Chat Highlights
Healthy Lifestyles and Glaucoma
March 7, 2001

Norma Devine, Editor

On Wednesday, March 7, 2001, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Healthy Lifestyles and Glaucoma." 

Moderator:  Tonight's topic is "Healthy Lifestyles and Glaucoma."

P:  What constitutes a healthy lifestyle for people with  glaucoma?

Dr. Wilson:  Exercise, lean and fit lifestyle, no hypertension, and good nutrition.  Within the last six months, the Japanese have demonstrated that obesity is a risk factor.

P:  There are conflicting opinions about ginkgo biloba.  Some say it is good for blood circulation in the brain and eyes; others say it causes retinal bleeding.  What do you think?  

Dr. Wilson:  The answer still isn't in.  At the moment, I don't recommend it.

P:  Are there any supplements you recommend for good nutrition? 

Dr. Wilson:  I suggest 400 IU of  vitamin E, a multivitamin, 500 units of Vitamin C and possibly an aspirin, in conjunction with your doctor's advice.

P:   It's frustrating because I exercise, have 120/85 blood pressure, cholesterol of 145, but I'm still losing vision.  I will be the healthiest guy with a white cane in my neighborhood.

P:  Last week I mentioned  a small magnesium study.  Any thoughts on that mineral and glaucoma? 

Dr. Wilson:  There has been a hint that zinc may be helpful, but I don't know anything about magnesium.

P:  I have just started an exercise and healthy eating plan. It will be interesting to see at my next checkup if my pressures come down from the low 20's in both eyes.  

Dr. Wilson:  Exercise will probably bring the intraocular pressure (IOP) down only by a point or two, unless there is the need for a weight loss and it is achieved.  

P:  Please give an example of a beneficial amount of exercise.

Dr. Wilson:  By exercise I mean 20 minutes or more of aerobic exercise at least four times a week.

P:  Are there any blood pressure medications that we should avoid?  

Dr. Wilson:  The beta blockers may be a problem for patients with normal-tension glaucoma (NTG), if the beta blockers cause the blood pressure to drop too low at night.

P:  I seem to remember my specialist saying that there are other blood pressure medications besides beta blockers that are now contraindicated for glaucoma patients.  Do you know of any?  

Dr. Wilson:  No, I don't.  Timoptic is a beta blocker, but  it is usually not used systemically.

P:  I have open-angle glaucoma and you advised me that a daytime blood pressure of  60/90 could be a problem while I was sleeping, and that I should be monitored. (Instead, I  raised the blood pressure to 120/70.)  But now you're suggesting that only NTG patients have nighttime blood pressure problems.  Or have I misunderstood you tonight?

Dr. Wilson:  NTG patients are the ones we usually worry about concerning blood pressure.

P:  I have pigmentary glaucoma and have read that jogging, etc., is not a good idea.  Is that correct?  

Dr. Wilson:  Impact exercises can cause pigment dispersion in the eye. It might be better to use an exercise bicycle, a treadmill, or a rowing machine.  

P:  Are there any risks to moderate weight-lifting for patients with either narrow-angle or open- angle glaucoma?  How about breathing? 

Dr. Wilson:  Weight training is probably fine.  I would not lie on my back with my legs up or be inverted off a bar or wear inversion boots.  Don't hold your breath when lifting weights.

P:  Why would lying on the back and lifting weights with the legs be detrimental for glaucoma patients? 

Dr. Wilson:  It only takes a few minutes to elevate IOP with the legs up.  Raising the legs allows gravity to pull the blood down into the body, elevating the blood pressure in the veins around the eye.  The aqueous fluid drains through the trabecular meshwork into the aqueous veins and venous blood system of the body.  If the blood pressure in the veins is high, the eye can't drain, and the IOP goes up.

P:  How much difference is there in IOP when sitting and when lying down with the legs elevated?  

Dr. Wilson:  In a person with a normal IOP, the IOP would be 15 mm Hg in a sitting position, 16.5 mm Hg lying down, 24 mm Hg with the legs elevated 30 degrees, and 36 mm Hg with the legs elevated 70 degrees.  

P:  When my legs are up while exercising, does the IOP drop quickly after I stop?  

Dr. Wilson:  Yes.  

P:  Should I be concerned about the pressure spikes? 

Dr. Wilson:  Maybe.   

P:  Would that indicate that we should sleep with our heads at least slightly elevated?

Dr. Wilson:  Only if you have NTG.   

P:  I have NTG and had never thought about the elevation problem.

Dr. Wilson:  Factors other than IOP seem to be at work in NTG.  

P:   I walk a minimum of  twenty minutes about five times a week.  Is that aerobic exercise? 

Dr. Wilson:  Yes, if  you walk fast and get your heart rate up to 100 beats or more per minute.  Any exercise, however, is better than none. 

Moderator:  Are there activities besides impact exercise that glaucoma patients should avoid, such as bowling, scuba diving, mountain climbing?  

Dr. Wilson:  Impact exercises are only a problem if you have pigment dispersion syndrome.  Scuba diving is fine unless you have a thin bleb from a trabeculectomy.  Most other exercise is excellent.

P:  It seems normal for blood pressure to drop while sleeping.  Is there any way to help moderate that effect, such as eating or not eating or exercising before bedtime? 

Dr. Wilson:  Eating salt tablets before bedtime can raise blood pressure in susceptible patients.  I would not use them unless you have had 24 hour blood pressure monitoring that showed a serious drop in blood pressure, usually between 2 and 4 A.M.  

P:  What about alcohol?   It lowers IOP, doesn't it?  

Dr. Wilson:  Alcohol may cause a dilation of the vessels to the nerve.  It may also cause a drop in blood pressure that would counterbalance any good the dilation did.

P:   Can eyestrain affect IOP?  When I use the computer quite a bit my eyes feel irritated by evening. 

Dr. Wilson:   The eyestrain you mention sounds like dry eyes, because you are concentrating so hard you don't blink your eyes enough to keep them moist, although it could be caused by the close work.  If anything, it helps glaucoma to look at something up close.  

P:  It seems that good lifestyles for glaucoma are the same as for the heart:  exercise, a low-fat diet, proper nutrition and supplements.  Bad lifestyles include being overweight, drinking too much alcohol, smoking, and not seeing your ophthalmologist.  

Dr. Wilson:  You're seeing the pattern there.  The heart and the eyes do much better (as does your brain) with a good blood supply.

On March 14, Dr. Wilson discussed "Systemic Effects of Glaucoma Meds" in the Chat room. Click here for highlights of that meeting.

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