The relation between exercise and glaucoma in a South Korean population-based sample

The Effect of Exercise on Intraocular Pressure and Glaucoma

PRCIS

A review of the literature found that certain types of exercise and physical activity result in transient reductions in intraocular pressure and may have a beneficial effect on glaucoma severity and progression.

INTRODUCTION

Glaucoma is the most common cause of irreversible vision loss worldwide. Raised intraocular pressure (IOP) is the most important risk factor for the disease. Exercise is known to result in changes in IOP. The purpose of this review was to investigate the effect of exercise on IOP and glaucoma.

METHODS

A comprehensive search of multiple literature databases was performed. Medline, EMBASE, and Cochrane libraries were used to search for the relevant terms. 16 original studies were selected for the review.

RESULTS

Exercise of varying intensity and type has differing effects on IOP. Moderate-intensity aerobic exercise results in transient reductions in IOP, while high-intensity resistance exercise and weight-lifting lead to transient elevations in IOP. There is evidence to suggest that exercise and higher levels of fitness may be protective against the development of glaucoma. In addition, increased daily physical activity may be associated with less visual field progression in patients with glaucoma. While secondary causes of glaucoma are included in some of the studies discussed in this review, the findings are largely applicable to primary open angle glaucoma.

CONCLUSION

Exercise may be a beneficial lifestyle modification in the management of glaucoma; however, further longitudinal studies are required to validate this.

Effects and potential mechanisms of exercise and physical activity on eye health and ocular diseases

In the field of eye health, the profound impact of exercise and physical activity on various ocular diseases has become a focal point of attention. This review summarizes and elucidates the positive effects of exercise and physical activities on common ocular diseases, including dry eye disease (DED), cataracts, myopia, glaucoma, diabetic retinopathy (DR), and age-related macular degeneration (AMD). It also catalogues and offers exercise recommendations based on the varying impacts that different types and intensities of physical activities may have on specific eye conditions. Beyond correlations, this review also compiles potential mechanisms through which exercise and physical activity beneficially affect eye health. From mitigating ocular oxidative stress and inflammatory responses, reducing intraocular pressure, enhancing mitochondrial function, to promoting ocular blood circulation and the release of protective factors, the complex biological effects triggered by exercise and physical activities reveal their substantial potential in preventing and even assisting in the treatment of ocular diseases. This review aims not only to foster awareness and appreciation for how exercise and physical activity can improve eye health but also to serve as a catalyst for further exploration into the specific mechanisms and key targets through which exercise impacts ocular health. Such inquiries are crucial for advancing innovative strategies for the treatment of eye diseases, thereby holding significant implications for the development of new therapeutic approaches.

Association between lifestyle habits and glaucoma incidence: a retrospective cohort study

BACKGROUND/OBJECTIVES

Although lifestyle habits may represent modifiable risk factors of glaucoma, the association between lifestyle factors and glaucoma is not well understood. The aim of this study was to investigate the association between lifestyle habits and the development of glaucoma.

SUBJECTS/METHODS

Participants who underwent health check-ups from 2005 to 2020 using a large-scale administrative claims database in Japan were included in the study. Cox regression analyses were performed where glaucoma development was regressed on the lifestyle (body mass index, current smoking, frequency and amount of alcohol consumption, eating habits, exercise habits and quality of sleep), age, sex, hypertension, diabetes mellitus and dyslipidaemia.

RESULTS

Among the 3,110,743 eligible individuals, 39,975 developed glaucoma during the mean follow-up of 2058 days. Factors associated with increased risk of glaucoma were overweight/obese (vs. moderate weight: hazard ratio, 1.04 [95% confidence interval, 1.02-1.07]), alcohol consumption of 2.5-4.9 units/day, 5-7.4 units/day, and ≥7.5 units/day (vs. <2.5 units/day: 1.05 [1.02-1.08], 1.05 [1.01-1.08] and 1.06 [1.01-1.12], respectively), skipping breakfast (1.14 [1.10-1.17]), late dinner (1.05 [1.03-1.08]) and daily walking of 1 h (1.14 [1.11-1.16]). Factors associated with decreased risk of glaucoma were daily alcohol consumption (vs. rarely: 0.94 [0.91-0.97]) and regular exercise (0.92 [0.90-0.95]).

CONCLUSIONS

Moderate body mass index, having breakfast, avoiding late dinner, limiting alcohol intake to <2.5 units/day, and regular exercise were associated with a reduced risk of developing glaucoma in the Japanese population. These findings may be useful for promoting glaucoma prophylaxis.

Towards modifying the genetic predisposition for glaucoma: An overview of the contribution and interaction of genetic and environmental factors

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.

The Association of Physical Activity with Glaucoma and Related Traits in the UK Biobank

PURPOSE

To examine the association of physical activity (PA) with glaucoma and related traits, to assess whether genetic predisposition to glaucoma modified these associations, and to probe causal relationships using Mendelian randomization (MR).

DESIGN

Cross-sectional observational and gene-environment interaction analyses in the UK Biobank. Two-sample MR experiments using summary statistics from large genetic consortia.

PARTICIPANTS

UK Biobank participants with data on self-reported or accelerometer-derived PA and intraocular pressure (IOP; n = 94 206 and n = 27 777, respectively), macular inner retinal OCT measurements (n = 36 274 and n = 9991, respectively), and glaucoma status (n = 86 803 and n = 23 556, respectively).

METHODS

We evaluated multivariable-adjusted associations of self-reported (International Physical Activity Questionnaire) and accelerometer-derived PA with IOP and macular inner retinal OCT parameters using linear regression and with glaucoma status using logistic regression. For all outcomes, we examined gene-PA interactions using a polygenic risk score (PRS) that combined the effects of 2673 genetic variants associated with glaucoma.

MAIN OUTCOME MEASURES

Intraocular pressure, macular retinal nerve fiber layer (mRNFL) thickness, macular ganglion cell-inner plexiform layer (mGCIPL) thickness, and glaucoma status.

RESULTS

In multivariable-adjusted regression models, we found no association of PA level or time spent in PA with glaucoma status. Higher overall levels and greater time spent in higher levels of both self-reported and accelerometer-derived PA were associated positively with thicker mGCIPL (P < 0.001 for trend for each). Compared with the lowest quartile of PA, participants in the highest quartiles of accelerometer-derived moderate- and vigorous-intensity PA showed a thicker mGCIPL by +0.57 μm (P < 0.001) and +0.42 μm (P = 0.005). No association was found with mRNFL thickness. High overall level of self-reported PA was associated with a modestly higher IOP of +0.08 mmHg (P = 0.01), but this was not replicated in the accelerometry data. No associations were modified by a glaucoma PRS, and MR analyses did not support a causal relationship between PA and any glaucoma-related outcome.

CONCLUSIONS

Higher overall PA level and greater time spent in moderate and vigorous PA were not associated with glaucoma status but were associated with thicker mGCIPL. Associations with IOP were modest and inconsistent. Despite the well-documented acute reduction in IOP after PA, we found no evidence that high levels of habitual PA are associated with glaucoma status or IOP in the general population.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Lifestyle Measures for Glaucoma Patients: An Objective Social Media Content Analysis

Aim

In this study, we analyze the content quality and characteristics of the most viewed search results on various internet platforms related to lifestyle measures for patients with glaucoma.

Materials and methods

In this internet-based cross-sectional study, we used search keywords "glaucoma," "lifestyle," "glaucoma," and "exercise" on the most popular internet platforms-Google, Facebook, YouTube, and Reddit. The top 30 Google searches about each of the keyword combinations were identified. We also assessed the first 30 videos on YouTube and Facebook Watch, the first 30 Reddit posts and the first 30 Google images about each of the keyword combinations. The quality of content from the platforms was evaluated by three independent reviewers using the well-established Sandvik score, Health on Net (HON) code, and risk score for different uploaders. The quality of content regarding lifestyle measures in glaucoma uploaded by healthcare professionals (HCPs) was further evaluated.

Results

The established criteria resulted in 48 websites from the Google search engine, 22 videos from YouTube, 37 posts from Reddit, and 28 videos from Facebook Watch, which were included in the final analysis. The mean Sandvik scores were 11.14 ± 1.8 (Google webpages), 10.4 ± 2.19 (YouTube videos), 10.54 ± 2.21 (Facebook Watch), and 4.24 ± 1.18 (Reddit). The mean risk scores were 0.22 ± 0.68 (YouTube videos), 0.18 ± 0.47 (Facebook Watch), and 0.11 ± 0.31 (Reddit). The mean HON code scores were 5.45 ± 1.62 (YouTube), 6.55 ± 1.44 (Google webpages), 5.29 ± 1.04 (Facebook Watch), and 8.27 ± 3.05 (Reddit). The content uploaded by HCPs was primarily from ophthalmologists and had significantly (p < 0.05) higher content quality scores. The majority of the content recommended aerobic exercise as a lifestyle measure in patients with glaucoma as an adjuvant to medical and surgical management.

Conclusion

The majority of the content regarding lifestyle measures in glaucoma was uploaded by HCPs and had medically accurate and well-referenced information, especially on Google and YouTube.

Clinical significance

Primary care physicians and ophthalmologists can reliably use social media content to guide recently diagnosed patients about the requisite lifestyle measures.

How to cite this article

Chahal R, Jindal A, Parmar UPS, et al. Lifestyle Measures for Glaucoma Patients: An Objective Social Media Content Analysis. J Curr Glaucoma Pract 2023;17(3):141-148.

The Assessment of Acute Chorioretinal Changes Due to Intensive Physical Exercise in Senior Elite Athletes

Regular physical exercise is known to lower the incidence of age-related eye diseases. We aimed to assess the acute chorioretinal alterations in older adults following intense physical strain. Seventeen senior elite athletes were recruited who underwent an aerobic exercise on a cycle ergometer and macular scanning by optical coherence tomography. A significant thinning of the entire retina was observed 1 min after exercise, followed by a thickening at 5 min, after which the thickness returned to baseline. This trend was similar in almost every single retinal layer, although a significant change was observed only in the inner retina. Choroidal thickness changes were neither significant nor did they correlate with the thickness changes of intraretinal layers. The mechanism of how these immediate retinal changes chronically impact age-related sight-threatening pathologies that, in turn, result in a substantially reduced quality of life warrants further investigation on nontrained older adults as well.

Association of Exercise Intensity with the Prevalence of Glaucoma and Intraocular Pressure in Men: A Study Based on the Korea National Health and Nutrition Examination Survey

Adequate exercise is essential for maintaining a healthy lifestyle and preventing ageing-related diseases. The purpose of this study was to assess the associations between exercise and glaucoma, as well as exercise and intraocular pressure (IOP) levels. This study used data from the Korea National Health and Nutrition Examination Surveys 2008–2012, which in total included 10,243 men aged ≥40 years. The presence of glaucoma and the higher IOP of each eye (IOPmax) taken from the health examination survey and the ophthalmic examination were used for analyses. A questionnaire was used to assess exercise activity, which was analysed regarding intensity, frequency, and duration. Regression analyses were used to determine the relationships of exercise parameters with the odds of glaucoma and IOPmax. The prevalence of glaucoma was significantly lower in men who engaged in moderate-to-vigorous intensity exercise compared to those who did not exercise (p = 0.012). The odds for glaucoma were the lowest in men engaged in vigorous intensity exercise (p = 0.009). However, IOPmax was highest in the vigorous intensity exercise group (p = 0.026) with no linear trend pattern. These results suggest that exercise decreased the odds of glaucoma via several factors including non-IOP mechanisms.

Effects of Exercise on Optic Nerve and Macular Perfusion in Glaucoma and Normal Subjects

PRCIS

Using optical coherence tomography angiography, we only found an increase in the blood flow in regional macular without significant changes in the optic disc in patients with glaucoma after a moderate exercise regime.

PURPOSE

To investigate the effect of moderate exercise on optic nerve and macular perfusion in glaucoma patients.

METHODS

Overall, 25 eyes of 25 patients with primary open-angle glaucoma and 22 eyes of 22 normal subjects were included in the glaucoma and control groups, respectively. Foveal avascular zone parameters, whole and regional vessel density in the superficial layer of macula, vessel densities in the radial peripapillary capillary (RPC) layer of the optic nerve head, intraocular pressure, and cardiovascular parameters were measured using optical coherence tomography angiography before, immediately after, and 30 minutes after a 20-minute run at moderate speed.

RESULTS

In the glaucoma group, macular superficial vessel density of the whole image, parafovea, and superior and nasal regions were higher after 30 minutes of rest (44.049±5.704, 47.238±5.741, 48.692±6.648, 47.852±5.078) than immediately after exercise(43.229±5.867, 46.334±5.984, 47.840±6.895, 46.793±5.238, P<0.05). The vessel density in the temporal and nasal regions was higher 30 minutes after exercise (45.105±5.512, 47.852±5.078) than before exercise (44.265±5.803 and 46.750±5.639, P<0.05). The intraocular pressure decreased immediately after exercise (14.20±2.51 and 14.51±2.96 mmHg for glaucoma and controls, respectively) but was restored after 30 minutes of rest (15.84±3.57 mmHg for glaucoma and 16.50±2.25 mmHg for controls) in both groups (P<0.001). Cardiovascular parameters were similar in both groups.

CONCLUSION

Moderate physical exercise for 20 minutes increased blood flow in the macula region without significant change to the optic nerve and lowered intraocular pressure in glaucoma and normal subjects. The benefit of these findings to glaucoma patients needs further study.

Characteristics of pigmentary glaucoma in Japanese individuals

Purpose

Myopia is a known risk factor of pigmentary glaucoma (PG), and the increased prevalence of myopia in Asian countries indicates that more cases of PG will likely develop soon. However, there are no diagnostic criteria for PG for Asians. Therefore, the purpose of this study is to determine the characteristics of PG in Japanese individuals and establish three diagnostic signs for PG.

Methods

This was a single-center, retrospective, case series study of glaucoma patients who visited the Kagoshima University Hospital between January 2015 and January 2020. The inclusion criteria were age <50 years at time of diagnosis and presence of pigmentation in the anterior chamber (AC) angle including a Sampaolesi line. Eyes with pigmentation of the AC angle caused by other types of glaucoma such as uveitis, trauma, exfoliation, or childhood glaucoma were excluded. We investigated the classic diagnostic triad of signs of PG; posterior corneal pigmentation, mid peripheral iris transillumination defect, and pigmentation of the trabecular meshwork. We also examined the Sampaolesi line, iris concavity, and midperipheral iris depigmentation in eyes with PG.

Results

Ten eyes of 5 Japanese men and 10 eyes of 5 Japanese women were studied. Their age ranged from 13 to 46 years at the time of diagnosis. One eye had posterior corneal pigmentation and 6 eyes had pigmentation of the trabecular meshwork. None had mid peripheral iris transillumination defect. The Sampaolesi line, iris concavity, and midperipheral iris depigmentation were found in all patients except one patient who lacked the mid peripheral depigmentation. Two eyes had the pigment reversal sign, none had lens pigmentation, and 2 eyes had peripheral retinal degeneration.

Conclusion

The presence of the Sampaolesi line, iris concavity, and midperipheral iris depigmentation may be appropriate signs for the diagnosis of PG in Asians.

Choroidal Vascularity Index Changes After Exercise in Patients With Glaucoma

Purpose: To investigate the changes in choroidal vascular structures after exercise in patients with glaucoma using an image binarisation algorithm with enhanced-depth imaging optical coherence tomography.

Methods: Thirty-four eyes of 19 patients with primary open-angle glaucoma and 40 eyes of 20 normal subjects were included in the glaucoma and control groups, respectively. All subjects were evaluated before, immediately after, and 30 min after 20-min running at moderate speed. The subfoveal choroidal area was segmented into the luminal area (LA) and stromal area (SA), and the choroidal vascularity index (CVI) was measured by calculating the ratio of LA to the total choroidal area (TCA). The mean intraocular pressure (IOP), subfoveal choroidal thickness, CVI, SA, CA, and TCA were compared within and between both groups. The correlation between CVI, IOP, and other vascular indexes was investigated.

Results: In the glaucoma group, a significantly lower CVI was found immediately after exercise and recovered 30 min after exercise. Higher TCA and LA levels were demonstrated 30 min after exercise compared to immediately after exercise. In both groups, IOP decreased immediately after exercise but was restored after a 30-min rest. In the glaucoma group, there was a higher correlation between CVI and other choroidal vascular parameters than in the control group. There was no difference in IOP or choroidal parameters between the groups at different time points.

Conclusion: In patients with glaucoma, CVI decreased significantly immediately after exercise, indicating that the choroidal layer is affected by exercise and an unhealthy vascular regulatory mechanism.

Therapeutic and preventive eff ect of physical exercises in primary open-angle glaucoma

The review assesses physical exercises as an additional non-pharmacological mean of combating the progression of primary open-angle glaucoma. The ophthalmic hypotensive effect is determined by the type of exercise, its duration and intensity. Moderate aerobic activity is preferred. Among dynamic exercises, jogging has the greatest hypotensive effect. Upper body isometric resistance training provides a more lasting decrease in ophthalmotonus. The decrease in intraocular pressure (IOP) in patients with glaucoma is several times more pronounced in comparison with healthy people and occurs regardless of the nature of the local drug antihypertensive therapy. After the termination of classes IOP returns to the previous level on average within a month. An increase in ocular perfusion pressure associated with physical activity dictates the appropriateness of physical exercise for patients with pseudo-normal pressure glaucoma. The combination of hypotensive, vascular, neuroprotective effects of physical activity with a high level of physical fi tness does not exclude a decrease in the risk of development and progression of primary open-angle glaucoma. The development of indications for the use of physical activity by patients with advanced glaucoma, including those who have undergone hypotensive surgery, remains relevant. The type, intensity, dosage and mode of performing the recommended physical exercises require an individual choice.

Do Age and Sex Play a Role in the Intraocular Pressure Changes after Acrobatic Gymnastics?

To evaluate the effects of an acrobatic gymnastics (AG) training session on intraocular pressure (IOP), a familiarization session was employed to confirm the participant's suitability for the study. Forty-nine gymnasts (63.27% females, 18-40 years old) voluntarily agreed to participate. As age, sex, baseline IOP, and central corneal thickness (CCT) were considered as potential predictors of the IOP variations, in the second session measurements of the above parameters were taken before and after 90 min of AG. A mixed-factorial analysis of variance evaluated differences. Linear regression was conducted to potentially predict the IOP variation with the exercise. After the scheduled exercise, highly significant (p < 0.001, effect size: 0.73) reductions in IOP, but no significant changes in CCT (p = 0.229), were observed. IOP was significantly modified in males, older than 25 years, and subjects with baseline IOP > 14 mmHg (p ≤ 0.001, effect sizes: 0.57-1.02). In contrast, the IOP of females, younger participants, and subjects with baseline IOP ≤ 14 mmHg was not significantly modified (p = 0.114). With the regression analyses, we concluded that both sex and baseline IOP levels were significant predictors of the IOP fluctuation with AG. These findings could be of interest for gymnasts, coaches, ophthalmologists, and/or optometrists in the prevention and control of risk factors associated with glaucoma.

Physical Activity and Cardiovascular Fitness During Childhood and Adolescence: Association With Retinal Nerve Fibre Layer Thickness in Young Adulthood

PRECIS

Higher physical working capacity (PWC) at age 17 was associated with thicker peripapillary retinal nerve fiber layer (pRNFL) at age 20, suggesting a mechanistic link between cardiovascular fitness and neuroretinal integrity.

PURPOSE

Physical activity and cardiovascular fitness have been linked with lower odds of developing glaucoma. We tested the hypothesis that early beneficial effects of physical activity and cardiovascular fitness can be observed by measuring the pRNFL thickness in young healthy adults.

METHODS

The Raine Study is a longitudinal study that has followed a cohort since before their births in 1989-1992. Parent-reported physical activity was collected between 8 and 17 years, and latent class analysis was used to identify the participants' physical activity trajectories. At the 20-year follow-up (participants' mean age=20.1±0.4 y), participants' metabolic equivalent of task-minutes/week was determined using self-reported physical activity data. Participants' PWC was assessed at the 14- and 17-year follow-ups to estimate their level of cardiovascular fitness. An eye examination, which included spectral-domain optical coherence tomography imaging, was conducted at the 20-year follow-up for 1344 participants.

RESULTS

Parent-reported or participant-reported physical activity was not associated with pRNFL thickness. However, higher PWC at 17 years was associated with thicker pRNFL globally [by 0.3 µm; 95% confidence interval (CI)=0.2-0.6; P<0.001], superotemporally (by 0.4 µm; 95% CI=0.1-0.7; P=0.013), inferonasally (by 0.7 µm; 95% CI=0.1-0.9; P=0.002), and nasally (by 0.4 µm; 95% CI=0.1-0.7; P=0.006) per 10 Watt increase in PWC.

CONCLUSIONS

The association between estimated cardiovascular fitness and pRNFL thickness suggests there may be overlapping mechanisms for cardiovascular health and retinal ganglion cell integrity. While the effect sizes were small, it is possible that larger effects and clinically significant associations may arise as we follow this cohort of participants through their later adulthood.

Association between Allergic Rhinitis and Regular Physical Activity in Adults: A Nationwide Cross-Sectional Study

Evidence regarding the association between allergic rhinitis (AR) and physical activity (PA) is conflicting. Previous studies have mostly relied only on self-reported symptoms to define AR, did not classify AR by severity or persistence, and included only children or athletes. The present cross-sectional study evaluated the association between PA and objectively-defined AR and its subtypes in the general adult population using data for 1932 eligible participants aged 19 years or older in the 2010 Korea National Health and Nutrition Examination Survey. Multivariable logistic regression analyses were performed to evaluate the relationship between three types of PA and overall AR, AR subtypes, and rhinoscopy findings showed that moderate-severe AR was positively associated with vigorous (odds ratio [OR] = 3.392, p = 0.002) and moderate (OR = 3.623, p = 0.007) PA compared to mild AR, while persistent AR was associated with vigorous (OR = 3.954, p = 0.004) and moderate (OR = 3.411, p = 0.022) PA compared to intermittent AR. On rhinoscopy, vigorous PA was significantly associated with watery rhinorrhea (OR = 2.203, p = 0.048) but not pale mucosa. Total immunoglobulin E (IgE) and three allergen-specific IgE were not significantly elevated in participants who performed PA. Therefore, regular vigorous PA is associated with subjective and objective aggravation of AR symptoms, which may not necessarily manifest as increased serum IgE levels.

Evening exercise is associated with lower odds of visual field progression in Chinese patients with primary open angle glaucoma

Background

Exercise is widely known to lower intraocular pressure and increase ocular blood flow, which may be beneficial for glaucoma management. However, there are few studies that have reported on the relationship between exercise and glaucoma progression. The aim of our study was to investigate the exercise habits of those with primary open angle glaucoma (POAG) and its association with the progression of visual field (VF) loss.

Methods

Daily physical activity (PA) was monitored by an accelerometer (ActiGraph wGT3x-BT) which patients wore for more than 10 h of being awake on their right wrists for 1 week.

Results

Seventy-one non-progressive and 27 progressive patients were enrolled in the study. 24-h moderate to vigorous physical activity (MVPA) exercise showed that POAG patients had similar variation trends consisting of 3 wave peaks and 2 wave hollows. Minutes spent in MVPA was 19.89 ± 15.81 and 21.62 ± 15.10 during 07:00–09:00 h (p = 0.204), 15.40 ± 14.49 and 15.67 ± 12.43 during 15:00–17:00 h (p = 0.822) and 17.26 ± 21.11 and 11.42 ± 11.58 during 18:00–20:00 h (p = 0.001) in the non-progressive and progressive group, respectively. Univariate analysis indicated that 10 min of MVPA (18:00–20:00 h) [odds ratio, OR (95% CI) = 0.82 (0.73, 0.92)], average mean arterial pressure [OR (95% CI) = 0.96 (0.94, 0.98)], age [OR (95% CI) = 1.06 (1.03, 1.08)], male [OR (95% CI) = 0.67 (0.48, 0.96)], spherical equivalent [OR (95% CI) = 1.14 (1.07, 1.22)] and IOP-lowering medications [OR (95% CI) = 1.54 (1.16, 2.05)] were significantly correlated with having progressive VF damage. Multivariable analysis showed that 10 min of MVPA (18:00–20:00 h) [OR (95% CI) = 0.85 (0.75, 0.97)] was associated with progressive VF loss even after adjusting for other risk factors.

Conclusions

Evening exercise may lower the odds of VF progression, suggesting that exercise habits possibly play an important role in glaucoma progression.

Lactate: More Than Merely a Metabolic Waste Product in the Inner Retina

The retina is an extension of the central nervous system and has been considered to be a simplified, more tractable and accessible version of the brain for a variety of neuroscience investigations. The optic nerve displays changes in response to underlying neurodegenerative diseases, such as stroke, multiple sclerosis, and Alzheimer's disease, as well as inner retinal neurodegenerative disease, e.g., glaucoma. Neurodegeneration has increasingly been linked to dysfunctional energy metabolism or conditions in which the energy supply does not meet the demand. Likewise, increasing lactate levels have been correlated with conditions consisting of unbalanced energy supply and demand, such as ischemia-associated diseases or excessive exercise. Lactate has thus been acknowledged as a metabolic waste product in organs with high energy metabolism. However, in the past decade, numerous beneficial roles of lactate have been revealed in the central nervous system. In this context, lactate has been identified as a valuable energy substrate, protecting against glutamate excitotoxicity and ischemia, as well as having signaling properties which regulate cellular functions. The present review aims to summarize and discuss protective roles of lactate in various model systems (in vitro, ex vivo, and in vivo) reflecting the inner retina focusing on lactate metabolism and signaling in inner retinal homeostasis and disease.

The Association Between Body Mass Index and Open-angle Glaucoma in a South Korean Population-based Sample

PURPOSE

The purpose of this article is to investigate the association between body mass index (BMI) and open-angle glaucoma (OAG) in a sample of the South Korean population.

MATERIALS AND METHODS

The sample consisted of a cross-sectional, population-based sample of 10,978 participants, 40 years of age and older, enrolled in the 2008 to 2011 Korean National Health and Nutrition Examination Survey. All participants had measured intraocular pressure <22 mm Hg and open anterior chamber angles. OAG was defined using disc and visual field criteria established by the International Society for Geographical and Epidemiological Ophthalmology. Multivariable analyses were performed to determine the association between BMI and OAG. These analyses were also performed in a sex-stratified and age-stratified manner.

RESULTS

After adjusting for potential confounding variables, lower BMI (<19 kg/m) was associated with greater risk of OAG compared with normal BMI (19 to 24.9 kg/m) [odds ratio (OR), 2.28; 95% confidence interval (CI), 1.22-4.26]. In sex-stratified analyses, low BMI remained adversely related to glaucoma in women (OR, 3.45; 95% CI, 1.42-8.38) but not in men (OR, 1.72; 95% CI, 0.71-4.20). In age-stratified analyses, lower BMI was adversely related to glaucoma among subjects 40- to 49-year old (OR, 5.16; 95% CI, 1.86-14.36) but differences in glaucoma prevalence were not statistically significant between those with low versus normal BMI in other age strata.

CONCLUSIONS

Lower BMI was associated with increased odds of OAG in a sample of the South Korean population. Multivariate analysis revealed the association to be statistically significant in women and those in the youngest age stratum.

Exercise-Induced Changes in Ocular Blood Flow Parameters in Primary Open-Angle Glaucoma Patients

PURPOSE

To evaluate exercise-induced changes in ocular blood flow (OBF) parameters in primary open-angle glaucoma (POAG) patients.

METHODS

A prospective observational study was carried out, in which medically treated patients with POAG were enrolled. Following inclusion, all patients performed a 40-min cycloergometry in a standardized fashion. The following parameters were measured and compared immediately before and 1 and 30 min after the exercise: intraocular pressure (IOP; Goldman applanation tonometry), mean arterial pressure (MAP), ocular pulse amplitude (OPA; assessed by dynamic contour tonometry), and ocular perfusion pressure (OPP; 2/3 MAP - IOP). In addition, we investigated possible factors associated with OBF parameter changes immediately after exercise.

RESULTS

A total of 30 eyes (30 patients; mean age was 62.9 ± 1.7 years) were included. Most patients were women (53%), and median visual field mean deviation index was -3.5 dB. Both MAP (mean change, 21%) and IOP (mean change, 17.3%) increased significantly immediately after the workout (p < 0.01), persisting higher than baseline following 30 min (p < 0.01%). Regarding OBF parameters, both OPA (mean change, 58.8%) and OPP (mean change, 21.7%) increased significantly immediately after the workout and persisted higher than baseline 30 min after the workout (p < 0.01). Regression analysis revealed that only age was significantly associated with OPA variation (R2 0.14; p < 0.05). No significant associations were found for OPP (p ≥ 0.19).

CONCLUSION

Aerobic exercise leads to a significant short-time increase in OBF parameters in patients with POAG. Even though IOP seems to present a modest elevation, it is accompanied by a significant increase in MAP, leading to higher OBF measurements. Exercise-induced short-term changes and its possible implications for glaucoma prognosis deserve further investigation.

Physical activity and eye diseases. The Beijing Eye Study

PURPOSE

To assess associations between the amount of physical activity and the prevalence of ocular diseases.

METHODS

The participants of the population-based Beijing Eye Study underwent a detailed ophthalmological examination and an interview. Physical activity was assessed in a standardized questionnaire.

RESULTS

Out of 3468 study participants, information on their physical activity was available for 3031 (87.4%) individuals (age: 64.6 ± 9.7 years; range: 50-93 years). In multivariate analysis (regression coefficient r: 0.41), higher physical activity was associated with a lower prevalence of diabetic retinopathy [p = 0.009; standardized regression coefficient beta: -0.05; non-standardized regression coefficient B: -15.7; 95% confidence interval (CI): -27.6, -3.90] after adjusting for younger age, rural region of habitation, lower level of education, lower blood concentrations of triglycerides and low-density lipoproteins and higher blood concentrations of high-density lipoproteins, higher systolic blood pressure, lower body mass index and lower depression score. Other major ocular diseases such as open-angle glaucoma (p = 0.25), angle-closure glaucoma (p = 0.59), nuclear cataract (p = 0.78), cortical cataract (p = 0.54), posterior subcapsular cataract (p = 0.96), retinal vein occlusions (p = 0.93) and central serous choroidopathy (p = 0.39) were not statistically associated with physical activity in that model. The association between higher physical activity and prevalence of age-related macular degeneration (p = 0.04; β: 0.04; B: 4.87; 95% CI: 0.25, 9.50) was marginally significant.

CONCLUSIONS

Higher physical activity and less sedentary lifestyle were associated with a lower prevalence of diabetic retinopathy, while the occurrence of other major ocular diseases such as any type of cataract and of glaucoma, retinal vein occlusions and central serous choroidopathy was statistically independent of physical activity or a more sedentary lifestyle.

Effect of a maximal treadmill test on intraocular pressure and ocular perfusion pressure: The mediating role of fitness level

Objectives:

We compared the impact of a maximal treadmill test on intraocular pressure and ocular perfusion pressure between trained and untrained individuals.

Methods:

Based on the maximal aerobic capacity (relative VO2 max), 31 military helicopter pilots were divided into groups of trained (n = 16; VO2 max = 57.06 ± 1.66) and untrained (n = 15; VO2 max = 43.42 ± 1.19) individuals. Intraocular pressure and blood pressure were collected before effort, just after volitional exhaustion and after 5 and 15 min of recovery.

Results:

The maximal treadmill test induced significant changes on intraocular pressure (p < 0.001, η2 = 0.52) and ocular perfusion pressure (p < 0.001, η2 = 0.60). Intraocular pressure and ocular perfusion pressure increased just after volitional exhaustion (effect size = 0.88 and 1.59, respectively), and these values returned to baseline levels after 5 (effect size = 0.87 and 1.26, respectively) and 15 (effect size = 1.23 and 1.91, respectively) min of recovery. The untrained group exhibited higher intraocular pressure and ocular perfusion pressure values in comparison with the trained group just after volitional exhaustion (effect size = 1.43 and 0.11 for intraocular pressure and effect size = 2.81 and 0.96 for ocular perfusion pressure). Five minutes of recovery was insufficient to reach baseline intraocular pressure and ocular perfusion pressure values only for the untrained group (effect size = 0.91 and 0.72, respectively).

Conclusion:

Our findings reveal that fitness level modulates the intraocular pressure and ocular perfusion pressure responses to a maximal treadmill test, being high fitness levels desirable in order to attenuate the impact of maximal efforts on these indices. These outcomes may be of clinical relevance for the management of glaucoma patients or those at risk, although future studies are needed to test these results in a clinical population.

Relationship of lifestyle, exercise, and nutrition with glaucoma

PURPOSE OF REVIEW

Although reducing the intraocular pressure (IOP) through medications, laser or surgery remains the primary means of glaucoma treatment, there is increasing evidence during the last decade that environmentally modifiable factors may help to prevent glaucoma or its progression through different mechanisms that may or may not involve lowering IOP. Additionally, patients are increasingly interested in maintaining a healthy lifestyle and taking an active role in the management of their disease. Therefore, the aim of this review is to summarize the current evidence regarding environmentally modifiable factors such as lifestyle, exercise, and nutrition in the pathogenesis of glaucoma.

RECENT FINDINGS

In the last decade, large population-based studies have helped to identify possible environmentally modifiable protective and risk factors with regard to glaucomatous disease. Smoking cessation; moderate aerobic exercise; recommended weight; and a balanced diet including green leafy vegetables, omega fatty-acids, and moderate intake of hot tea and coffee have been reported to be possibly protective against developing glaucoma or its progression.

SUMMARY

Modifiable environmental factors such as lifestyle, exercise, and nutrition may play a role in glaucoma pathogenesis. Large prospective studies with long-term follow-up should be encouraged to corroborate these findings, which may guide future treatments for our patients, some of which may not be limited to IOP reduction.

Fitness Level Modulates Intraocular Pressure Responses to Strength Exercises

Purpose/Aim: The execution of strength exercises has demonstrated to increase the intraocular pressure (IOP) levels, and it may have a negative impact on the ocular health. We aimed to explore the influence of fitness level on the acute IOP response to strength exercises performed under different loading conditions, as well as to test whether the IOP responses differ between the bench press and jump squat when performed against the same relative loads.

MATERIALS AND METHODS

Forty military personnel males were divided in two subgroups (20 high-fit and 20 low-fit) based on their relative to body mass one-repetition maximum (1-RM). Participants performed an incremental loading test in the bench press and jump squat exercises, and IOP was assessed before and after each repetition by rebound tonometry.

RESULTS

IOP increased immediately after executing both exercises (p < 0.01 in both cases), being the magnitude of the IOP increment positively and linearly associated with the increment of the load in both groups (i.e., high-fit and low-fit) and in both exercises (R² range: 0.81-1.00). Higher fitness level attenuated the IOP rise produced by both exercises (p < 0.01 in both cases). The bench press induced higher IOP increments than the jump squat for both groups at relative loads of ~50%1-RM and ~60%1-RM (p < 0.01 in all cases).

CONCLUSIONS

These data indicate that IOP increases as a consequence of performing strength exercises, being the increment accentuated with the increase of the load and in the bench press compared to the jump squat exercise. Of special importance would be that the IOP responses were significantly reduced in high-fit individuals. These findings should be addressed in glaucoma patients.

Muscular Strength Is Associated with Higher Intraocular Pressure in Physically Active Males

SIGNIFICANCE

The positive association between intraocular pressure (IOP) and relative maximum force may have relevance for exercise recommendations when IOP is a concern.

PURPOSE

The relationship between exercise and IOP has been approached in several studies. However, the influence of muscle function on IOP remains underexplored. This study aimed to determine the relationship between the maximal mechanical capabilities of muscles to generate force, velocity, and power with IOP.

METHODS

Sixty-five physically active males participated in this cross-sectional study. Baseline IOP measures were obtained by rebound tonometry, and participants performed an incremental loading test in the ballistic bench press.

RESULTS

Baseline IOP showed a strong positive correlation with relative maximum force (r65 = 0.85, P < .001) relative maximum power (r65 = 0.85, P < .001), and relative one-repetition maximum (r65 = 0.91, P < .001). Also, a moderate positive association was obtained between baseline IOP and maximum force (r65 = 0.74, P < .001), maximum power (r65 = 0.72, P < .001), and maximum dynamic strength (r65 = 0.80, P < .001). No significant correlations between IOP and maximal velocity were obtained (all P > .05).

CONCLUSIONS

There is a positive association between greater upper-body power and strength with higher baseline IOP, which might have important implications in the management of ocular health and especially in individuals constantly involved in resistance training programs (e.g., military personnel, weightlifters). The possible protective effect of high fitness level on the acute IOP response to strength exercise needs to be addressed in future studies.