Can Glaucoma be managed with lifestyle changes?
Mr Tariq Ayoub - 9 Mar 2021
Conventional treatments for glaucoma include eye drops, laser treatment and surgery. But can glaucoma be managed with lifestyle changes? This article identifies multiple lifestyle areas with potential roles in disease.
Glaucoma is an eye disease characterised by optic nerve damage associated with intraocular pressure (eye pressure) and visual field changes. Usually the changes are insidious and can lead to loss of vision if not treated appropriately. Reducing eye pressure continues to be the mainstay of glaucoma treatment and cannot be substituted for any other form of treatment.
Lifestyle modifications are less likely to have a significant impact on glaucoma as it is usually difficult to measure the effects of these lifestyle changes for a variety of reasons. However, some studies have demonstrated that lifestyle changes can have some impact on the progression of glaucoma.
Recommendations on diet are difficult due to reliance on self-reporting and the lack of prospective studies available. Despite the beneficial role of antioxidants in glaucoma, a prospective study on the intake of carotenoids, vitamin C, and vitamin E showed no effect on glaucoma. However, foods high in dietary nitrates such as leafy and dark green plants may have a beneficial effect on glaucoma.
The effects of Omega fatty acids on glaucoma show a possible benefit with omega-3 fatty acids. One study found a lower risk of glaucoma in those who consumed a high amount of omega-3 fatty acids. The same study found an increased risk of glaucoma in patients with high intakes of polyunsaturated fatty acids. Although additional studies are needed, it is reasonable to have a diet high in omega-3 fatty acids and to limit your total consumption of polyunsaturated fatty acids.
Ginkgo biloba extract (GBE) has been shown to have some potential neuroprotective and blood flow effects on the optic nerve. Although, larger clinical trials are needed, GBE supplementation may have a positive effect, especially in normal-tension glaucoma.
Aerobic exercise has been shown to reduce baseline eye pressure by nearly 5mmHg. This reduction in pressure is proportionally related to duration and intensity of exercise. Although IOP reduction after intense exercise is short-lived, sedentary individuals who achieve some degree of physical fitness can have sustained IOP reduction that persists for several weeks after exercise cessation.
Conversely, heavy weight lifting has been shown to do the opposite. Holding your breath while exerting yourself (called the Valsalva maneouver) can increase eye pressure. The clinical significance of this is unclear. However, it may be better to use low weights with more repetitions of lifting than heavy weights which make you grunt!
A study on yoga practitioners showed a significant increase in eye pressure with any head down position that can double after a few minutes if the position is maintained. As such, it would be wiser to avoid any positions where your head is lower than your heart, especially if you have progressive or advanced glaucoma.
Some studies have shown that sleeping in the lateral decubitus position (lying sideways) increases eye pressure in the dependent eye – the eye closest to the pillow. Sleeping in the head-down position has also been shown to increase eye pressure. Lying on your back with the head elevated may be a better position to sleep in and avoid sleeping on your sides, especially in asymmetric glaucoma.
Playing musical instruments which require holding your breath (Valsalva manoeuvre) can increase eye pressure. One study showed a greater chance of developing glaucoma in symphonic wind players. If you do play wind instruments then it may be wise to have a glaucoma assessment.
Smoking marijuana can lower eye pressure. However, its short duration of action (3-4 hours), side-effect profile and lack of evidence that it alters the progression of glaucoma makes long-term therapy unreasonable.
Caffeine and alcohol intake
Caffeine has been shown to elevate eye pressure by approximately 1 mm Hg for at least 90 minutes after consumption. Although small to moderate amounts of caffeine is reasonable, you should avoid heavy consumption.
The effects of alcohol on glaucoma are less clear and further studies are required to elucidate a relationship between the two.
Blood pressure control
The importance of maintaining stable blood pressure for general health and improving cardiovascular risk is well known. However, low blood pressure at night has been linked to the progression of glaucoma, especially normal-tension glaucoma. Given this, it is important to avoid evening dosing of blood pressure medications, especially in progressive glaucoma. If you have progressive glaucoma, it is advisable to maintain a blood pressure chart and monitor your blood pressure in the evenings.
Many people assume that ‘using your eyes’ can worsen your glaucoma. Reading, watching TV or using your phone or computer does not have any impact on your glaucoma.
As mentioned previously, early detection and regular monitoring are important in managing glaucoma. Anyone above the age of 40 should have a glaucoma assessment every eighteen months that should include a pressure check and nerve assessment.