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GLAUCOMA AND LIFESTYLE

 

Lifestyle Adjustments may reduce the risk of glaucoma

 

Lifestyle-Exercise

Currently, lowering the intraocular pressure is the only management that is shown to slow the progression of glaucoma.

Is there anything that we can do that may help glaucoma?

Possible modifiable risk factors:

Aerobic Exercise Lowers Intraocular Pressure (IOP)

Aerobic exercise (walking, jogging or cycling) lowers IOP, even after 5 minutes. This reduction is greater with longer duration and higher intensity. It may have more effect in individuals with glaucoma.

Once regular exercise is established (for at least 3 months), this IOP lowering effect continues for up to 3 weeks after cessation of exercise. Physically fit individuals have a lower baseline IOP, and get much less additional lowering of IOP with exercise.

Interestingly, this reduction with exercise is additive to the effect of any glaucoma drops.

Exercise also lowers blood pressure. (See below)

It must be remembered that in pigment dispersion, aerobic exercise may increase IOP when pigment is dispersed.

NB: aerobic exercise differs from weight lifting and yoga, which may increase IOP.

Antioxidants

Lifestyle-VegesOne study showed that foods with antioxidant properties may reduce the risk of glaucoma. These foods include:

  • Green collards and kales once/month
  • Two servings of carrots/week
  • Canned or dried peaches each week

We would recommend a balanced diet with five fruits and vegetables a day, trying to include the above.

Cholesterol

  • Dietary - A diet high in omega-6 and possibly omega-3 oils may reduce the risk of glaucoma.
  • Medical lowering of cholesterol

Use of a cholesterol lowering medication (statin or non-statin) for more than 24 months has been shown to reduce the risk of glaucoma.

High Body Mass Index (BMI) and Obesity

Being overweight is associated with high IOP, but there is conflicting evidence about the association with glaucoma. A high BMI is associated with sleep apnoea.

Sleep Apnoea

Sleep apnoea syndrome (SAS) is associated with glaucoma. SAS is the repetitive collapse of the airway during sleep. Due to the poor quality of sleep, patients have chronic fatigue, daytime sleepiness and reduced cognitive function. People are more at risk for SAS if they are male, obese, snore, drink excessive alcohol, and smoke.

Smoking

Current smoking is possibly related to glaucoma risk. No study has found an association between glaucoma and past history of smoking.

Excessive Water Drinking

A significant rise in IOP may occur after drinking a high volume of water (500mL to 1L) over a short time period (15minutes). Glaucoma patients should avoid ingesting large volumes of fluid rapidly.

Coffee

Caffeinated coffee is known to elevate IOP. It seems safer to ingest caffeine in moderation – no more than 2 cups of coffee a day.

Alcohol

Alcohol may lower IOP initially, but daily alcohol causes a slight elevation in IOP. We recommend moderation.

High Blood Pressure

Untreated systemic hypertension is associated with glaucoma. This is not a direct association, rather indirect, possibly due to high blood pressure damaging the blood vessels to the optic nerve over time. It is recommended that high blood pressure is treated.

NB: High blood pressure is not correlated with high eye pressure.

Low Blood Pressure

Some glaucoma patients have progressive visual field loss despite adequately controlled IOP. One possible cause is excessive lowering of blood pressure, in patients on BP medications who may be over-medicated. 24-hour blood pressure monitoring can detect this.

Increasing Intraorbital Pressure – Playing Wind Instruments

IOP can almost double within 20 seconds when playing a wind instrument, but returns to baseline almost immediately.

Yoga

The inverted position in yoga has been associated with significant increases in intraocular pressure in some people and could lead to worsening of glaucoma.

Summary

Several lifestyle factors affect IOP, but there are no studies confirm whether these changes influence glaucoma progression. However, there is significant evidence that these lifestyle changes are good for general health, and they seem unlikely to cause more glaucomatous damage. Hence, with the current information available, we recommend them.

 

Modifiable Risk Factors

  1. Exercise regularly = MOST IMPORTANT
  2. Eat FIVE fruits / vegetables per day (especially carrots, greens and peaches)
  3. Omega-6 +/- omega-3 are good
  4. Lower your cholesterol
  5. Keep weight in healthy range
  6. If you snore, exclude sleep apnoea
  7. Stop smoking
  8. Do not drink over 200ml in 15 minutes
  9. Reduce coffee intake
  10. Drink alcohol in moderation
  11. Maintain a healthy blood pressure
  12. AVOID: Lifting heavy weights
  13. AVOID: Playing wind instruments
  14. AVOID: Head-down yoga positions
Lifestyle-Peaches

 

Glaucoma and Air Travel

Air travel rarely has any effect on intraocular pressure (IOP). Because the air pressure within the cabin is carefully regulated as the plane ascends and descends, there is little change in eye pressure.

Lifestyle-Air-Travel

However air travel does affect the volume of gases in the air. This may be of relevance to those who have recently had retinal surgery. At the time of surgery, a gas bubble is placed in the eye to help keep the retina in place. The bubble is usually present for 6-8 weeks. Changes in altitude may cause the gas bubble to expand and cause increased IOP. So those people who have had a gas bubble inserted during retinal surgery are usually advised to avoid air travel for the following couple of months.

In contrast, gas bubbles are not used for glaucoma surgery, so people with glaucoma usually do not have air travel restrictions after surgery. However, it is always best to consult with your eye doctor before travelling, especially after any kind of eye surgery.

Because air in the cabin can become dry, artificial tears may be helpful for use when flying, especially on a long flight. Carry your glaucoma medication onboard with you. This will prevent any missed doses associated with delays, lengthy flights, or lost luggage. Also, make sure the bottle caps are tightly sealed to prevent leakage.

Happy travelling.


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