Meditation: A Polypill for Comprehensive Management of Glaucoma Patients

Effect of mindfulness-based stress reduction on acute central serous chorioretinopathy: a randomized control trial

PURPOSE

To assess the positive effects of mindfulness-based stress reduction (MBSR) on the structural and functional outcomes of patients with central serous chorioretinopathy (CSCR).

METHODS

This study included 60 patients with CSCR who were randomly allocated to one of two groups: MBSR or control (which did not practice MBSR). These groups were then evaluated in terms of best corrected visual acuity (BCVA) and central macular thickness (CMT) at months 1, 3, and 6.

RESULTS

There were no significant differences in BCVA or mean CMT between the groups at the beginning of the study (p = 0.615 and p = 0.561, respectively). There were statistically significant differences between the groups in terms of BCVA at 1, 3, and 6 months (p = 0.018, p = 0.001, and p = 0.002, respectively). There were also significant differences in the mean CMT across the groups at the first, third, and sixth months (p < 0.001, p = 0.001, and p < 0.001, respectively).

CONCLUSION

MBSR may have beneficial outcomes in the early treatment of patients with CSCR, resulting in faster resolution of subretinal fluid and enhancement of BCVA.

Effect of "365 Breathing Technique" on Intraocular Pressure and Autonomic Functions in Patients With Glaucoma: A Randomized Controlled Trial

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.

Stress and Allostatic Load in Patients With Primary Open Angle Glaucoma

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.

Stimulated brains and meditative minds: A systematic review on combining low intensity transcranial electrical stimulation and meditation in humans

Background

Low intensity transcranial electrical stimulation (tES) and meditation are two promising, yet variable, non-pharmacological interventions. Growing research is investigating combined effects of both techniques on one's cognitive, emotional, and physical health.

Objective

This article reviews the current research that combines tES and meditation interventions in healthy and diseased participants. The review considers the intervention parameters and their effects in a well-organized manner.

Method

A systematic search for clinical and experimental published studies was conducted in the PubMed, Cochrane, and transcranial direct current stimulation (tDCS) databases using common keywords for tES and for meditation techniques well defined by previous studies. Unpublished ongoing studies were identified with the ClinicalTrials.gov and DRKS.de clinical trial websites.

Results

20 published studies and 13 ongoing studies were included for qualitative analysis. 13 published articles studied patients with chronic pain, psychological disorders, cognitive impairment, and movement disorders. Anodal tDCS was the only tES technique while mindfulness meditation was the most common meditation type. Eight studies had a main group effect, with outcome improvement in the active combined intervention. However, most published studies showed improvements after at least one combined intervention with variable effects.

Conclusion

Pairing anodal tDCS with meditation shows promising improvements of the physical, mental, and emotional aspects of daily life. Further studies are required to confirm the relevance of this combination in the clinic.

Effect of various relaxation techniques on the intraocular pressure of patients with glaucoma: a systematic review and meta-analysis

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.

Effect of yoga on intra-ocular pressure in patients with glaucoma: A systematic review and meta-analysis

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.

Effect of Jyoti-Trataka on intraocular pressure, autonomic control, and blood glucose in diabetic patients with high-tension primary open-angle glaucoma: a randomized-controlled trial

OBJECTIVES

Yoga is used as a complementary therapy to control the symptomatic and complicated consequences of type 2 diabetes mellitus (T2DM) but the effect of Jyoti-Trataka yoga (gazing steadily at a 4-feet away-fixed candle flame) on the intraocular pressure (IOP), autonomic control, and fasting blood glucose (FBG) in T2DM patients with high-tension primary open-angle glaucoma (POAG) was not previously investigated. This study aimed to search the effect of Jyoti-Trataka on IOP, systolic blood pressure (SBP), respiratory rate (RR), diastolic blood pressure (DBP), FBG, and pulse rate (PR) in T2DM patients with bilateral high-tension POAG.

METHODS

The patients with a 52- to 67-year range and body mass index below 30 kg/m² were randomly assigned to one of two 30-patient groups, study or control groups. Besides the administered oral hypoglycemic drugs by both groups, the study group only received one month of daily 55-min Jyoti-Trataka session.

RESULTS

A significant decrease (p<0.05) was identified after the comparison between the pre and post SBP, RR, DBP, FBG, IOP of both eyes, and PR in the study group while the control group exhibited no significant changes of all measures (p>0.05). In-favor-of the study group, the between-group post-treatment comparison showed a significant improvement of all measures (p<0.05).

CONCLUSIONS

Jyoti-Trataka is a good yogic complementary therapy that can be used to regulate autonomic functions, blood glucose, and IOP in T2DM patients with high-tension POAG.

Effect of Mindfulness-Based Stress Reduction on Intraocular Pressure in Patients With Ocular Hypertension: A Randomized Control Trial

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.

Beneficial effect of mindfulness based stress reduction on optic disc perfusion in primary open angle glaucoma: A randomized controlled trial

Background and aim

Glaucoma is one of the leading causes of visual impairment worldwide. Next to intraocular pressure (IOP), vascular factors play a major role in glaucoma. Mindfulness-based stress reduction (MBSR) has been shown to reduce the IOP, normalize the stress biomarkers, modulate gene expression, and also improve the quality of life. This study was aimed to assess the effect of MBSR in optic disc perfusion of patients with primary open angle glaucoma (POAG).

Experimental procedure

POAG patients with controlled IOP (<21 mmHg) were randomised in to intervention group (n = 30) and control group (n = 30). Both the groups continued their routine glaucoma medications while the intervention group practiced 45 min of MBSR every day in addition. IOP and optic disc perfusion using OCT-Angiography were recorded at baseline and at 6 weeks for both the groups.

Results

The mean age of the participants were 53.23 ± 8.4yr in intervention and 50.23 ± 7.3yr in the control group (p = 0.06). All the baseline parameters were comparable in both groups. After MBSR, in the intervention group there was a significant reduction of IOP (p=0.001), increase in circum-papillary vessel density in superior quadrant (15.8%-17.4%, p=0.02) and nasal quadrant (14.2%-16.5%, p=0.01), increase in circum papillary vascular perfusion, in superior quadrant (38.9%-41.1%, p<0.001), in temporal quadrant (42.2%-44.5%, p<0.001), in inferior quadrant (40.1%-43.8%, p<0.001), and in nasal quadrant (40.6%-42.8%, p<0.001). There was also a significant increase in Flux Index after 6weeks (0.38-0.40, p<0.001).

Conclusion

MBSR can reduce barotrauma and improve optic disc perfusion in POAG patients and serve as a useful adjunct to the standard medical therapy.

Can Breathing Exercise or Pranayama Affect the Intraocular Pressure in the Short-term?

PURPOSE

To demonstrate any transient short-term effect of a particular type of breathing exercise (alternate nostril breathing of Nadi Shuddhi type of pranayama exercise) on the intraocular pressure (IOP) in glaucomatous as well as healthy eyes.

METHODS

A prospective, nonrandomized, observational, cross-sectional study was conducted in a tertiary eyecare hospital setup recruiting 3 groups of subjects-glaucoma group and a normal group that underwent the breathing exercise as well as a normal group that did not. IOP was recorded at baseline, then at 4 minutes after 10 cycles of the breathing exercise and also after 10 minutes of rest-corresponding to IOPb, IOPc, and IOPr of all the study groups. Only those subjects were recruited who were above 18 and under 80 years and were naive to breathing exercise.

RESULTS

A total of 56 normal eyes (28 subjects, Normalb) and 33 glaucomatous eyes (19 subjects) were recruited for the breathing exercise and were compared with the IOP as obtained for 26 eyes of 26 subjects that did not undergo the breathing exercise (Normalnb). IOPb did not differ between both normal groups (13.7±1.4 mm Hg in Normalb vs. 13.9±1.6 mm Hg in Normalnb, P=0.183) but was significantly different between groups (16.7±3.1 mm Hg in the glaucoma group and 13.7±1.4 in Normalb, P<0.001 and Normalnb 13.9±1.6 mm Hg, P<0.001) but analysis of variance was not significant within groups comparing IOPb, IOPc, and IOPr of all the study groups.

CONCLUSION

There is no short-term transient effect of alternate nostril breathing exercise on IOP; a longitudinal study is recommended.

Effect of Mindfulness Meditation on Intraocular Pressure and Trabecular Meshwork Gene Expression: A Randomized Controlled Trial

PURPOSE

To evaluate the effect of mindfulness meditation (MM) on intraocular pressure (IOP) and trabecular meshwork (TM) gene expression in patients with medically uncontrolled primary open angle glaucoma (POAG).

DESIGN

Parallel arm, single-masked, randomized controlled trial.

METHODS

Sixty POAG patients with IOP ≥21 mm Hg taking maximal topical medication and scheduled for trabeculectomy were included in this study at a tertiary eye care center in India. Thirty patients (Group 1) underwent 3 weeks of 45-minute daily MM sessions in addition to medical therapy while Group 2 continued medical therapy only. Primary outcome was change in IOP (ΔIOP) after 3 weeks of MM. Secondary outcomes were probability of success, percentage of reduction in IOP, effect on diurnal variations of IOP, changes in quality of life (QoL), and changes in gene expression patterns in TM.

RESULTS

At 3 weeks, a significant decrease in IOP was seen in Group 1 (20.16 ± 3.3 to 15.05 ± 2.4mm Hg; P = .001), compared to Group 2 (21.2 ± 5.6 to 20.0 ± 5.8mm Hg; P = .38). ΔIOP was significantly higher in Group 1 than in Group 2 (5.0 ± 1.80 vs. 0.20 ± 3.03mm Hg; P = .001). Analysis of gene expression revealed significant upregulation of nitric oxide synthetase (NOS1 and NOS3) and neuroprotective genes with downregulation of proinflammatory genes in Group 1 in comparison to Group 2 (P = .001).

CONCLUSIONS

MM was associated with significant decrease in IOP and changes in TM gene expression, indicating its direct impact on ocular tissues.

Allostatic Load and Glaucoma: Are We Missing the Big Picture?

How to cite this article: Dada T, Mahalingam K, Gupta V. Allostatic Load and Glaucoma: Are We Missing the Big Picture? J Curr Glaucoma Pract 2020;14(2):47–49.