Relationship of Lifestyle, Exercise, and Nutrition With Glaucoma

Claudio I. Perez; Kuldev Singh; Shan Lin

Disclosures

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

In This Article

Exercise

Regular physical activity has numerous benefits to general health. It has been shown that aerobic exercise decreases IOP,[46] whereas isometric exercise such as weightlifting and selected yoga postures can cause transient IOP elevation by increasing intrathoracic pressure, which may cause glaucomatous damage in vulnerable study participants.[47,48] Regarding an association between exercise and glaucoma prevalence, a population-based study showed a U-shaped association for male study participants, in whom low and high levels of intensity during exercise was associated with a greater glaucoma prevalence compared to moderate intensity exercise as recommended in the American College of Sports Medicine (ACSM) guidelines.[49] In addition, daily vigorous exercise was associated with a higher prevalence of glaucoma as compared with similar intensity exercise performed 3 days per week.[49] Exhaustive exercise has been related to accumulation of free radicals producing structural damage or inflammatory reactions within muscle tissue, which may explain those findings, as oxidative stress plays a role in glaucomatous disease. Also it has been reported that healthy study participants with a high fitness level are able to reduce IOP spikes in response to strength exercise in comparison with study participants with a low fitness level.[50] A recent longitudinal study also demonstrated that study participants who performed more than 150 min of moderate-intensity exercise a week showed a lower incidence of glaucoma in comparison with study participants that did not exercise.[51] A small retrospective study showed in 24 patients with POAG or pseudoexfoliative glaucoma that patients who performed at least 30 min of exercise per week had less glaucomatous visual field progression than patients who did not perform exercise.[52] Of course, larger prospective studies are needed to corroborate those findings. Patients with pigment dispersion syndrome or pigmentary glaucoma need to be warned about the possibility of IOP spikes during aerobic exercise. The use of swimming goggles is considered safe in the healthy population,[53] although it has the potential to elevate IOP and produce disturbances in the ocular hemodynamics, which could lead to further damage in patients with established glaucoma.[54] The IOP elevation with swimming goggles was associated with a larger orbital rim area and with a greater goggle elastic force.[54]

The effects of exercise on neuroprotection and the mental health of patients with glaucoma are also intriguing. In animal models, exercise has been shown to upregulate brain-derived neurotrophic factor and to enhance mitochondrial function, reducing retinal oxidative stress, which might be effective in preventing vision loss caused by retinal ganglion cell death from glaucoma.[55,56] Finally, anxiety and depression, which are common among patients with glaucoma, can be potentially alleviated with physical exercise, thus improving the quality of life of these patients with chronic disease.

Therefore, moderate intensity exercise, ideally 3 days per week may be suggested to our patients to improve their general health, to potentially decrease the odds of glaucoma risk in healthy study participants. Once again, it is noteworthy that while the overall health benefits of exercise are undeniable, the benefit in terms of glaucoma risk is not well established enough to provide specific recommendations with confidence.

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