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Zaher O, Kuchtaruk AA, McGinnis ES, Paunic M, Malvankar-Mehta MS. Effect of various relaxation techniques on the intraocular pressure of patients with glaucoma: systematic review and meta-analysis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e343-e349. [PMID: 37364856 DOI: 10.1016/j.jcjo.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 05/11/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To conduct a systematic review focusing on the impact of various relaxation techniques on the intraocular pressure of patients with glaucoma. METHODS A systematic literature search was performed through CINAHL, MEDLINE, EMBASE, ClinicalTrials.gov, ProQuest Dissertations and Theses Global, and conferences until July 2022. Covidence software (Veritas Health Innovation, Melbourne, Australia) was used to conduct the systematic review. The screening was done by 2 independent reviewers, and a risk-of-bias assessment was completed after data extraction. Stata Statistical Software, version 14 (StataCorp LLC, College Station, Texas) was used to conduct a meta-analysis. RESULTS Twelve articles (596 subjects) were included for qualitative analysis and 5 articles (332 subjects) for quantitative analysis. One hour of daily mindfulness meditation for 3 weeks resulted in the most significant reduction in intraocular pressure (IOP) at 31.8%. Meditation consistently caused long-term reductions in IOP (standardized mean difference = -2.02; range, -3.16 to -0.89). Autogenic relaxation exercises showed a trend toward reducing IOP acutely but a significant reduction in the long term. Ocular relaxation exercises combined with visual imagery of aqueous humour drainage showed both acute and long-term reductions in IOP. The effects of yoga on IOP could depend on the positions being practiced. CONCLUSION Various relaxation techniques, such as meditation, visual imagery, autogenic relaxation exercises, and ocular relaxation exercises, seem to cause significant reductions in IOP. Future randomized, controlled trials should be carried out to further explore the utility of these techniques for patients with glaucoma.
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Affiliation(s)
- Omar Zaher
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Adrian A Kuchtaruk
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Emma S McGinnis
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON
| | - Milica Paunic
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Monali S Malvankar-Mehta
- Departments of Epidemiology and Biostatistics and Ophthalmology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON..
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Wu BQ, Kuo HT, Hsu AY, Lin CJ, Lai CT, Tsai YY. The Clinical Efficacy of Different Relaxation Exercises on Intraocular Pressure Reduction: A Meta-Analysis. J Clin Med 2024; 13:2591. [PMID: 38731121 PMCID: PMC11084912 DOI: 10.3390/jcm13092591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Objective: The aim of this study was to synthesize the available evidence on the clinical efficacy of different relaxation exercises on intraocular pressure (IOP) reduction. Methods: A systemic search of PubMed, Embase, Cochrane CENTRAL, and Web of Science was undertaken from the earliest record to 10 April 2024. Peer-reviewed studies that reported on healthy individuals and glaucoma patients engaging in relaxation exercises for at least three weeks were included. The primary outcome was changes in IOP levels from baseline, before the commencement of relaxation exercises, to post-exercise. Our statistical analysis employed a random-effects model, with effect sizes reported using Hedges' g. Results: Twelve studies were included, totaling 764 eyes (mean participant age ranging from 21.07 to 69.50 years). Relaxation exercises significantly reduced IOP, with Hedges' g being -1.276 (95% CI: -1.674 to -0.879) and I2 = 84.4%. Separate subgroup analyses showed that breathing exercises (Hedges' g = -0.860, p < 0.0001), mindfulness-based stress reduction (MBSR) (Hedges' g = -1.79, p < 0.0001), and ocular exercises (Hedges' g = -0.974, p < 0.0001) were associated with reduced IOP levels. The reduction in IOP following the relaxation exercises was found to be associated with baseline IOP either greater than (Hedges' g = -1.473, p < 0.0001) or less than 21 mmHg (Hedges' g = -1.22, p < 0.0001). Furthermore, this effect persisted with follow-up durations of less than (Hedges' g = -1.161, p < 0.0001) and more than one month (Hedges' g = -1.324, p < 0.0001). Conclusions: The current meta-analysis indicates that relaxation exercises can significantly reduce IOP levels. Relaxation exercises are a potential class of novel treatments for glaucoma patients that deserve further evaluation.
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Affiliation(s)
- Bing-Qi Wu
- Department of General Medicine, China Medical University Hospital, Taichung 404, Taiwan; (B.-Q.W.); (H.-T.K.)
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (A.Y.H.); (Y.-Y.T.)
| | - Hou-Ting Kuo
- Department of General Medicine, China Medical University Hospital, Taichung 404, Taiwan; (B.-Q.W.); (H.-T.K.)
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (A.Y.H.); (Y.-Y.T.)
| | - Alan Y. Hsu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (A.Y.H.); (Y.-Y.T.)
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (A.Y.H.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan
- Department of Optometry, Asia University, Taichung 413, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (A.Y.H.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan
- Department of Optometry, Asia University, Taichung 413, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (A.Y.H.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan
- Department of Optometry, Asia University, Taichung 413, Taiwan
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Dada T, Gwal RS, Mahalingam K, Chandran DS, Angmo D, Gupta S, Velpandian T, Deepak KK. Effect of "365 Breathing Technique" on Intraocular Pressure and Autonomic Functions in Patients With Glaucoma: A Randomized Controlled Trial. J Glaucoma 2024; 33:149-154. [PMID: 38194285 DOI: 10.1097/ijg.0000000000002356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/25/2023] [Indexed: 01/10/2024]
Abstract
PRCIS Patients with primary open angle glaucoma were advised to follow the "365 breathing technique" for 6 weeks in addition to their pharmacological glaucoma treatment. It helped to reduce intraocular pressure (IOP), stress biomarker-cortisol, and improve autonomic dysfunction. OBJECTIVE To study the effect of the "365 breathing technique" on IOP, autonomic functions, and stress biomarkers in patients with primary open angle glaucoma. METHODS In this randomized, controlled, interventional trial, after randomization, 40 patients in the intervention group followed "365 breathing" (three times a day, breathing rate: 6 cycles/min for 5 min) in addition to their pharmacological glaucoma treatment and 40 patients in the control group continued only with their pharmacological glaucoma treatment. IOP, serum cortisol, heart rate variability (HRV), and heart rate response to deep breathing test (DBT) were recorded at preintervention and 6 weeks postintervention. RESULTS The mean IOP, serum cortisol, parameters of the HRV test, and DBT were comparable between the two groups at baseline. At the 6-week follow-up, in the intervention group, mean IOP was significantly lower (16.09 ± 2.24 vs 18.38 ± 1.58 mm Hg, P = 0.03) and serum cortisol were significantly lower (13.20 ± 3.11 vs 14.95 ± 2.60 mcg/dL, P = 0.038) compared with the control group. In the HRV test, time domain analysis showed a significant difference in the root mean square of the successive difference between RR interval values between both groups at 6 weeks ( P = 0.015) pointing towards higher postintervention parasympathetic activation in the intervention group. In frequency domain analysis (HRV test), the ratio of the low-frequency component to the high-frequency component was significantly lower in the intervention group at 6 weeks (1.65 vs 1.79, P = 0.019) indicating a shift in sympathovagal balance towards greater vagal modulation.There was a significant increase in delta heart rate ( P = 0.019) and expiratory:inspiratory ratio ( P = 0.011) in the intervention group at 6 weeks when compared with baseline values, indicating improved parasympathetic reactivity to DBT. CONCLUSION "365 breathing" technique can reduce IOP and serum cortisol, and improve autonomic dysfunction in patients with glaucoma.
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Affiliation(s)
| | | | | | - Dinu Santha Chandran
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Kishore K Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Gc K, Mahalingam K, Gupta V, Angmo D, Gupta S, Dada T. Stress and Allostatic Load in Patients With Primary Open Angle Glaucoma. J Glaucoma 2024; 33:87-93. [PMID: 37974317 DOI: 10.1097/ijg.0000000000002332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/15/2023] [Indexed: 11/19/2023]
Abstract
PRCIS This study evaluated the allostatic load (AL) in primary open angle glaucoma (POAG) patients and reported that the AL score was significantly higher in glaucoma patients compared with age-matched controls. PURPOSE To evaluate the AL in patients with POAG. METHODS This case-control study comprised 50 POAG (glaucoma patients) and 50 age-matched controls without glaucoma (controls). AL was estimated based on 13 variables: systolic blood pressure (BP), diastolic BP, homocysteine, triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, body mass index, serum cortisol, glycosylated hemoglobin, albumin, creatinine clearance, and C-reactive protein. High-risk thresholds were determined based on biological cutoffs of each biomarker. One point was assigned for each biomarker reading above cutoff and were summated to obtain AL score; score ≥4 was considered high. RESULTS Mean age of glaucoma patients was 60.82±6.26 and 60.14±6.72 years in controls ( P =0.602). All components of AL score (except C-reactive protein) had higher values in glaucoma patients. There was a statistically significant difference in homocysteine ( P =0.001), total cholesterol ( P =0.037), high-density lipoprotein ( P =0.005), and glycosylated hemoglobin ( P =0.003). Mean AL score was 4.68±2.09 in glaucoma patients and 3.32±1.34 in controls ( P <0.001). There was significant association of high AL score with older age ( P =0.006), low socioeconomic status ( P =0.020), and glaucoma severity ( P =0.001). Negative correlation was seen between AL and retinal nerve fiber layer thickness (Right Eye: r =-0.37, P <0.001; Left Eye: r =-0.298, P <0.001) and visual field mean deviation (Right Eye: r =-0.469, P <0.001; Left Eye: r =-0.520, P <0.001). CONCLUSIONS Glaucoma patients exhibited allostatic overload indicating physiological dysregulation to chronic stress although additional research is required to establish causality. A holistic approach with lifestyle modifications to reduce chronic stress should be an integral part of managing glaucoma patients as it would serve both to possibly reduce or prevent disease progression and improve overall health outcomes.
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Affiliation(s)
- Kiran Gc
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Stuart KV, Pasquale LR, Kang JH, Foster PJ, Khawaja AP. Towards modifying the genetic predisposition for glaucoma: An overview of the contribution and interaction of genetic and environmental factors. Mol Aspects Med 2023; 93:101203. [PMID: 37423164 PMCID: PMC10885335 DOI: 10.1016/j.mam.2023.101203] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
Glaucoma, the leading cause of irreversible blindness worldwide, is a complex human disease, with both genetic and environmental determinants. The availability of large-scale, population-based cohorts and biobanks, combining genotyping and detailed phenotyping, has greatly accelerated research into the aetiology of glaucoma in recent years. Hypothesis-free genome-wide association studies have furthered our understanding of the complex genetic architecture underpinning the disease, while epidemiological studies have provided advances in the identification and characterisation of environmental risk factors. It is increasingly recognised that the combined effects of genetic and environmental factors may confer a disease risk that reflects a departure from the simple additive effect of the two. These gene-environment interactions have been implicated in a host of complex human diseases, including glaucoma, and have several important diagnostic and therapeutic implications for future clinical practice. Importantly, the ability to modify the risk associated with a particular genetic makeup promises to lead to personalised recommendations for glaucoma prevention, as well as novel treatment approaches in years to come. Here we provide an overview of genetic and environmental risk factors for glaucoma, as well as reviewing the evidence and discussing the implications of gene-environment interactions for the disease.
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Affiliation(s)
- Kelsey V Stuart
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jae H Kang
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul J Foster
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
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Tiwari P, Dada R, Dada T. From Inner Balance to Visual Health: Unraveling the Therapeutic Role of Yoga in Optic Neuropathy and Ocular Manifestations - Narrative Review. Int J Yoga 2023; 16:171-179. [PMID: 38463653 PMCID: PMC10919409 DOI: 10.4103/ijoy.ijoy_182_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 03/12/2024] Open
Abstract
The optic nerve comprises approximately 1.2 million axons of retinal ganglion cells and is vulnerable to degeneration due to a myriad of causes. While traditional treatments have been the cornerstone of ocular care, emerging evidence highlights the benefits of integrative approaches, which can be used as an adjunct in the management of optic neuropathy. Yoga is a mind-body energy medicine encompasses physical postures, breath control, and meditation. Currently, it has gained attention for its holistic effects on well-being, by promoting health, preventing onset of diseases, adjunct in disease management, and for its rehabilitative potential. In addition, the underlying mechanisms through which yoga exerts its therapeutic influence, evaluates clinical outcomes, and explores potential synergistic effects with conventional treatments remain largely unexplored. Neuroprotective mechanisms of yoga, such as enhancing retinal ganglion cell function, reducing oxidative stress, coupled with its ability to modulate inflammatory processes and improve circulation, contribute to its potential benefits in visual health. Analysis of clinical studies reveals promising outcomes, including improvements in visual acuity, visual fields, quality of life, and functional outcomes in individuals with optic neuropathy and ocular manifestations who undergo yoga intervention (especially dhyaan) with awareness of breath. Furthermore, the integration of yoga with conventional treatments and complementary modalities unveils the possibilities of multidisciplinary approaches in ocular care that need evaluation. By unraveling the role of yoga intervention in ocular health, this review provides valuable insights for clinicians and researchers, fostering a deeper understanding of the mind-body connection and paving the way for enhanced visual health outcomes. Embracing yoga as an adjunctive therapy may has the potential to revolutionize the management of optic neuropathy and ocular manifestations, offering individuals a holistic approach to optimize visual well-being, reduce comorbid depression and caregiver burden, and improve overall quality of life.
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Affiliation(s)
- Prabhakar Tiwari
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Rima Dada
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Tanuj Dada
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Pommy J, Smart CM, Bryant AM, Wang Y. Three potential neurovascular pathways driving the benefits of mindfulness meditation for older adults. Front Aging Neurosci 2023; 15:1207012. [PMID: 37455940 PMCID: PMC10340530 DOI: 10.3389/fnagi.2023.1207012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023] Open
Abstract
Mindfulness meditation has been shown to be beneficial for a range of different health conditions, impacts brain function and structure relatively quickly, and has shown promise with aging samples. Functional magnetic resonance imaging metrics provide insight into neurovascular health which plays a key role in both normal and pathological aging processes. Experimental mindfulness meditation studies that included functional magnetic resonance metrics as an outcome measure may point to potential neurovascular mechanisms of action relevant for aging adults that have not yet been previously examined. We first review the resting-state magnetic resonance studies conducted in exclusively older adult age samples. Findings from older adult-only samples are then used to frame the findings of task magnetic resonance imaging studies conducted in both clinical and healthy adult samples. Based on the resting-state studies in older adults and the task magnetic resonance studies in adult samples, we propose three potential mechanisms by which mindfulness meditation may offer a neurovascular therapeutic benefit for older adults: (1) a direct neurovascular mechanism via increased resting-state cerebral blood flow; (2) an indirect anti-neuroinflammatory mechanism via increased functional connectivity within the default mode network, and (3) a top-down control mechanism that likely reflects both a direct and an indirect neurovascular pathway.
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Affiliation(s)
- Jessica Pommy
- Department of Neurology, Division of Neuropsychology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Colette M. Smart
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Andrew M. Bryant
- Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Yang Wang
- Department of Neurology, Division of Neuropsychology, Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
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Wu ACL, Choy BNK. Psychological interventions to reduce intraocular pressure (IOP) in glaucoma patients: a review. Graefes Arch Clin Exp Ophthalmol 2023; 261:1215-1227. [PMID: 36441225 DOI: 10.1007/s00417-022-05912-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/07/2022] [Accepted: 11/12/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Glaucoma has been increasing recognised to cause significant mental health burden to patients while psychological factors also play important roles in the development and progression of glaucoma. This review presents the current evidence of the impact of psychological interventions in glaucoma patients to improve their holistic care in terms of both physical and mental health by modulating psychological symptoms and supporting glaucoma control. METHODS A literature search was conducted on PubMed for relevant studies up to February 2022. Types of psychological interventions include meditation, autogenic relaxation, music, hypnosis, motivational interviewing, psychological nursing and bright light exposure. Outcomes investigated were ocular parameters including intraocular pressure, mental health, patient motivation and satisfaction, and overall quality of life. RESULTS Seventeen studies investigating the effects of psychological interventions on improving the care of glaucoma patients were reviewed. Daily meditation for 30 to 60 min has been shown to be effective in improving glaucoma control in terms of reducing intraocular pressure by 1.5 to 6.1 mmHg and improving ocular perfusion and quality of life. The impacts of music, autogenic training and psychological nursing on glaucoma control, vision outcomes and psychological symptoms are also promising while bright light exposure has shown some effects on sleeping quality. However, there is insufficient basis to support the adoption of motivational interviewing or hypnosis in glaucoma patients yet. CONCLUSION Psychological interventions, especially meditation, can play a bigger role in the holistic care of glaucoma patients by controlling disease progression as an adjunct to conventional approaches and alleviating the mental health burden caused by the disease through stress reduction and emotional regulation. They empower patients to gain greater control of their disease and provides additional advantages of low cost, non-invasiveness and minimal side effects. Future research should involve well-conducted randomised trials with larger sample sizes and longer duration of intervention and follow-up to establish the long-term benefits for glaucoma patients.
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Affiliation(s)
- Anson Chun Long Wu
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Bonnie Nga Kwan Choy
- Department of Ophthalmology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong SAR, China.
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Kumar A, Ou Y. From bench to behaviour: The role of lifestyle factors on intraocular pressure, neuroprotection, and disease progression in glaucoma. Clin Exp Ophthalmol 2023; 51:380-394. [PMID: 36859798 PMCID: PMC11144012 DOI: 10.1111/ceo.14218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/03/2023]
Abstract
Current glaucoma management centres on intraocular pressure (IOP) reduction through pharmacological and surgical therapy. Despite broad interest in active management of glaucoma through lifestyle modifications, such recommendations have yet to be incorporated into standards of treatment. In this review, noteworthy preclinical studies and their translations in clinical populations are discussed to evaluate the roles of lifestyle factors in lowering IOP, offering neuroprotection, and/or slowing disease progression in those with open-angle glaucoma. Current literature suggests that aerobic exercise may be associated with neuroprotection and decreased disease progression. Mindfulness is associated with IOP reductions and neuroprotection. Caffeine is associated with mild, transient IOP elevations of uncertain significance. Nicotinamide supplementation is associated with neuroprotection and short-term visual function improvement. This review also highlights knowledge gaps regarding these factors and opportunities to strengthen our understanding of their role in glaucoma, including future preclinical studies that elucidate underlying mechanisms and clinical studies with additional functional endpoints and longer follow-up.
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Affiliation(s)
- Anika Kumar
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Yvonne Ou
- Department of Ophthalmology, University of California, San Francisco, California, USA
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Chetry D, Singh J, Chhetri A, Katiyar VK, Singh DS. Effect of yoga on intra-ocular pressure in patients with glaucoma: A systematic review and meta-analysis. Indian J Ophthalmol 2023; 71:1757-1765. [PMID: 37203026 PMCID: PMC10391478 DOI: 10.4103/ijo.ijo_2054_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Glaucoma is the second leading cause of blindness in the world, with an estimated 57.5 million people suffering from glaucoma globally. Treatment of glaucoma focuses on lowering intra-ocular pressure to prevent progression of visual field defects, which is the only proven method for treating this disease. Yoga practices are believed to lower intra-ocular pressure in the eyes and prevent further damage in patients with glaucoma. Therefore, this systematic review was planned to explore the available scientific studies on yoga and intra-ocular pressure in glaucoma patients. PubMed, Cochrane Library, and Google Scholar were the basis for the investigation of the literature. The Jadad Scale was used to assess the quality of included clinical trials, and the JBI Critical Appraisal Checklist was used to assess the quality of included case studies. Based on the quality assessment and eligibility, six studies on yoga and intra-ocular pressure in glaucoma patients carried out between 2007 and 2021 were included in the final review. The results showed a reduction in intra-ocular pressure in patients with glaucoma through Jyoti-trataka (gazing steadily on a point or candle flame) and some other slow yogic breathing techniques, whereas studies on inversion Asanas (yoga postures) showed a rapid increase in intra-ocular pressure soon after starting. The three high-quality RCTs included in the meta-analysis showed a greater improvement in intra-ocular pressure in the yoga groups in both eyes than in the control groups; however, there were some limitations related to a small sample size, study quality, a long-term follow-up period, and variations in the yoga practices. Therefore, further studies with larger sample sizes and long-term follow-up are needed to overcome the limitations for a better understanding.
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Affiliation(s)
- Dipak Chetry
- Department of Yoga, University of Patanjali, Haridwar, Uttarakhand, India
| | - Jayvindra Singh
- Department of Yoga, University of Patanjali, Haridwar, Uttarakhand, India
| | - Archana Chhetri
- Department of Yoga, Uttarakhand Sanskrit University, Haridwar, Uttarakhand, India
| | | | - Daya Shankar Singh
- Department of Shalakya Tantra (ENT), Patanjali Bhartiya Ayurvigyan Evam Anusandhan Sansthan, Haridwar, Uttarakhand, India
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Daily Meditation Practice for Managing Glaucoma- patients' Attitudes and Acceptance. J Glaucoma 2022; 31:e75-e82. [PMID: 35882038 DOI: 10.1097/ijg.0000000000002076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
Abstract
PRECIS 63% of glaucoma patients agreed to 45-60 minutes of daily meditation. Predictors of accepting meditation included previous meditation practice, a diagnosis of glaucoma <1 year, and having a marital status of "single". PURPOSE To explore patients' acceptance and barriers towards 45-60 minutes daily meditation for glaucoma management and to identify glaucoma patients with higher perceived stress levels who may benefit more from meditation practice. METHODS Glaucoma patients attending the Royal Victorian Eye and Ear Hospital, Melbourne, Australia outpatient department were invited to complete a patient survey. This explored if patients would agree to 45-60 minutes of daily meditation and included the Determinants of Meditation Practice Inventory and Perceived Stress Scale questionnaires. Questionnaire scores were compared across participants' clinical and demographic characteristics using student's T-Test, ANOVA, and multiple-linear-regression analysis. RESULTS Of the 123 eligible patients screened, one hundred completed the survey (81.3%). Sixty-three (63%) patients would agree to 45-60 minutes of daily meditation if advised by their doctor. Univariate analysis showed increased acceptance of meditation (lower Determinants of Meditation Practice Inventory scores) to be associated with agreeing to meditate 45-60 minutes daily (P=0.002), currently or previously practicing meditation (P=0.006 and P=0.0004 respectively), and having a marital status of "single" (P=0.02). Multi variate regression analysis showed previous meditation practice and a glaucoma diagnosis of <1 year to be predictive of accepting meditation (P=0.01 and P=0.03 respectively). There were no predictive factors of Perceived Stress Scale scores. CONCLUSION Given the high acceptance rate of 45-60 minutes daily meditation (63% of glaucoma patients sampled), this may be recommended for benefit of patients. Patients who have previously meditated, have a relatively new diagnosis of glaucoma, and are single (marital status) were more accepting of meditation practice.
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Dada T, Mondal S, Midha N, Mahalingam K, Sihota R, Gupta S, Angmo D, Yadav RK. Effect of Mindfulness-Based Stress Reduction on Intraocular Pressure in Patients With Ocular Hypertension: A Randomized Control Trial. Am J Ophthalmol 2022; 239:66-73. [PMID: 35122746 DOI: 10.1016/j.ajo.2022.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate the effect of mindfulness-based stress reduction (MBSR) on intraocular pressure (IOP) in patients with ocular hypertension (OHT). DESIGN Parallel arm, single masked, randomized controlled trial. METHODS Sixty patients with ocular hypertension and IOP > 21 and < 30 mmHg were recruited at a tertiary eye care centre in India. Thirty patients (group 1) underwent six weeks of one hour daily MBSR sessions, while the other 30 patients (group 2) were waitlisted and kept on follow-up. The primary outcome was change in IOP (ΔIOP) after six weeks of MBSR. Secondary outcomes were effect on serum cortisol level, diurnal variation of IOP, vessel perfusion and vessel density on optical coherence tomography angiography (OCTA), and quality of life (QOL). RESULTS At six weeks, a significant decrease in IOP was noted in group 1 (23.05 ± 1.17 to 19.15 ± 1.45 mmHg; P = .001) compared with group 2 (22.55 ± 0.98 mmHg to 22.37 ± 1.07 mmHg; P = .107). The ΔIOP was significantly greater in group 1 (3.93 ± 1.47) than group 2 (0.17 ± 0.58; P = .001). The diurnal fluctuation of IOP decreased in group 1 (4.87 ± 1.13 mmHg to 2.73 ± 0.98 mmHg; P = .001) as compared with group 2 (4.50 ± 0.86 mmHg to 4.30 ± 0.83 mmHg; P = .227). Significant improvement in vessel perfusion, vessel density, and flux index was noted on OCTA in group 1 compared with group 2. Group 1 showed a significant decrease (P ≤ .001) in serum cortisol level and an improved QOL (P = .001). CONCLUSION Mindfulness-based stress reduction was associated with a significant decrease in IOP and serum cortisol, along with an improvement in optic nerve head perfusion and QOL. Mindfulness-based stress reduction can be considered as a potential treatment option in the management of OHT.
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