Practicing mindfulness meditation is a way patients can deal with the stress of a glaucoma diagnosis; but new research is suggesting that it can have a direct impact on ocular tissues and help to decrease intraocular pressures (IOP). The study also shows its association with changes in trabecular meshwork (TM) gene expression. 

Stress can cause a rise in endogenous cortisol levels, the investigators explain. This can lead to an increase in IOP. Stressors — such as the threat of vision loss, lifelong treatment, side-effects of medications, and high healthcare costs — can follow the diagnosis itself.

The research, published in the American Journal of Ophthalmology, asks: If practicing mindful meditation, defined as a “set of contemplative practices aimed at balancing mental and emotional wellbeing by employing mindfulness (conscious awareness) and directed attention,” can reduce stress, can it decrease IOP as well? 

To find out, the investigators sought to specifically evaluate the effects of mindfulness meditation on IOP and TM gene expression in patients with medically uncontrolled primary open-angle glaucoma (POAG).


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A total of 60 participants were included in the study at a tertiary eye care center in India. All were diagnosed with moderate to advanced POAG, were 40 years of age or older with best corrected visual acuity (BCVA) of greater than 20/200 on Snellen’s visual acuity chart, had a chronically elevated IOP above 21 mm Hg on maximal topical medication, and were scheduled for trabeculectomy.  Individuals already practicing yoga or meditation were excluded from the study. 

The participants were randomly separated into 2 groups. Group 1 (30 participants) underwent 3 weeks of 45 minutes daily mindfulness meditation in addition to medical therapy while group 2 (30 participants) continued medical therapy only. The investigators checking the IOP and performing gene expression studies were masked to the mindfulness meditation intervention.

The primary outcome was change in IOP (ΔIOP) after 3 weeks of mindfulness meditation. Secondary outcomes included the probability of success defined as final IOP. The researchers noted a significant decrease in IOP in group 1 (20.16 mm Hg ± 3.3 mm Hg to 15.05 mm Hg ± 2.4 mm Hg, P =.001), as compared with group 2 (21.2 mm Hg± 5.6 mm Hg to 20.0 ± 5.8 mm Hg, P =.38) after 3 weeks. 

Also, in group 1, ΔIOP was significantly higher than in group 2 (5.0 mm Hg ± 1.80 mm Hg vs 0.20 mm Hg ± 3.03 mm Hg, P =.001). Gene expression analysis revealed significant upregulation of nitric oxide synthetase (1 and 3) and neuroprotective genes with downregulation of proinflammatory genes in group 1 in comparison with group 2 (P =.001).

“The epigenetic evidence suggests that environmental factors (nutrition, stress, thoughts, etc.) control the binding of regulatory proteins to DNA and thus modify gene expression. Changes in perception or stress reduction due to meditation can potentially alter the cell biology and positively regulate TM gene expression.”

Also, at the 3 week mark, group 1 saw a significant decrease in the diurnal variation of IOP (4.07 mm Hg ± 1.3 mm Hg to 2.95 mm Hg ± 1.75 mm Hg, P =.006) compared with group 2 (4.5 mm Hg ± 2.17 mm Hg to 4.38 mm Hg ± 2.3 mm Hg, P =.83). Participants’ quality of life was measured using the glaucoma quality of life questionnaire (GQL-15), which ranks disability caused by glaucoma on a scale from 1 (less difficult) to 5 (most difficult). Researchers noted a significant decrease in GQL-15 scores for group 1 (64.08 ± 4.56 to 40.05 ± 5.11, P =.0001) in comparison with group 2 (65.66 ± 5.65 to 64.23 ± 4.43, P =.661), suggesting an improved quality of life in glaucoma patients after 3 weeks of mindfulness meditation.

Mindfulness meditation, “can modify the course of glaucoma by several mechanisms,” the researchers explain. These mechanisms include “direct effect on IOP, decreasing endogenous cortisol, decreased inflammation and oxidative stress, improved blood flow-oxygenation of the brain, upregulating neurotrophins such as brain-derived neurotrophic factor and direct impact on central and autonomic nervous system.”

The study suggests that stress management strategies should be incorporated into treatment plans for glaucoma patients. Limitations include the study’s small sample size and the uncertain nature of the study group’s compliance and replication of the same at-home medication practice in the absence of expert supervision.

Reference

Dada T, Bhai N, Midha N, et al. Effect of mindfulness meditation on intraocular pressure and trabecular meshwork gene expression: a randomised controlled trialAmJ Ophthalmol. Published October 22, 2020. doi: 10.1016/j.ajo.2020.10.012