In the news: Mindfulness Meditation Lowers IOP & Impacts Ocular Tissue

Mindfulness Meditation Lowers IOP in Glaucoma

Many glaucoma patients have high levels of anxiety and depression with poor psychosocial functioning and stress due to anticipated vision loss. This stressful state may be a contributing factor to the worsening of the disease. Stress, for example, can cause a rise in endogenous cortisol level which can in turn lead to an increase in IOP.

A new prospective randomized controlled study(1) from the All India Institute of Medical Sciences indicates that a short course of stress reduction through mindfulness meditation in glaucoma patients significantly reduces intraocular pressure (IOP) and appears to have a direct impact on ocular tissues.

Methods

The study included sixty POAG patients with IOP > 21 mmHg receiving maximal topical medication and scheduled for trabeculectomy. Thirty of the patients received 3 weeks of mindfulness meditation (45 minutes daily) in addition to their routine medical therapy, while the remaining 30 patients continued on medical therapy only.

The primary outcome was change in IOP after 3 weeks of mindfulness mediation. Secondary outcomes were probability of success, percentage reduction in IOP, effect on diurnal variation of IOP, change in quality of life and changes in gene expression pattern in the trabecular meshwork.

Results

At the end of 3 weeks, a significant decrease in IOP was seen in the meditation group (20.16 ± 3.3 to 15.05 ±2.4 mmHg, P = 0.001), compared to the non-meditation group (21.2 ± 5.6 to 20.0 ± 5.8 mmHg, P = 0.38).

The change in IOP was significantly higher in the meditators than non-meditators (5.0 ± 1.80 versus 0.20 ± 3.03 mmHg, P = 0.001).

Gene expression analysis of trabecular meshwork tissue samples revealed significant upregulation of nitric oxide synthetase (1 and 3) and neuro-protective genes with downregulation of pro-inflammatory genes in meditators vs. nonmeditators (P = 0.001).

A significant decrease in diurnal variation in IOP (4.07 ± 1.3 to 2.95 ±1.75 mmHg) was seen at 3 weeks in meditators (P = 0.006) compared to the nonmeditation group (4.5 ± 2.17 to 4.38 ± 2.3 mmHg, P = 0.83). There was a significant difference between the two groups at 3 weeks (P = 0.001).

There was also a significant improvement in the glaucoma-specific quality of life questionnaire score after 3 weeks of meditation (P = 0.0001).

Comments

Though the study was small and short in duration, the results are promising: mindful meditation was effective in significantly lowering IOP in POAG patients with a concomitant reduction in diurnal fluctuation of IOP. Eyes that underwent trabeculectomy after the mindful meditation course also had better outcomes in the early post-operative period as compared to the control group.

The changes in gene expression patterns in the trabecular meshwork reflect that the meditation practice positively affected cellular mechanisms involved in glaucoma pathogenesis through both IOP-dependent and independent mechanisms.

Mindfulness meditation is simply observing the breath by focusing attention on the natural relaxed flow of air going in and out of the body. In the study, it was directed by a certified yoga instructor. As glaucoma patients face anxiety – likely exacerbated by the current pandemic – online mindfulness mediation may be just what the doctor ordered.

References

1. Mindfulness meditation is simply observing the breath by focusing attention on the natural relaxed flow of air going in and out of the body. In the study, it was directed by a certified yoga instructor. As glaucoma patients face anxiety – likely exacerbated by the current pandemic – online mindfulness mediation may be just what the doctor ordered.