Chat Highlights
Exercise and Glaucoma
October 3, 2001

Norma Devine, Editor

On Wednesday, Octobor 3, 2001, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Exercise and Glaucoma." 

Moderator:  Hello, Doctor Rick.  Tonight we are discussing exercise and glaucoma.

Dr. Rick Wilson:  I want everyone huffing and puffing from all the exertion of this chat.

P:  Are there exercises that are bad for glaucoma? 

Dr. Rick Wilson:  Yes, avoid any exercise that puts your legs higher than your head for any length of time. That raises the pressure of  blood in the veins around the eye.  The fluid in the eye cannot leave  the eye unless it is higher than the pressure of blood in the veins.

P:  Is there a time limit on exercises that require lowering the head below the heart, or should such exercises be avoided?  I'm thinking of a Yoga exercise.

Dr. Rick Wilson:  I wouldn't do that for more than 10 seconds or so, unless you have something that is so worth it that it counterbalances the risk of raising your IOP (intraocular pressure).  For instance, Yoga headstands for any prolonged period would seem too risky to me.

P:  Last year I was still doing hamstring stretches and sometimes abdominal exercises with my legs straight up, for much longer than ten seconds, until I learned from Dr. Rick in this chat room about that causing an increase in intraocular pressure.  I'm grateful.  I wish everybody "out there" knew.

P:  Neither my glaucoma doctor nor my ophthalmologist ever said anything about exercise!

P:  I did housework two days after my trabeculectomy.  I had to have it stitched up because of that.  I'll never do that again!  Next time, I will listen to doctor.  

Dr. Rick Wilson:  Did you pop a stitch? 

P:  Yes, four times.

P:  I'm curious about the effect of strenuous exercise on my normal-tension glaucoma.  I race bikes and ski cross-country.  I often push my heart rate close to 90% of maximum for extended periods.  Also, I've heard that strenuous exercise may produce free radicals, which I understand may adversely affect the optic nerve.  I try to take antioxidants. 

Dr. Rick Wilson:  I think that any effects of increased free radicals would be counterbalanced by the improvement in circulation to the optic nerve and the lowering in IOP inherent in aerobic exercise.

P:  Is walking probably a better exercise for us than aerobics?

Dr. Rick Wilson:  No.  Any aerobic exercise is good.  Aerobic means exercise that uses oxygen.  So consistent movement for 20 minutes  -- such as walking, biking, swimming -- would be good.

P:  How about aerobic exercise classes? 

Dr. Rick Wilson:  Aerobic exercises are good.  They usually get your heart rate up for 20 to 30 minutes, and being with a group will help keep you motivated.

P:  I am 32-years-old, have congenital glaucoma and I run three miles a day, four to five times a week.  That should be okay, right?

Dr. Rick Wilson:  That should be terrific.  Wow! 

Moderator:  Do you have any suggestions about how to start an exercise program and stick to it?

Dr. Rick Wilson:  Yes.  You should work it into a convenient time of the day.  However, it always takes will power to do it.  I swim at 6:30 in the morning, but in the winter I really have to force myself out into the cold to go to the "Y" and hop in the pool.

P:  Is there any difference between exercise that generates sweat, and exercise that doesn't, besides the obvious? 

Dr. Rick Wilson:  No.  Oxygen consumption is the sine qua non of exercise.

Moderator:  What does "sine qua non" mean?

Dr. Rick Wilson:  It means, "without which, nothing."  In other words, if you aren't consuming oxygen, you aren't exercising.

P:  How about swimming in a pool after you've had trabeculectomies?  Is the pool water safe?

Dr. Rick Wilson:  Usually, unless your conjunctiva is very thin.  Your doctor can tell you whether you should use goggles or not swim at all.

P:  What about weight training?  I use the weight machines.

Dr. Rick Wilson:  Weight training is good for the body, but does little that I know of for glaucoma.  It counts toward your general health, muscle tone, weight control, etc., but does not lower IOP or increase circulation much.

P:  Can weightlifting raise IOP?

Dr. Rick Wilson:  Yes.  Holding one's breath and straining also raises the venous blood pressure.  However, most people cannot heave huge weights for very long.

P:  I walk briskly a lot for short distances at work.  I've been told that for my diabetes that's as good as a long, steady walk.  But is that also good for my glaucoma?  

Dr. Rick Wilson:  Not as good as a 20-minute walk.  The Oregon glaucoma doctors studied the effects of exercise on glaucoma and found that exercising 20 minutes, 4 times a week, lowered intraocular pressure.  Exercising 20 minutes 3 times a week did not have that effect.  Losing weight if you are overweight also helps reduce IOP (intraocular pressure).  

P:  What about exercise that involves bouncing and jerking?  Is that risky for glaucoma and a detached retina?  

Dr. Rick Wilson:  Could be for a detached retina. Not risky for glaucoma, except in the case of pigmentary glaucoma where these movements may cause more pigment to be rubbed off the back of the iris.  This pigment floats in the fluid flow in the eye and gets sieved out by the trabecular meshwork (the meshwork overlying the drain of the eye) and blocks the outflow of the watery fluid filling the eye.  This can cause an abrupt rise in intraocular pressure. 

P:  How much reduction in intraocular pressure can we hope to see if we do reasonably strenuous aerobic exercise for 20 minutes 4 or 5 days a week for a sustained time?  Two points?  

Dr. Rick Wilson:  Yes, about that.

P:  So if we have hypotony, we should forget exercising? 

Dr. Rick Wilson:  No.  At those lower pressures, exercise should not reduce them further.  

P:  I have been fast walking three miles nearly every day for years, but it has not lowered my intraocular pressure. 

Dr. Rick Wilson:  You would have to stop walking for three months or so, and recheck the pressure to tell if the walking has been helping.  

P:  I won't do that.  

Moderator:  Would there be any restrictions for scuba divers and sky divers who have glaucoma?

Dr. Rick Wilson:  Scuba diving causes the oxygen and carbon dioxide concentration in the blood to rise.  The carbon dioxide levels would cause vasodilation, which would probably be helpful, if anything.  High oxygen saturation would probably not have much effect.  The worry would be for blebs (surgically created drains) and whether the mask could hit the eye and hurt the bleb.  I used to use spit to keep my mask from fogging up, which is not a good idea for a patient with a bleb.  It would be better to use a commercial defogger or toothpaste.

P:  I think the drops I'm using make me feel tired.  

Dr. Rick Wilson:  What are meds are you using?  

P:  Xalatan.  

Dr. Rick Wilson:  It's hard to link the Xalatan to tiredness.  

P:  Could Cosopt, pilocarpine and Lumigan cause me to feel tired?

Dr. Rick Wilson:  Alphagan is the classic drop that makes patients lethargic.  The timolol in Cosopt has a sedative effect in a few people. 

Dr. Rick Wilson:  Time for me to say goodnight.  Dr. Jeff Henderer will be here next week.  

Moderator:  Have a great trip, and don't forget to come back from Brazil, Doctor Rick.

End of highlights for October 3, 2001.

On October 10, Dr. Henderer discussed "Neuroprotection" in the Chat room. Click here for highlights of that meeting.

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