conditions. In glaucoma, a disease characterized by damage to the optic nerve, elevated cortisol has been shown to correlate with increased intraocular pressure, a primary risk factor for the disease.4 The autonomic nervous system, perpetually in a “fight-or-flight” state under chronic stress, further constricts blood vessels, potentially starving the optic nerve of vital oxygen and nutrients and accelerating nerve fiber degeneration.5 Stress impacts more than glaucoma.6 Research links stress and depression to increased risk of advancing from dry to wet age-related macular degeneration, which involves new, abnormal blood vessel growth.7 Stress-driven inflammation is likely key in this shift. In diabetic retinopathy, psychological distress can worsen the disease by harming glycemic control and causing inflammation that damages retinal vessels.8 Even dry eye discomfort rises with stress and anxiety, likely through changes in tears and surface inflammation. Many studies have also suggested potential correlations between psychological stress,9 psychoneuroimmunology,10 and female hormones,11 all of which might directly or indirectly affect vision and visual function. The Colors of Emotion and the Focus of Attention Beyond the progression of disease, our psychological state can alter the very fabric of our moment-to-moment visual experience. Our emotions, for instance, act as a filter, subtly tinting our perception of the world. Pioneering studies have demonstrated that sadness can genuinely dull our perception of color, making the world appear more gray and less vibrant. This phenomenon, which has been linked to alterations in the brain’s processing of chromatic information along the blue-yellow axis, suggests that our emotional state can directly modulate the neural signals that constitute our experience of color.8 Conversely, a positive mood can enhance the saturation of colors, making them appear richer and more vivid, a perceptual echo of our inner joy.12 This subjective experience is powerfully shaped by the cognitive process of attention. Our visual system is constantly inundated with an overwhelming amount of information, far more than we can consciously process. Attention acts as a crucial gatekeeper, a spotlight that selects and prioritizes information deemed relevant by our brain.12 This selection is not always a conscious choice; it is heavily influenced by our goals, fears, and desires. An individual with arachnophobia, for example, will have an attentional system primed to detect the faintest hint of a spider’s leg in a cluttered room, often spotting it before anyone else.13 This “motivated perception” extends beyond our fears. In a fascinating study, researchers found that desired objects, such as a bottle of water to a thirsty person, are perceived as being physically closer than less-desired objects, a phenomenon dubbed “wishful seeing.”14 Our minds, it seems, bend the rules of visual space to bring our goals within perceived reach. This highlights a critical truth: we do not see the world as it is, but as it is useful for us to see it. This has profound implications for everything from eyewitness testimony, where emotional trauma can drastically alter the memory of what was seen, to the everyday interpretation of ambiguous social cues. The Anxious Eye and the Optimist’s Gaze Our deep-seated personality traits also cast a long shadow over our visual world. Individuals high in neuroticism, a trait characterized by a tendency toward anxiety, worry, and negative emotions, are more likely to interpret neutral or ambiguous visual stimuli in a threatening way.15 Their perceptual systems are, in a sense, biased toward detecting danger, a trait that may be evolutionarily advantageous but can contribute to a state of chronic hypervigilance and stress. In contrast, optimism appears to confer a degree of perceptual resilience. Optimists are more likely to direct their attention away from negative or threatening images and toward positive ones. This attentional bias may not only contribute to their emotional well-being but could also have long-term benefits for physical health, potentially by mitigating the physiological cascade of the stress response.16
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