Chat Highlights
Glaucoma and Stress
January 31, 2001

Norma Devine, Editor

On Wednesday, January 31, 2001, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Glaucoma and Stress." 

Moderator:  Doctor,  what is stress?

Dr. Wilson:  All my patients feel that stress raises their IOP (intraocular pressure). Unfortunately, stress is such a subjective thing that it's hard to quantify and investigate.

P:  Doesn't blood pressure rise during stress?

Dr. Wilson:  Yes. 

P:  Is it true that high blood pressure actually helps to keep the intraocular pressure lower?

Dr. Wilson:  No.  In the short term,  high blood pressure pushes blood into the eye against the eye pressure and provides a slightly protective effect.  However, high blood pressure over the longer term causes changes in the blood vessels themselves that counteract the good effects. If medications are then added to lower blood pressure to normal, the blood flow to the eye may be reduced from normal because of the chronic changes that have already occurred.

P:  If stress can raise blood pressure, then can stress raise IOPs?

Dr. Wilson:  Yes.

P:  If you are anxious every time you get your pressure checked, as I am,  and your heart is pounding, could that give you a higher reading?

Dr. Wilson:  Yes, but a sudden rise in IOP only raises the eye pressure for several minutes.  Then auto-regulatory mechanisms in the eye reduce the blood pressure in the eye and the eye pressure to normal.  High blood pressure causes a rise in IOP over the course of at least two years,  according to a Johns Hopkins' study.

P:  Do any of the eye drops used for glaucoma cause blood pressure to increase or decrease?  

Dr. Wilson:  Timolol lowers blood pressure.  Epinephrine, Propine, and possibly Alphagan may cause the blood pressure to rise.

P:  I read in a book on glaucoma that glaucoma is a disease of stress.

P:  Having this disease seems to cause a lot of us stress.

P:   If some people think stress can cause glaucoma, then why do babies and young children get glaucoma?  

Dr. Wilson:  I know glaucoma causes stress in the patients it afflicts, but I do not believe it plays a major role in the causation of glaucoma. 

P:  Isn't just about every disease today a disease of stress?

Dr. Wilson:  I think stress is a part of daily life.  Exercise, having friends and family to discuss your problems with and get emotional support from, having pets, and a realistic approach to life all can limit the harmful effects of stress on your lives.  Do any of you have particularly effective ways of dealing with stress?

P:  Yes, transcendental meditation.

P:  I find that taking a brisk walk helps me, if it is possible to walk when I feel stressed.

P:  Playing the piano or organ.

P:  Regular aerobic exercise.

Moderator:  Playing golf in season.

P:  Faith and prayer.

P:  Is it safe for glaucoma patients to take saunas?  Are there contraindications?  I have exfoliating glaucoma and had a trabeculectomy.  I heard that saunas lower systemic blood pressure.  

Dr. Wilson:  As far as I know,  if you are systemically healthy, a sauna should not affect your glaucoma unless your blood pressure drops too much.

P:  Do you mean systemic blood pressure or intraocular pressure? It would be difficult to tell with the IOP.

Dr. Wilson:   Systemic blood pressure.

P:  Are there any links to glaucoma and the immune system?

Dr. Wilson:  One cause of  Normal Tension Glaucoma is thought to be an autoimmune disease.  

P:  Isn't it difficult to design studies to discover the role, if any, of  stress, exercise and other aspects of life style, in glaucoma?   Moreover, no one stands to profit from such studies.  Do they exist?

Dr. Wilson:  No good ones exist concerning stress.   There have been studies about exercise lowering eye pressure, and certainly about improving general conditioning and blood flow.

P:  What kind of exercising specifically helps and how frequently?

Dr. Wilson:  Twenty minutes of aerobic exercise four times a week.  Repeat:  four times a week.  Three times a week did not work. 

P:  How about sex as a reliever of stress?

Dr. Wilson:  A recent study showed that men who had sex twice a week lived longer than those who didn't have it, or who had it four times a week or more.

P:  So if you have sex more than four times a week you are an early goner!

P:  It amazes me that the study about frequency of sex and life span was done with men.  Was anybody else in the room?  In their lives?  If men died sooner from no sex, presumably, maybe the women died even sooner.  Or much later.  That study sounds like it began so long ago -- before women's suffrage.

P:  We are relieving stress here, everyone.

P:  Yes, we are.  I always feel better after these chats.

On February 7, Dr. Rapuano discussed "Dry Eyes and Cornea Problems" in the Chat room. Click here for highlights of that meeting.

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