Vision restoration in glaucoma: improved subjective visual function after personalised digital lifestyle coaching

Glaucoma-related vision loss is associated with stress, anxiety, and reduced quality of life. Because availability of psychological support and evidence-based life style information for patients are limited, we developed “VisionWise” (ViWi), a personalised digital lifestyle education course for glaucoma patients. We hypothesized that ViWi participation could improve subjective well-being, increase knowledge about the disease, increase positive lifestyle habits and possibly improve subjective vision. In this exploratory AB/BA study (N = 27), patients of the AB group participated in a nine-week ViWi course (A) followed by a waiting period (B) while the BA group waited before taking the course. All were asked to complete questionnaires on stress (PSQ-20), depression (PHQ-8), anxiety (GAD-7), subjective vision (NEI-VFQ-25), personality (NEO-FFI), and glaucoma-related knowledge at three time points. Intervention effects were analysed as pre-post comparison: AB:T1–T2 and BA:T1–T3. Subjective general vision improved significantly in group AB (p < .001) but also - unexpectedly - in group BA (p < .001) already during the waiting period, suggesting a placebo or expectancy effect. Changes were observed regarding stress-related measures, depressive symptoms, and anxiety. Some personality dispositions (higher agreeableness) were associated with greater reductions in anxiety and depressive symptoms. Usability ratings of ViWi were high, and no adverse events were observed. ViWi is a feasible and personalised digital lifestyle coaching tool to partially restore subjective vision in glaucoma patients. It can be used at home and empowers patients to cope with vision loss through behavioural eye exercises, management of stress-related risk factors, and novel strategies to adapt to low vision. Although the observed vision improvements are in part explainable by a placebo effect, this finding indirectly supports the relevance of positive attitudes in helping patients better control anxiety and stress, which are known co-factors in glaucoma progression. ViWi also supports patients in becoming better informed and more proactive in their glaucoma management. Our pilot study may guide future study designs to verify and optimise training effects through individualization, user engagement, and online accessibility as low-cost means “what else” they can do to complement standard glaucoma care. Within the framework of predictive, preventive and personalized medicine (PPPM), the present findings highlight the potential of digital lifestyle interventions to support patients´ awareness of psychosocial and stress-related risk factors, while exploratory analyses provide predictive insights into risk constellations associated with intervention outcomes. By addressing stress-related and behavioural factors, ViWi may contribute to a paradigm shift from reactive disease management towards a more personalised, positive, and patient-centred glaucoma care.