Lifestyle and Glaucoma
Chat Highlights
January 3, 2007

On Wednesday, January 3, 2006, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Lifestyle and Glaucoma."

Moderator:  Since many of us glaucoma patients make New Year’s resolutions, tonight seems like a particularly good time to discuss lifestyle changes that may help us.

P:   Why is exercise important to the health of the eye and, for that matter, the body?

Dr. Rick Wilson:  One basic principle of aging is, if you don't use it, you lose it.  As we've talked about on many occasions, the intraocular pressure (IOP) is just the main known risk factor for glaucoma.  Circulation seems to be the second main risk factor, especially for those with normal-tension glaucoma (NTG).

P:  What are the most beneficial habits for glaucoma patients?

Dr. Rick Wilson:  Exercise tones the cardiovascular system and actually increases the body's ability to function efficiently.  Therefore, exercise can be a big help in resisting the damaging effects of glaucoma.  If done aerobically for 20 or more minutes four times a week, exercise lowers IOP, while also benefiting circulatory conditioning.

Weight control is linked to exercise.  There are supposed to be a mile of capillaries (the smallest blood vessels) in every pound of fat.  Excess weight means the heart has to pump harder to circulate blood through the increased number of blood vessels in the body.  That often leads to high blood pressure and hardening of the arteries, both of which are risk factors over time for glaucoma damage.

P:  Does nutrition play an important role?

Dr. Rick Wilson:  Good nutrition is also linked to weight control.  Although megavitamins and other supplements have not been shown to assist in glaucoma care or prevention, they are part of the basics of maintaining the best health to resist disease, in this case glaucoma.

P:  What do you mean by aerobic exercising?

Dr. Rick Wilson:  If you run a 50-yard dash, you do so with energy and oxygen stored in the muscles.  If you run a mile, you use oxygen and glycogen in the muscles to power your effort, that is, aerobically, as opposed to running a 50-yard dash, which is mostly anaerobically.

P:  Does walking slowly provide any benefit for glaucoma patients?

Dr. Rick Wilson:  With aerobic effort, both the oxygen and glycogen have to be brought to the muscles.  Actually, a gentle stroll is an aerobic exercise, as it lasts longer than the stored oxygen and glycogen stored in the muscles, and you are breathing faster than if you were at rest.  Studies are continually showing that some exercise is much better than no exercise; to obtain good benefits, a slow, 20 to 30 minute walk is quite effective in producing health benefits.

P:  Are there activities that should be avoided by patients who have had trabeculectomies or shunt surgery?

Dr. Rick Wilson:  Anyone with glaucoma should not hold a position where the head is lower than the body for any length of time.  That position raises the blood pressure around the eyes and, to the same extent, the IOP.

Although controversial, playing horns, such as trumpets and trombones that require the user to blow hard, may have a similar effect on the IOP.  Many repetitions of bench presses with the heavier weights may have the same effect.  We are not sure if horn playing or bench pressing are deleterious to glaucoma patients, but theoretically they should be.

If you have a thin bleb after a trabeculectomy, skin diving and swimming in polluted waters are not a good idea.  For both blebs and shunts, contact sports, when blows to the eyes are frequent, require protective glasses or goggles.

P:  Is it safe to SCUBA dive with medically controlled glaucoma if the glaucoma patient has not had a trabeculectomy?

Dr. Rick Wilson:  Yes.  The partial pressure of oxygen in the blood increases during SCUBA diving.  That should not harm the eye.  The partial pressure of carbon dioxide also increases, which should have a slight dilatory effect on the blood vessels.  That might prove to be helpful in some forms of glaucoma. If you have a bleb, be sure not to use saliva to keep your face mask clear.

P:  How can glaucoma patients know whether they have thin blebs?

Dr. Rick Wilson:  They have to ask their surgeons, who have examined the blebs with the slit lamp microscope.

P:  Nine months ago I started a walking routine, usually 45 to 50 minutes a day.  After five months of that exercise, my blood pressure had dropped low enough that I no longer needed medicine to control it.  My cholesterol also dropped.  Further, I lost 17 pounds.  The best news, however, is that at my last checkup my IOPs were10 mm Hg.  My glaucoma specialist said that my visual field is stable.  Since I have not changed glaucoma medication, I attribute the decrease in IOPs to walking.  My IOPs have never been that low.

Dr. Rick Wilson:  You are a good example:  I see that all the time. In fact, when my son was born 21 years ago, I was found to have seriously high blood pressure. I started swimming four times a week and lost 15 pounds.  I have never had to take medicine for high blood pressure as it dropped significantly.

P:  Would you advise a normal-tension glaucoma patient to sleep on a bed with the head of it elevated to keep her head above her heart?

Dr. Rick Wilson:  I would if the medicine did not keep the patient from progressing. Sleeping with the head on a pillow might help anyone with normal-tension glaucoma.

P:  Would the reduction in barometric pressure in a small, unpressurized plane as it climbed from sea level to 10,000 feet affect the pilot’s IOP or a bleb?

Dr. Rick Wilson:  The higher the plane, the higher the IOP, though at 10,000 feet that may not be a big difference.  The bleb could be distended slightly, but in most cases that should not pose too much of a problem.

Moderator:  The relationship between blood pressure and glaucoma seems to be unclear. Is there any evidence showing whether systolic or diastolic blood pressure is more important?

Dr. Rick Wilson:  For glaucoma patients, the diastolic pressure should be in the normal range; that is, not too low.  The mean (the average of diastolic and systolic) or systolic should not be too high. I don't think we know more than that.

Moderator:  Have you heard of a machine that measures systolic and diastolic variations within the eye itself?

Dr. Rick Wilson:  There are machines that measure the pulse of blood pressure as it enters the eye.

Moderator:  Dr. Wilson, thank you again for sharing your time and wisdom.  You are helping all of us to have a better year in 2007. And may it be great for you, too!

Dr. Rick Wilson:  Everyone have a good two weeks and a healthy and satisfying New Year.

On January 17, Dr. Pro discussed "Angle-closure Glaucoma" in the Chat room. Click here for highlights of that meeting.

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