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PubMed This is a summary of 15 peer-reviewed journal articles Updated
Ophthalmology · Juvenile Open-Angle Glaucoma

More Than Medicine: Mental Health & Daily Life with JOAG

At a Glance

Managing Juvenile Open-Angle Glaucoma (JOAG) requires addressing both eye health and mental well-being. Preventing treatment fatigue and carefully planning the transition from pediatric to adult care are critical steps to protect against vision loss and improve a young adult's quality of life.

A diagnosis of Juvenile Open-Angle Glaucoma (JOAG) changes the rhythm of a person’s life. It is not just a medical challenge; it is a marathon of emotional resilience, financial planning, and time management. Validating these burdens is the first step in managing them. Research shows that families and young adults often face the highest economic and emotional impact in the first year after diagnosis, driven by the frequency of surgeries and the sudden need for lifelong medications [1][2].

For young adults, this condition adds significant stress to already challenging life transitions, such as navigating college, starting a career, or managing driving independence. For parents, it often involves the logistical stress of appointments and managing daily eye drop schedules.

Mental Health and the Risk of “Treatment Fatigue”

The weight of a lifelong, vision-threatening condition is heavy for a young person. Studies have indicated that patients with JOAG are at a significantly higher risk for depression and anxiety compared to those without the condition [3].

Common signs that a patient may be struggling include:

  • Withdrawal from friends, hobbies, or social milestones.
  • Expressions of hopelessness about the future or their vision.
  • “Non-adherence” (refusing or forgetting eye drops), which is often a sign of treatment fatigue or a desire for control [4][3].

Helping to manage stress—whether through mindfulness, counseling, or simple relaxation—is a highly beneficial supportive measure for overall well-being. While chronic mental stress has been linked to a trend toward faster deterioration of the visual field over time, normal daily stress will not cause immediate vision loss [5][6].

Preparing for the Future: Transition of Care

JOAG is a lifelong journey, and one of the most critical milestones is the move from a pediatric specialist to an adult glaucoma specialist. This “transition of care” should not be a single appointment but a years-long process [7][8].

  • Build Independence: Starting in early adolescence, patients should be encouraged to learn the names of their medications and how to put in their own drops [9].
  • Structured Planning: Research shows that patients in “structured” transition programs—where readiness is tracked and records are carefully coordinated—have much lower rates of “loss to follow-up” (missing appointments) as young adults [10][11].
  • Avoid Gaps: The biggest risk for vision loss in JOAG occurs during the 18–25 age range, when young adults may move away for college or work and stop seeing their specialist [12][13].

Supporting the Caregiver and Patient

Finally, remember that the burden of care is real. The logistics of appointments, the stress of surgical outcomes, and the daily “eye drop battle” can lead to burnout [14][15]. Mental health support is the foundation of long-term care. Seeking out support groups or counseling is not a sign of failure; it is a vital part of long-term success with JOAG [14].

Common questions in this guide

How does juvenile open-angle glaucoma affect mental health?
Living with JOAG can increase the risk of depression and anxiety due to the stress of managing a lifelong, vision-threatening condition. Patients may experience treatment fatigue, which can lead to missed eye drops and feelings of hopelessness.
Can stress make juvenile glaucoma worse?
While normal daily stress does not cause immediate vision loss, chronic mental stress has been linked to a faster worsening of the visual field over time. Managing stress through counseling or mindfulness is an important part of overall glaucoma care.
What is treatment fatigue in glaucoma?
Treatment fatigue happens when a patient becomes overwhelmed by the daily demands of their illness, such as constantly administering eye drops. This can result in refusing or forgetting medications, making it critical to seek emotional and psychological support.
When should a JOAG patient transition to an adult eye doctor?
The transition from a pediatric to an adult glaucoma specialist should be a gradual, years-long process starting in early adolescence. This structured planning helps prevent gaps in care, which are a major risk for vision loss between ages 18 and 25.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.How can we better monitor the emotional and psychological impacts of this diagnosis during regular exams?
  2. 2.Are there mental health professionals who specialize in supporting young people with chronic vision-threatening conditions?
  3. 3.What is our clinic's specific protocol for transitioning care from a pediatric specialist to an adult glaucoma specialist?
  4. 4.Can you help us document the medical necessity of certain procedures or preservative-free drops for our insurance to ease the economic burden?

Questions For You

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References

References (15)
  1. 1

    The Economic Burden of Childhood Glaucoma.

    Liu D, Huang L, Mukkamala L, Khouri AS

    Journal of glaucoma 2016; (25(10)):790-797 doi:10.1097/IJG.0000000000000412.

    PMID: 26950576
  2. 2

    Surgical Management of Secondary Pediatric Glaucoma.

    Carrabba N, Zhaver D, Blieden LS

    International ophthalmology clinics 2022; (62(1)):111-130 doi:10.1097/IIO.0000000000000390.

    PMID: 34965230
  3. 3

    Suicide risk in juvenile open angle glaucoma patients.

    Seong HJ, Jung S, Choe S

    International journal of ophthalmology 2024; (17(10)):1880-1886 doi:10.18240/ijo.2024.10.15.

    PMID: 39430028
  4. 4

    Medication Adherence and Common Barriers for Caregivers of Preschool Children with Pediatric Glaucoma.

    Liu Z, Zhang Y, Liu P, et al.

    Journal of ophthalmology 2022; (2022()):6389822 doi:10.1155/2022/6389822.

    PMID: 37273462
  5. 5

    Influence of mental stress on intraocular pressure and visual field testing: is there a white coat syndrome in glaucoma?

    Keren S, Waisbourd M, Gomel N, et al.

    Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie 2022; (260(1)):209-214 doi:10.1007/s00417-021-05315-9.

    PMID: 34463840
  6. 6

    Psychological Stress and Intraocular Pressure in Glaucoma: A Randomized Controlled Trial.

    Ferreira NS, Costa VP, Miranda JF, et al.

    Ophthalmology. Glaucoma 2024; (7(6)):518-530 doi:10.1016/j.ogla.2024.07.004.

    PMID: 39019157
  7. 7

    Optimizing the Transition and Transfer of Care in Pediatric Inflammatory Bowel Disease.

    Fishman LN, Ding J

    Gastroenterology clinics of North America 2023; (52(3)):629-644 doi:10.1016/j.gtc.2023.05.004.

    PMID: 37543405
  8. 8

    Reframing healthcare transition: Systems, relationships, and independence in adolescent-to-adult care.

    Walsh C, Reed S, Dave S, et al.

    Health care transitions 2025; (3()):100122 doi:10.1016/j.hctj.2025.100122.

    PMID: 41126842
  9. 9

    Perceptions in the experience of transition from pediatric to adult care of patients with childhood-onset epilepsy in Japan.

    Sasaki T, Irie W, Sugahara A, et al.

    Epilepsy & behavior : E&B 2024; (161()):110119 doi:10.1016/j.yebeh.2024.110119.

    PMID: 39510018
  10. 10

    Successful implementation of a clinical transition pathway for adolescents with juvenile-onset rheumatic and musculoskeletal diseases.

    Walter M, Kamphuis S, van Pelt P, et al.

    Pediatric rheumatology online journal 2018; (16(1)):50 doi:10.1186/s12969-018-0268-3.

    PMID: 30075795
  11. 11

    A Practice in Maturation: Current Perspectives on the Transition from Pediatric to Adult Care for Young Adults with Diabetes.

    Sandler CN, Garvey KC

    Current diabetes reports 2019; (19(11)):126 doi:10.1007/s11892-019-1247-x.

    PMID: 31728765
  12. 12

    Prolonged lapses between pediatric and adult care are associated with rise in HbA1c and inpatient days among patients with type 1 diabetes.

    Tilden DR, French B, Shoemaker AH, et al.

    Diabetes research and clinical practice 2022; (192()):110113 doi:10.1016/j.diabres.2022.110113.

    PMID: 36208847
  13. 13

    Transition from pediatric to adult care in type 1 diabetes mellitus: a longitudinal analysis of age at transfer and gap in care.

    Soliman D, Crowley MJ, Manning A, et al.

    BMJ open diabetes research & care 2022; (10(6)) doi:10.1136/bmjdrc-2022-002937.

    PMID: 36328375
  14. 14

    Quality of life and caregiver burden in pediatric glaucoma: A systematic review.

    Basilious A, Villani S, Jang H, et al.

    PloS one 2022; (17(10)):e0276881 doi:10.1371/journal.pone.0276881.

    PMID: 36288373
  15. 15

    Quality of life in children with glaucoma: a qualitative interview study in Australia.

    Knight LSW, Ridge B, Staffieri SE, et al.

    BMJ open 2022; (12(7)):e062754 doi:10.1136/bmjopen-2022-062754.

    PMID: 35858727

This page provides information on the mental health and daily life impacts of JOAG for educational purposes. It does not replace professional medical advice from your eye specialist or mental health provider.

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