Lifestyle and Glaucoma
Having a diagnosis of glaucoma can be daunting and many patients want to know what they can do to help themselves in their glaucoma journey.
Currently, lowering your intraocular pressure is the only management that is shown to slow the progression of glaucoma. There are thing you can do that may help glaucoma. People with glaucoma can generally continue to do the things they love. However, those with more advanced glaucoma should consider limiting some activities and consult with their ophthalmologist with any queries:
If you go swimming, it’s best to wear larger goggles, because smaller ones press on the orbit of the eye which increases eye pressure. It is even more important to wear larger swimming goggles if you have had eye surgery, especially a trabeculectomy as smaller goggles may press on the bleb. There is no proof that any of these worsen glaucoma. Larger snorkelling-type goggles are safer with less impact on eye pressure and should be worn in preference to smaller ones. However, repeated use of goggles has not been proven to be a risk for glaucoma.
Yoga and Glaucoma
The inverted position in yoga has been associated with significant increases in intraocular pressure and could lead to worsening of glaucoma. As a precautionary measure, while more research is being done, it is probably best for yoga enthusiasts with glaucoma to avoid headstand positions during their routines.
Some wind instruments, e.g. bagpipes, trumpet, trombone, are associated with increasing pressure around the face and upper airways – this causes raised IOP and can be harmful in glaucoma. These should be used with caution among people with glaucoma (especially advanced glaucoma)
IOP can almost double within 20 seconds when playing a wind instrument but returns to baseline almost immediately.
Aerobic Exercise and Glaucoma
Aerobic exercise (walking, jogging or cycling) lowers IOP, even after 5 minutes. This reduction is greater with longer duration and higher intensity exercise. Exercise may have more IOP lowering effect in individuals with glaucoma. This reduction of IOP with exercise is additive to the effect of glaucoma drops.
Once regular exercise is established (for at least 3 months), this IOP lowering effect continues for up to 3 weeks after cessation of exercise. Physically fit individuals have a lower baseline IOP and get much less additional lowering of IOP with exercise. Marathon runners have the lowest intraocular pressure, as a group.
There is one group that should be cautious: in individuals with pigment dispersion syndrome or pigmentary glaucoma, pigment dispersion during aerobic exercise may lead to increased IOP
Note: aerobic exercise differs from weight lifting, which may increase IOP.
Blood Pressure and Glaucoma
High Blood Pressure
Untreated systemic hypertension is associated with glaucoma. This is not a direct association, rather indirect, possibly due to high blood pressure damaging the blood vessels to the optic nerve over time. It is recommended that high blood pressure is treated.
NB: High blood pressure is not correlated with high eye pressure.
Low Blood Pressure
Some glaucoma patients have progressive visual field loss despite adequately controlled IOP. One possible cause is excessive lowering of blood pressure, in patients on BP medications who may be over-medicated. 24-hour blood pressure monitoring can detect this.
Excessive Water Drinking
A significant rise in IOP may occur after drinking a high volume of water (500mL to 1L) over a short time period (15minutes). Glaucoma patients should avoid ingesting large volumes of fluid rapidly.
Caffeinated coffee is known to elevate IOP. It seems safer to ingest caffeine in moderation – no more than 2 cups of coffee a day.
Alcohol may lower IOP initially, but daily alcohol causes a slight elevation in IOP. We recommend moderation.
One study showed that foods with antioxidant properties may reduce the risk of glaucoma. These foods include:
- Green collards and kales once/month
- Two servings of carrots/week
- Canned or dried peaches each week
We would recommend a balanced diet with five fruits and vegetables a day, trying to include the above.
- Dietary – A diet high in omega-6 and possibly omega-3 oils may reduce the risk of glaucoma.
- Medical lowering of cholesterol
Use of a cholesterol lowering medication (statin or non-statin) for more than 24 months has been shown to reduce the risk of glaucoma.
High Body Mass Index (BMI) and Obesity
Being overweight is associated with high IOP, but there is conflicting evidence about the association with glaucoma. A high BMI is associated with sleep apnoea.
Sleep apnoea syndrome (SAS) is associated with glaucoma. SAS is the repetitive collapse of the airway during sleep. Due to the poor quality of sleep, patients have chronic fatigue, daytime sleepiness and reduced cognitive function. People are more at risk for SAS if they are male, obese, snore, drink excessive alcohol, and smoke.
Current smoking is possibly related to glaucoma risk. No study has found an association between glaucoma and past history of smoking.