Beneficial effect of mindfulness based stress reduction on optic disc perfusion in primary open angle glaucoma: A randomized controlled trial

Abstract

Background and aim Glaucoma is one of the leading causes of visual impairment worldwide. Next to intraocular pressure (IOP), vascular factors play a major role in glaucoma. Mindfulness-based stress reduction (MBSR) has been shown to reduce the IOP, normalize the stress biomarkers, modulate gene expression, and also improve the quality of life. This study was aimed to assess the effect of MBSR in optic disc perfusion of patients with primary open angle glaucoma (POAG). Experimental procedure POAG patients with controlled IOP (<21 mmHg) were randomised in to intervention group (n = 30) and control group (n = 30). Both the groups continued their routine glaucoma medications while the intervention group practiced 45 min of MBSR every day in addition. IOP and optic disc perfusion using OCT-Angiography were recorded at baseline and at 6 weeks for both the groups. Results The mean age of the participants were 53.23 ± 8.4yr in intervention and 50.23 ± 7.3yr in the control group (p = 0.06). All the baseline parameters were comparable in both groups. After MBSR, in the intervention group there was a significant reduction of IOP (p=0.001), increase in circum-papillary vessel density in superior quadrant (15.8%–17.4%, p=0.02) and nasal quadrant (14.2%–16.5%, p=0.01), increase in circum papillary vascular perfusion, in superior quadrant (38.9%–41.1%, p<0.001), in temporal quadrant (42.2%–44.5%, p<0.001), in inferior quadrant (40.1%–43.8%, p<0.001), and in nasal quadrant (40.6%–42.8%, p<0.001). There was also a significant increase in Flux Index after 6weeks (0.38–0.40, p<0.001). Conclusion MBSR can reduce barotrauma and improve optic disc perfusion in POAG patients and serve as a useful adjunct to the standard medical therapy.

Daily Meditation Practice for Managing Glaucoma Patients’ Attitudes and Acceptance

“…Meditation can reduce intraocular pressure, increase blood flow to the optic nerve, increase quality of life, and possibly offer neuroprotective benefits for glaucoma patients 4,7–10…”

“…Meditation can reduce intraocular pressure, increase blood flow to the optic nerve, increase quality of life, and possibly offer neuroprotective benefits for glaucoma patients. 4,[7][8][9][10] The goal of this survey was to determine what proportion of glaucoma patients would agree to this alternative therapy, and commit 45-60 minutes to daily meditation practice. The patient cohort in our study consisted of English-speaking patients, with the majority being born in Australia (43%) but also a good representation of the European and Asian-born patients (22% and 23%, respectively).…”

“…In a similar study design, a drop in average IOP from 23.05 to 19.15 mm Hg was noted for ocular hypertension patients versus 22.55 to 22.37 mm Hg in the control group. 8 In addition to IOP lowering, increased optic disc perfusion has been measured on optical coherence tomography angiography following mindfulness meditation practice; 9 this may be particularly relevant in managing patients with normal tension glaucoma.…”

From bench to behaviour: The role of lifestyle factors on intraocular pressure, neuroprotection, and disease progression in glaucoma

“…32 Over two decades later, in a series of randomised controlled trials, Dada and colleagues demonstrated that patients with primary open-angle glaucoma engaging in a 45-min daily meditation sessions for 3-6 weeks resulted in significantly greater reductions in IOP, downregulation of proinflammatory genes, and upregulation of nitric oxide synthase and other neuroprotective genes; these changes all correlated with lower biomarker levels of stress, such as cortisol, IL6, and TNF-alpha. 29,30,35 Interestingly, the meditation group experienced an increase in BDNF, 36 which is also upregulated in exercise and is essential in maintaining RGC number and function (see Section 2). The researchers also noted that the group randomised to the mindfulness meditation intervention experienced increased optic disc perfusion, which could relate to the previously posited but understudied vascular hypothesis of stress in Wang and colleagues' aforementioned animal experiment.…”

“…Indeed, Kaluza and colleagues were the first to explore this hypothesis when they found that autogenic relaxation and exercises of imagination of ocular drainage resulted in significant reductions of IOP in glaucoma patients over 8 weeks; they even noted that over half of their intervention group were able to decrease their medication dosage by the end of the study 32 . Over two decades later, in a series of randomised controlled trials, Dada and colleagues demonstrated that patients with primary open‐angle glaucoma engaging in a 45‐min daily meditation sessions for 3–6 weeks resulted in significantly greater reductions in IOP, downregulation of proinflammatory genes, and upregulation of nitric oxide synthase and other neuroprotective genes; these changes all correlated with lower biomarker levels of stress, such as cortisol, IL6, and TNF‐alpha 29,30,35 . Interestingly, the meditation group experienced an increase in BDNF, 36 which is also upregulated in exercise and is essential in maintaining RGC number and function (see Section 2).…”