**4. Faith: influence of beliefs**

In societies with strong theosophical backgrounds, the role of religious beliefs and claims to divine intervention are often brought to the fore. Patients facing imminent blindness look to prayer and divine healing in order to stay positive about their prognosis [6]. As a spiritual meditation, the activity has been shown to have physiologic benefits: clinically significant reduction in and ambulatory blood pressure, reduced heart rate, cardiorespiratory synchronization promotion, altered levels of melatonin and serotonin, suppressed corticostriatal glutamatergic neurotransmission, immune response boosting, decreased levels of reactive oxygen species as measured by ultra-weak photon emission and reduced stress.

Invoking healing through prayer has been compared with the placebo effect, influenced by personality, expectancy, optimism, and motivation. Randomized controlled studies, have been inconclusive about the benefits of prayer, though faith has had documented positive impact on outcomes in treatment groups studied. Considerations given to the Hawthorne and Rosenthal effects have been attributed to some of these outcomes [6]. The Hawthorne effect refers to change that occurs as a result of the act of observation or measurement, whereas the Rosenthal effect refers to change resulting from observer or rater expectancy. Study conditions may foster exaggeration of measurement results on the part of the subject, and relaxation of the measurement criteria on the part of the observer respectively. With specific reference to glaucoma, I have found that patients with a positive attitude maintain functional vision despite advanced disc and Retinal Nerve Fiber Layer (RNFL).

Andrade and Radhakrishnan [6] examined the correlation of medical and psychosocial benefits to religious affiliations and practices by posing a series of questions (see Appendix 7.1). The results were inconclusive and as such a definite relationship could not be determined. The door to research of this nature remains open, with respect to religious and theological customs and beliefs.

Optimism in our patients facing blindness has a positive impact on the way they experience environmental stimuli, and how this information is used in coping strategies optimism may contribute to the well-being of persons who have lost their vision both directly and by promoting problem-focused coping and engagement in positive social comparisons [7]. Research has found that non-acceptance of vision loss, using avoidance or ventilation coping, and not facing reality with a positive outlook may lead to negative feelings and low adaptation. Ophthalmologists' attitudes towards the underlying disease, and how they convey hope or despair to patients, can influence psychosocial adaptation in patients. The concept of neuroplasticity and the individualistic nature of healing and repair cannot be minimized. Shifting the focus to realistic goals such as optimal IOP in glaucoma, and discussing breakthroughs in neuro-therapy such as stem cell research will help keep hope alive and foster positive outlook.
