This article was authored by: Dr. Eileen Javidi, MD, Dr. Georges Durr, MD FRCSC and Dr. Younes Agoumi, MD FRCSC. The PRC Committee wish to acknowledge Félix Plamondon from the University of Laval for their initiative and contribution.

Patients suffering from glaucoma often seek advice on lifestyle changes such as exercise, diet, and other habits that may help them preserve their vision alongside conventional treatments. Although new research is emerging and our understanding of the complex pathophysiology of glaucoma is continuously growing, the relationship between lifestyle habits and glaucoma progression remains to be fully elucidated. This page aims to provide a clear and concise summary of the scientific data currently available, offering guidance for ophthalmologists when counseling their patients on lifestyle changes for glaucoma.

Exercise

Physical activity may be associated with slower rates of visual field loss in patients with glaucoma.¹ Aerobic exercise, beyond its benefits for cardiovascular health, has also been shown to reduce IOP significantly. This effect is greater in previously sedentary people than in those who are already physically active.² When a regular exercise regimen is adopted by previously sedentary individuals, IOP reduction may be sustained for longer periods of time (several weeks).³

Other studies have shown that strength training may increase IOP, particularly when holding one’s breath (Valsalva maneuver) while performing a weight-lifting exercise.⁴ On the other hand, some studies have found that resistance training may slightly decrease IOP in the minutes that follow the exercise.⁵ Since extensive research is still lacking, it may be safer to counsel patients to limit their resistance training to low or moderate intensities, to make sure to breathe out during the exercise and to avoid weigh- lifting altogether in moderate to advanced glaucoma.

Yoga, when practiced vigilantly through exercises involving relaxation and breathing techniques and while making sure to keep the head above the heart, appears to be safe and may even reduce IOP.⁶ However, glaucoma patients must be strongly advised to avoid handstands and head-down positions, as these are known to acutely increase IOP, up to doubling it.^7,8

Sleep

IOP is higher during sleep and in the supine position, increasing to a greater extent in patients with glaucoma and more advanced disease.⁹ It is also higher in lateral decubitus in the dependent eye,¹⁰ and when sleeping face down with contact with a pillow.¹¹ These effects may be mitigated by avoiding sleeping face down or on the side, and by adding a wedge pillow to elevate the head by 30 degrees.¹²

Diet and Supplements

Coffee increases IOP immediately after consumption,¹³ but the data on its long-term impact on IOP and risk of glaucoma remains conflicting. Caffeine consumption may be associated with an increased risk of developing glaucoma in individuals with family history of glaucoma, but no association has been found in those without family history.¹⁴ It seems reasonable for most patients to consume moderate amounts of caffeine, but greater intakes should be discouraged, particularly in those with high IOP, severe glaucoma and a positive family history.¹⁵

Ginkgo biloba extract has gained attention for its potential antioxidant and neuroprotective effects, and benefits on blood circulation. However, current data is inconclusive regarding effects on IOP and visual field progression in glaucoma.¹⁶

Smoking

A large retrospective study has shown that being a current or past smoker is associated with elevated IOP. This association is even greater in glaucoma patients.¹⁷

Marijuana

Marijuana has been discussed as a potential alternative treatment for glaucoma, as it reduces IOP for three to four hours following its consumption by inhalation. However, maintaining adequate IOP control using marijuana would require near-continuous use; therefore, using marijuana for controlling glaucoma is highly ill-advised given its numerous cognitive, respiratory, and other adverse effects such as impairment in functioning.¹⁸

Meditation

Mindfulness meditation has been found to lower IOP and can be used as adjuvant treatment to medical therapy for IOP control in glaucoma.^19-21

References

1.         Lee MJ, Wang JX, Friedman DS, Boland MV, De Moraes CG, Ramulu PY. Greater Physical Activity Is Associated with Slower Visual Field Loss in Glaucoma. Ophthalmology. Jul 2019;126(7):958-964. doi:10.1016/j.ophtha.2018.10.012

2.         Roddy G, Curnier D, Ellemberg D. Reductions in Intraocular Pressure After Acute Aerobic Exercise: A Meta-Analysis. Clin J Sport Med. Sep 2014;24(5):364-372.

3.         Passo MS, Goldberg L, Elliot DL, Van Buskirk EM. Exercise training reduces intraocular pressure among subjects suspected of having glaucoma. Arch Ophthalmol. Aug 1991;109(8):1096-8. doi:10.1001/archopht.1991.01080080056027

4.         Vieira GM, Oliveira HB, de Andrade DT, Bottaro M, Ritch R. Intraocular pressure variation during weight lifting. Arch Ophthalmol. Sep 2006;124(9):1251-4. doi:10.1001/archopht.124.9.1251

5.         Chromiak JA, Abadie BR, Braswell RA, Koh YS, Chilek DR. Resistance training exercises acutely reduce intraocular pressure in physically active men and women. J Strength Cond Res. Nov 2003;17(4):715-720.

6.         Chetry D, Singh J, Chhetri A, Katiyar VK, Singh DS. Effect of yoga on intra-ocular pressure in patients with glaucoma: A systematic review and meta-analysis. Indian J Ophthalmol. May 2023;71(5):1757-+. doi:10.4103/ijo.IJO_2054_22

7.         Baskaran M, Raman K, Ramani KK, Roy J, Vijaya L, Badrinath SS. Intraocular pressure changes and ocular biometry during Sirsasana (headstand posture) in yoga practitioners. Ophthalmology. Aug 2006;113(8):1327-1332. doi:10.1016/j.ophtha.2006.02.063

8.         Jasien JV, De Moraes GV, Ritch R. Rise of Intraocular Pressure in Subjects With and Without Glaucoma during Four Common Yoga Positions. Invest Ophth Vis Sci. Apr 2014;55(13)

9.         Prata TS, De Moraes CGV, Kanadani FN, Ritch R, Paranhos A. Posture-induced Intraocular Pressure Changes: Considerations Regarding Body Position in Glaucoma Patients. Survey of Ophthalmology. Sep-Oct 2010;55(5):445-453. doi:10.1016/j.survophthal.2009.12.002

10.       Lee TE, Yoo C, Lin SC, Kim YY. Effect of Different Head Positions in Lateral Decubitus Posture on Intraocular Pressure in Treated Patients With Open-Angle Glaucoma. Am J Ophthalmol. Nov 2015;160(5):929-936 e4. doi:10.1016/j.ajo.2015.07.030

11.       Flatau A, Solano F, Idrees S, et al. Measured Changes in Limbal Strain During Simulated Sleep in Face Down Position Using an Instrumented Contact Lens in Healthy Adults and Adults With Glaucoma. JAMA Ophthalmol. Apr 2016;134(4):375-82. doi:10.1001/jamaophthalmol.2015.5667

12.       Buys YM, Alasbali T, Jin YP, et al. Effect of Sleeping in a Head-Up Position on Intraocular Pressure in Patients with Glaucoma. Ophthalmology. Jul 2010;117(7):1348-1351. doi:10.1016/j.ophtha.2009.11.015

13.       Higginbotham EJ, Kilimanjaro HA, Wilensky JT, Batenhorst RL, Hermann D. The effect of caffeine on intraocular pressure in glaucoma patients. Ophthalmology. May 1989;96(5):624-6. doi:10.1016/s0161-6420(89)32852-1

14.       Kim J, Aschard H, Kang JH, et al. Intraocular Pressure, Glaucoma, and Dietary Caffeine Consumption: A Gene-Diet Interaction Study from the UK Biobank. Ophthalmology. Jun 2021;128(6):866-876. doi:10.1016/j.ophtha.2020.12.009

15.       Kang JH, Willett WC, Rosner BA, Hankinson SE, Pasquale LR. Caffeine consumption and the risk of primary open-angle glaucoma: a prospective cohort study. Invest Ophthalmol Vis Sci. May 2008;49(5):1924-31. doi:10.1167/iovs.07-1425

16.       Kang JM, Lin S. Ginkgo biloba and its potential role in glaucoma. Curr Opin Ophthalmol. Mar 2018;29(2):116-120. doi:10.1097/ICU.0000000000000459

17.       Lee CS, Owen JP, Yanagihara RT, et al. Smoking Is Associated with Higher Intraocular Pressure Regardless of Glaucoma

®. Ophthalmol Glaucoma. Jul-Aug 2020;3(4):253-261. doi:10.1016/j.ogla.2020.03.008

18.       Green K. Marijuana smoking vs cannabinoids for glaucoma therapy. Arch Ophthalmol-Chic. Nov 1998;116(11):1433-1437. doi:DOI 10.1001/archopht.116.11.1433

19.       Abdelaal A, Fouda MF, Elmallahy M, et al. The Efficacy of Mindfulness Meditation in Medically-Treated Glaucoma. Invest Ophth Vis Sci. Jun 2023;64(8)

20.       Dada T, Mittal D, Mohanty K, et al. Mindfulness Meditation Reduces Intraocular Pressure, Lowers Stress Biomarkers and Modulates Gene Expression in Glaucoma: A Randomized Controlled Trial. J Glaucoma. Dec 2018;27(12):1061-1067. doi:10.1097/Ijg.0000000000001088

21.       Dada T, Mondal S, Midha N, et al. Effect of Mindfulness-Based Stress Reduction on Intraocular Pressure in Patients With Ocular Hypertension: A Randomized Control Trial. American Journal of Ophthalmology. Jul 2022;239:66-73. doi:10.1016/j.ajo.2022.01.017