Relationship of Lifestyle, Exercise, and Nutrition With Glaucoma

Claudio I. Perez; Kuldev Singh; Shan Lin


Curr Opin Ophthalmol. 2019;30(2):82-88. 

In This Article


Caffeine (1,3,7-trimethylxanthine) is a common ingredient in several beverages such as coffee, tea, and colas. A regular cup of coffee (236 mL) contains 135–150 mg of caffeine. It has been shown that one cup of coffee is able to raise the IOP approximately 1 mmHg and increase ocular perfusion pressure by about 1.25–1.5 mmHg.[35] Nevertheless, the 106 study eyes included five eyes which demonstrated an increase in IOP more than 2 mmHg and a decrease in the ocular perfusion pressure of more than 5 mmHg. These findings suggest that coffee consumption should not have a significant clinical impact in the majority of the patients with POAG, but there could be significant changes in a small number of patients.[35] A large prospective study showed that caffeine did not increase the risk of POAG, although in a secondary analysis the authors found that a greater caffeine intake appeared to elevate the risk of high-tension POAG among those with a family history of glaucoma.[36] In the same cohort of patients, caffeine intake was linked with the development of pseudoexfoliation glaucoma but not with normal-tension glaucoma, which may be plausible because coffee intake increases plasma and aqueous homocysteine levels that have been shown to be elevated in exfoliative syndrome.[37] A recent population-based study showed that caffeinated coffee did not increase or decrease the risk of POAG.[38] On the other hand, there are in-vitro and in-vivo studies in animal models that have shown a protective effect of the chlorogenic acid present in coffee, which prevents hypoxia-related retinal degeneration and glutamate neurotoxicity.[39] Also, caffeine has been postulated to have a beneficial effect with decrease in neuroinflammation and reduction in retinal ganglion cell loss.[40] These hypothetical benefits may correlate with caffeine's positive findings evaluated in other fields of medicine, such as in preterm infants, in which the use of caffeine to treat apnea has been shown to be associated with decreased risk of neurological impairment.[41] It is also noteworthy that coffee drinking has been associated with a decrease in mortality in the adult population.[42] Therefore, glaucoma patients may be encouraged to maintain their coffee habits if done in moderation. Nevertheless, patients who have progression of their disease and are heavy coffee drinkers could be advised to decrease their amount of coffee intake because of the risk of IOP spikes and decrease in the ocular perfusion pressure.