Pressure In Glaucoma Research Articles

Profiling the miRNA from Exosomes of Non-Pigmented Ciliary Epithelium-Derived Identifies Key Gene Targets Relevant to Primary Open-Angle Glaucoma.

Oxidative stress (OS) on tissues is a major pathological insult leading to elevated intraocular pressure (IOP) and primary open-angle glaucoma (POAG). Aqueous humor (AH) produced by the non-pigmentary ciliary epithelium (NPCE) drains out via the trabecular meshwork (TM) outflow pathway in the anterior chamber. The exosomes are major constituents of AH, and exosomes can modulate the signaling events, as well as the responses of their target TM tissue. Despite the presence of molecular mechanisms to negate OS, oxidative damage directly, as well as indirectly, influences TM health, AH drainage, and IOP. We proposed that the expression of microRNA (miRNAs) carried by exosomes in the AH can be affected by OS, and this can modulate the pathways in target cells. To assess this, we subjected NPCE to acute and chronic OS (A-OS and C-OS), enriched miRNAs, performed miRNA microarray chip analyses, and miRNA-based gene targeting pathway prediction analysis. We found that various miRNA families, including miR27, miR199, miR23, miR130b, and miR200, changed significantly. Based on pathway prediction analysis, we found that these miRNAs can regulate the genes including Nrf2, Keap1, GSK3B, and serine/threonine-protein phosphatase2A (PP2A). We propose that OS on the NPCE exosomal miRNA cargo can modulate the functionality of the TM tissue.

Sustained release of brimonidine from polydimethylsiloxane-coating silicone rubber implant to reduce intraocular pressure in glaucoma.

Glaucoma is the leading cause of irreversible blindness, affecting 111 million people by 2040 worldwide. Intraocular pressure (IOP) is the only controllable risk factor for the disease and current treatment options seek to reduce IOP via daily taking eye drops. However, shortcomings of eye drops, such as poor bioavailability and unsatisfied therapeutic effects, may lead to inadequate patient compliance. In this study, an effective brimonidine (BRI)-loaded silicone rubber (SR) implant coated with polydimethylsiloxane (BRI@SR@PDMS) is designed and fully investigated for IOP reduction treatment. The in vitro BRI release from BRI@SR@PDMS implant reveals a more sustainable trend lasting over 1 month, with a gradually declined immediate drug concentration. The carrier materials show no cytotoxicity on human corneal epithelial cells and mice corneal epithelial cells in vitro. After administrated into rabbit's conjunctival sac, the BRI@SR@PDMS implant releases BRI in a sustained fashion and effectively reduces IOP for 18 days with great biosafety. In contrast, BRI eye drops only maintain IOP-lowering effect for 6 h. Therefore, as a substitute of eye drops, the BRI@SR@PDMS implant can be applied as a promising non-invasive platform to achieve long-term IOP-lowering in patients suffering from ocular hypertension or glaucoma.

Blood Pressure Measures and Incident Primary Open-Angle Glaucoma.

To investigate the association of systemic blood pressure and incident primary open-angle glaucoma (POAG) using a large open-access database. Prospective cohort study included 484,268 participants from the UK Biobank without glaucoma at enrollment. Incident POAG events were recorded through assessment visits, hospital inpatient admissions, and primary care data. Blood pressure measures included systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP). Repeated measurements throughout the study period were analyzed as time-varying covariables. The parameters were modeled as both categorical and continuous nonlinear variables. The primary outcome measure was the relative hazard of incident POAG. There were 2390 incident POAG events over 5,715,480 person-years of follow-up. Median follow-up was 12.08 years. In multivariable analyses, compared to SBP and PP in the normal range (SBP, 120-130 mmHg; PP, 40-50 mmHg), higher SBP and PP were associated with an increased risk of incident POAG (linear trend P = 0.038 for SBP, P < 0.001 for PP). Specifically, SBP of 130 to 140 mmHg or 140 to 150 mmHg was associated with a 1.16 higher hazard of incident POAG (95% CI, 1.01-1.32 and 1.01-1.33, respectively), whereas a PP of greater than 70 mmHg was associated with a 1.13 higher hazard of incident glaucoma (95% CI, 1.00-1.29). In multivariable models, no statistically significant associations were found for DBP or MAP with incident glaucoma. These findings were similar when blood pressure measures were modeled as continuous variables. Higher SBP and PP were associated with an increased risk of incident POAG. Further studies are required to characterize these relationships better.

Müller‐retinal ganglion cell interactions

AbstractGlaucoma is a neurodegenerative disease and the leading cause of irreversible blindness in the world, whose main risk factor is increased intraocular pressure. When visual problems are first detected in patients with glaucoma, already half of the retinal ganglion cells (RGCs), the neurons that send visual information from the eye to the brain, have died principally in the peripheral retina. The timeframe of cell death is prolonged, lasting even decades after an initial diagnosis. Müller glia (MG) are the main macroglial cell in the retina, play prominent roles regulating normal and pathological physiology and react to neuronal injury in glaucoma. The change to a reactive phenotype of MG initiates signalling cascades that may serve a neuroprotective role but may also proceed to promote damaging effects on RGCs. However, the underlying mechanisms and signalling pathways that specifically promote protective versus destructive roles of reactive glial cells are mostly unclear.Our main hypothesis is that MGs exert an important role in the death of RGCs in glaucoma with the MGs in the periphery being the most sensitive to intraocular pressure, promoting the death of RGCs. Preventing MG response to elevated pressure, MG can neuroprotect RGCs in early stages of glaucoma.We have proved in vitro, that in control condition MG secret neuroprotective factors, and under elevated pressure MG are the responsible for the RGCs death, being less sensitive to the elevated hydrostatic pressure (EHP) the MG present in the central retina. Moreover, stretch‐activated nonselective TRPV4 cation channels present in MG are differently activated by the pressure depending on their location within the retina. Proteomic analysis from the conditioned media (CM) of MG revealed different protein expression levels being more pronounced in the CM from MG from peripheral retina in EHP. Proteins identified correspond mainly to functions such as: apoptosis, oxidative stress, inflammation and angiogenesis.We conclude that the different sensibility of the RGCs to pressure in glaucoma could be related with the different activation of the neighbours MG.Supported by ELKARTEK (KK‐2019/00086), MINECO‐Retos (PID2019‐111139RB‐I00) and PIBA (2020_1_0026).

Implication of Müller glia in glaucoma

AbstractGlaucoma is a neurodegenerative disease and the leading cause of irreversible blindness in the world, whose main risk factor is increased intraocular pressure. When visual problems are first detected in patients with glaucoma, already half of the retinal ganglion cells (RGCs), the neurons that send visual information from the eye to the brain, have died principally in the peripheral retina. The timeframe of cell death is prolonged, lasting even decades after an initial diagnosis. Müller glia (MG) are the main macroglial cell in the retina, play prominent roles regulating normal and pathological physiology and react to neuronal injury in glaucoma. The change to a reactive phenotype of MG initiates signalling cascades that may serve a neuroprotective role, but may also proceed to promote damaging effects on RGCs. However, the underlying mechanisms and signalling pathways that specifically promote protective versus destructive roles of reactive glial cells are mostly unclear.Our main hypothesis is that MGs exert an important role in the death of RGCs in glaucoma with the MGs in the periphery being the most sensitive to intraocular pressure, promoting the death of RGCs. Preventing MG response to elevated pressure, MG can neuroprotect RGCs in early stages of glaucoma.We have proved in vitro, that in control condition MG secret neuroprotective factors, and under elevated pressure MG are the responsible for the RGCs death, being less sensitive to the elevated hydrostatic pressure (EHP) the MG present in the central retina. Moreover, stretch‐activated nonselective TRPV4 cation channels present in MG are differently activated by the pressure depending of their location within the retina. Proteomic analysis from the conditioned media (CM) of MG revealed different protein expression levels being more pronounced in the CM from MG from peripheral retina in EHP. Proteins identified correspond mainly to functions such as: apoptosis, oxidative stress, inflammation and angiogenesis.We conclude that the different sensibility of the RGCs to pressure in glaucoma could be related with the different activation of the neighbours MG.

Nutraceuticals: A Promising Therapeutic Approach in Ophthalmology.

Oxidative stress represents one of the main factors driving the pathophysiology of multiple ophthalmic conditions including presbyopia, cataracts, dry eye disease (DED), glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy (DR). Currently, different studies have demonstrated the role of orally administered nutraceuticals in these diseases. For instance, they have demonstrated to improve lens accommodation in presbyopia, reduce protein aggregation in cataracts, ameliorate tear film stability, break up time, and tear production in dry eye, and participate in the avoidance of retinal neuronal damage and a decrease in intraocular pressure in glaucoma, contribute to the delayed progression of AMD, or in the prevention or treatment of neuronal death in diabetic retinopathy. In this review, we summarized the nutraceuticals which have presented a positive impact in ocular disorders, emphasizing the clinical assays. The characteristics of the different types of nutraceuticals are specified along with the nutraceutical concentration used to achieve a therapeutic outcome in ocular diseases.

Wireless theranostic smart contact lens for monitoring and control of intraocular pressure in glaucoma

Glaucoma is one of the irreversible ocular diseases that can cause vision loss in some serious cases. Although Triggerfish has been commercialized for monitoring intraocular pressure in glaucoma, there is no smart contact lens to monitor intraocular pressure and take appropriate drug treatment in response to the intraocular pressure levels. Here, we report a precisely integrated theranostic smart contact lens with a sensitive gold hollow nanowire based intraocular pressure sensor, a flexible drug delivery system, wireless power and communication systems and an application specific integrated circuit chip for both monitoring and control of intraocular pressure in glaucoma. The gold hollow nanowire based intraocular pressure sensor shows high ocular strain sensitivity, chemical stability and biocompatibility. Furthermore, the flexible drug delivery system can be used for on-demand delivery of timolol for intraocular pressure control. Taken together, the intraocular pressure levels can be successfully monitored and controlled by the theranostic smart contact lens in glaucoma induced rabbits. This theranostic smart contact lens would be harnessed as a futuristic personal healthcare platform for glaucoma and other ocular diseases.

Association of sleep behaviour and pattern with the risk of glaucoma: a prospective cohort study in the UK Biobank

ObjectivesGiven the role of intraocular pressure in glaucoma, the patient’s sleeping pattern might contribute to the development and progression of glaucoma. We performed a study to understand the association between...

Neovascular glaucoma in atypical central serous chorioretinopathy and pachychoroid disease

We report an atypical central serous chorioretinopathy (CSCR) with pachychoroid disease and consequent recalcitrant neovascular glaucoma (NVG). A 45-year-old man with persistent subretinal fluid, pachychoroid and bilateral large areas of capillary nonperfusion exudative detachment, and CSCR presented with raised intraocular pressure (IOP) and neovascular glaucoma. Failure after trabeculectomy with mitomycin-C mandated the implantation of Ahmed glaucoma valve followed by two epiconjunctival MMC applications over the AGV plate/bleb in the hypertensive phase. He was also started on 25 mg oral eplerenone twice a day for the first month, followed by 25 mg once a day over the next two months, followed by intravitreal bevacizumab injection. The retinal neovascularization regressed along with normalization of IOP at over eight months follow-up.

How can one learn to perform atrabeculectomy? : The Mainz treatment scheme

Trabeculectomy represents the glaucoma surgical procedure that achieves the greatest reduction in intraocular pressure and enables a low pressure regulation especially in normal pressure glaucoma. For the beginner the operation is challenging due to potential intraoperative and postoperative difficulties. With this in mind this article explains how to learn to perform atrabeculectomy and explains the various steps from assessing the indications via training, performing the surgery independently and follow-up care. The article points out the challenges during the procedure and the possible solutions and explains the individual aftercare using the Mainz treatment scheme as an example. In this way, the risk of serious complications can be reduced to aminimum and in the vast majority of patients asufficient regulation of intraocular pressure can be achieved without the need for eye drops.

Study to Identify and Evaluate Predictor Factors for Primary Open-Angle Glaucoma in Tertiary Prophylactic Actions.

The aim of this study is to develop a predictive model with several explanatory variables that can guide ophthalmologists to make a more objective assessment of the evolution of open-angle glaucoma (OAG) during tertiary prevention. Objectives: The evaluation of risk factors and different predictors of symptom progression between patients with POAG and non-glaucoma patients (NG), as well as between primary open-angle glaucoma with high intraocular pressure (POAG) and primary open-angle glaucoma with normal intraocular pressure (NTG), in tertiary prophylactic activities. Methods: This research is an analytical epidemiological study of a prospective cohort. For the study, we took into account personal medical history, physical ophthalmological examination, intraocular pressure (IOP) values, and visual field (VF) parameters, examined with the Opto AP-300 Automated Perimeter using the “fast threshold” strategy. The results of gonioscopy were inconsistently recorded; they were not considered in the study due to missing values, the processing of which would have seriously distorted the statistical analysis. Ophthalmological examination was completed with a dichotomous questionnaire entitled “Symptom Inventory”, made according to the accusations of patients resulting from a “focus group” study. The study was carried out in the ophthalmology office within the Integrated Outpatient Clinic of the Emergency Clinical Hospital of Oradea, Bihor County (IOCECHO) between January–December 2021. The threshold of statistical significance was defined for p value < 0.05. The obtained results were statistically processed with specialized software SPSS 22. Results: The study included 110 people, of which 71 (64.54%) had POAG (IOP > 21 mmHg) and 39 people (35.46%) had NTG (IOP < 21 mmHg), the two groups being statistically significantly different (χ2 = 9.309, df = 1, p = 0.002). For the POAG group, glaucomatous loss was early, AD < −6 dB, according to the staging of glaucomatous disease, HODAPP classification. In addition, the groups of POAG and NTG patients was compared with a group of 110 NG patients, these three groups being statistically significantly different (χ2 = 34.482, df = 2, p = 0.000). Analysis of confounding factors (age, sex, residence, marital status) shows a statistically significant relationship only for age (F = 2.381, df = 40, p = 0.000). Sex ratio for the study groups = 5.11 for OAG and =5.87 for NG. After treatment (prostaglandin analogues and neuroprotective drugs) IOP decreased statistically significantly for both POAG and NTG. Conclusions: this study identified possible predictors of OAG, at the 5% level (risk factors and symptoms as independent variables) using a dichotomous questionnaire tool with a complementary role in tertiary prophylactic activities. The implementation of the focus group interview results as a socio-human research technique will be supportive to clinicians.

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

Using optical coherence tomography angiography, we found an increase in the blood flow in regional macular without significant changes in the optic disk in patients with glaucoma after a moderate exercise regime. To investigate the effect of moderate exercise on optic nerve and macular perfusion in glaucoma patients. 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 (VD) in the superficial layer of macula, VDs in the radial peripapillary capillary 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. In the glaucoma group, macular superficial VD 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, and 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 VD in the temporal and nasal regions was higher 30 minutes after exercise (45.105±5.512 and 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±2.96mmHg for glaucoma and controls, respectively) but was restored after 30 minutes of rest (15.84±3.57mmHg for glaucoma and 16.50±2.25mmHg for controls) in both groups ( P <0.001). Cardiovascular parameters were similar in both groups. 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.

The Association of Female Reproductive Factors with Glaucoma and Related Traits: A Systematic Review

This systematic review summarizes evidence for associations between female reproductive factors (age at menarche, parity, oral contraceptive [OC] use, age at menopause, and postmenopausal hormone [PMH] use) and intraocular pressure (IOP) or open-angle glaucoma (OAG). Understanding the associations between female reproductive factors and glaucoma may shed light on the disease pathogenesis and aid clinical prediction and personalized treatment strategies. Importantly, some factors are modifiable, which may lead to new therapies. Two reviewers independently extracted articles in MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials databases to identify relevant studies. Eligibility criteria included studies with human subjects aged > 18 years; a measured outcome of either IOP or OAG; a cohort, case-control, cross-sectional, or randomized controlled trial design; a reported measure of association, such as the hazard ratio, relative risk, odds ratio, or mean difference, with an associated confidence interval; and a measured exposure of at least 1 of the following variables: age at menarche, parity, OC use, age at menopause, or PMH use. We included a total of 27 studies. Substantial differences in study designs, exposure and treatment levels, treatment durations, and variable reporting precluded a meaningful quantitative synthesis of the identified studies. Overall, relatively consistent associations between PMH use and a lower IOP were identified. Estrogen-only PMH use may be associated with lower OAG risk, which may be modified by race. No significant associations were found with combined estrogen-and-progesterone PMH use. No strong associations between parity or age at menarche and glaucoma were found, but a younger age at menopause was associated with an increased glaucoma risk, and adverse associations were identified with a longer duration of OC use, though no overall association with OC use was found. The association between PMH use and lower IOP or OAG risk is a potentially clinically relevant and modifiable risk factor and should be investigated further, although this needs to be interpreted in the context of a high risk of bias across included studies. Future research should examine associations with IOP specifically and how the relationship between genetic factors and OAG risks may be influenced by female reproductive factors.

Исследование макулярного кровотока сетчатки при глаукоме нормального давления

Purpose. To study the blood flow of the macular area of the retina in the superficial and deep choroid plexuses using the OCTA method in patients with newly diagnosed normal tension glaucoma. Material and methods. 29 patients (50 eyes) with newly diagnosed normal pressure glaucoma aged 45 to 65 years with initial (28.0 %), advanced (42 %) and advanced (30 %) stages of the disease were examined. Results and discussion. The OCTA method revealed changes in the indicators of microcirculation of the macular zone of the retina in the fovea and parafovea. The index of vessel density in patients with different stages of the disease was significantly reduced in the superficial and deep vascular plexuses and by sector in the eyes with different stages of the disease. Conclusion. In patients with normal tension glaucoma, according to OCTA data, microcirculation disorders of the macular area of the retina at the levels of the superficial and deep vascular plexuses were revealed, increasing with the progression of the disease. Keywords: normal pressure glaucoma, primary open angle glaucoma, optical coherence tomography with angiography, microcirculation.

Outcomes of combined single-use dual blade goniotomy and cataract surgery

PurposeSingle-use dual blade goniotomy (SBG) is a novel ab interno procedure that removes three to five clock hours of trabecular meshwork (TM). We analysed the reduction of intraocular pressure (IOP) and topical glaucoma medication (Meds) in eyes following combined cataract surgery and SBG (Cat-SBG).MethodsIOP and Meds were evaluated retrospectively in 55 eyes of 38 patients. 44 eyes had high tension glaucoma (HTG) and eleven eyes had normal tension glaucoma (NTG). Complete success (no Meds) and qualified success (with Meds) for IOP levels ≤ 21, ≤ 18 , ≤ 16 mmHg or ≥ 20% IOP reduction at the two- and six-month follow-up were evaluated.ResultsIOP and Meds were significantly reduced from before to two months after Cat-SBG in HTG- and NTG-patients (HTG: IOP 19.4 ± 3.3 to 15.1 ± 3.3 mmHg; p < 0.001; Meds 2.1 ± 1.3 to 0.8 ± 1.3; p < 0.001; NTG: IOP 14.0 ± 2.3 to 11.5 ± 2.3 mmHg; p = 0.004; Meds 1.6 ± 0.7 to 0.3 ± 0.7; p < 0.001). IOP and Meds did not change significantly from two to six months after Cat-SBG.In HTG, complete and qualified success rates were 43% (19/44) and 93% (41/44) for IOP ≤ 18 mmHg, 36% (16/44) and 64% (28/44) for IOP ≤ 16 mmHg and 30% (13/44) and 43% (19/44) for ≥ 20% IOP reduction six months after surgery. In NTG, complete and qualified success was 81% (9/11) and 100% (11/11) for IOP ≤ 18 and ≤ 16 mmHg, and 27% (3/11) for IOP reduction ≥ 20%.IOP and Meds reduction were comparable between HTG and NTG eyes.Only minor postoperative complications occurred.ConclusionCat-SBG is an efficient method to significantly lower IOP in patients with HTG and NTG.

Consanguinity Among Refractive Error, Intraocular Pressure and Etiology of Glaucoma in Diabetics Among Wheatish Population

The objective of this paper is to explore the connotation among refractive error, intraocular pressure (IOP), and primary open-angle glaucoma (POAG) among the Wheatish populace. Population-based studies give significant data with respect to the predominance and hazard factors which include refractive error for glaucoma. The connotation between myopia and glaucoma is robust at lower IOP levels and deteriorated slowly with increasing IOP. This study shows the relationship between IOP and glaucoma is solid at a lower mean value of 15 ±± 3.23 levels and debilitated progressively with expanding IOP of 17.59 ±± 3.33 for PACG, 18.85 ±± 1.20 for POAG, 18.59 ±± 2.52 for PIGM and 19.12 ±± 1.42 for OH among Wheatish population. The illustration of glaucoma in myopic eyes deteriorated with growing IOP and no association has been detected with IOP ≥≥35 mmHg.

Should mitral valve prolapse be considered as one of the risk factors for open angle glaucoma? A preliminary observation.

To assess the incidence of mitral valve prolapse in patients with newly diagnosed primary open angle glaucoma. The study included 12 patients without any other comorbidities or taking any general or local medications. Each patient underwent a full ophthalmological examination with visual field assessment and optical computed tomography of the macula and optic nerve head. Carotid Doppler ultrasound was performed to exclude impaired blood flow in this region and transthoracic echocardiography with assessment of the function and morphology of the heart valves. In the study group, mitral valve prolapse was found in seven patients (58.3%), while mitral valve regurgitation in 11 patients (91.7%). One case of normal pressure glaucoma and four cases of juvenile glaucoma were diagnosed. There were also other risk factors for glaucoma: myopia (58.3%), migraine headaches (41.7%), a positive family history of glaucoma (16.7%). Mitral valve prolapse could be indicated as a new risk factor for glaucoma. It seems reasonable to conduct screening tests for glaucoma in patients with mitral valve prolapse in the course of echocardiography.

Blood pressure control and glaucoma risk in postmenopausal women: an analysis from the Women's Health Initiative.

Individuals with elevated systolic blood pressure (BP) or low diastolic BP, whether or not on antihypertensive treatment, may be at higher risk for developing glaucoma. We aimed to investigate BP levels in relation to glaucoma risk in a large cohort of postmenopausal women. Prospective follow-up of 101,447 postmenopausal women without prior history of glaucoma enrolled in the Women's Health Initiative Study. BP was measured in-clinic at baseline and after 3 years using standardized procedures. Antihypertensive medication use was determined by drug inventory at baseline and year 3. Women self-reported incident newly diagnosed glaucoma annually. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazards analyses adjusting for demographic, medical history, and lifestyle covariates. During a mean follow-up of 4.7 years, we documented 7,514 glaucoma cases. Among women not on antihypertensive treatment, those with systolic BP ≥ 140 mm Hg or diastolic BP ≥80 mm Hg were not at higher risk of developing glaucoma (HR 0.97, 95% confidence intervals 0.88-1.08 and HR 1.00 [0.93-1.08], respectively), compared with women with a systolic BP < 120 mm Hg or a diastolic BP 60 to <80 mm Hg. Among women on antihypertensive treatment, neither systolic BP ≥ 140 mm Hg nor diastolic BP ≥80 mm Hg was associated with an increased glaucoma risk (HR 0.89 [0.79-1.00] and HR 0.97 [0.90-1.05], respectively). A diastolic BP <60 mm Hg was not associated with a higher risk compared with a diastolic BP 60 to <80 mm Hg. BP control is not associated with an increased or decreased glaucoma risk in postmenopausal women.

Effect of Tratak (Yogic Ocular Exercises) on Intraocular Pressure in Glaucoma: An RCT.

Introduction:In healthy subjects, the intraocular pressure (IOP) is maintained by a dynamic equilibrium between continuous production of aqueous humor by ciliary bodies and continuous outflow through the two drainage pathways: trabecular meshwork and uveoscleral outflow. Here, we hypothesized that yogic ocular exercises, including extraocular muscles exercise, and modified Tratak Kriya (mTK), might reduce the IOP as well as stress and improve quality of life (QoL) in patients with glaucoma.Methodology:A parallel two-arm randomized controlled trial (RCT) was conducted in glaucoma patients (Control group and Intervention group). Control group patients were on standard medical treatment and intervention group patients practiced a Yoga-based lifestyle intervention (YBLI) for 4 weeks as add-on therapy with their standard medical treatment. All Participants were assessed at baseline day 1, day 14 (D14), and day 28 (D28). A minimum of 30 patients were recruited in each group.Results:We did not observe any statistically significant different mean IOP of right (IOP-r) or, left eyes at any time point as well as cortisol level and QoL between the two groups. However, with in intervention group, there was a reduction in IOP-r at D14 (15.54 ± 2.81 mmHg) and D28 (15.24 ± 3.1 mmHg), P = 0.006 and 0.001, respectively, compared to their baseline IOP (16.26 ± 2.98).Conclusion:Based on the present RCT, yoga-based ocular exercises practiced here cannot be recommended for management of raised IOP in glaucoma patients. Further larger studies are warranted with yoga-based interventions in patients with glaucoma.Clinical Trial Registration Number:CTRI/2016/03/006703

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.