Michael Lesgart, Class of 2020
As mindfulness meditation gains popularity through apps like Headspace, scientists are increasingly investigating its effects on various diseases. Mindfulness based stress reduction (MBSR), which cultivates nonjudgmental attentiveness to the present moment along with breathing techniques, has been shown to have positive effects on cardiovascular disease and diabetes (Loucks et al. 2015). In light of the potential benefits of mindfulness interventions, a study by Dada et al. investigated how MBSR affects glaucoma.
Glaucoma, as the second leading cause of blindness impacting 65 million people (Tham et al. 2014), is characterized by high intraocular pressure (IOP) within the eye, damaging the optic nerve. Patients with glaucoma also have a significantly lower quality of life (Gupta et al. 2011) than control populations, suggesting that glaucoma is linked to elevated stress and inflammation. To determine the effect of MBSR on IOP and inflammation, Dada et al. (2018) conducted a randomized controlled trial with glaucoma patients.
The trial compared two groups (180 total eyes) of glaucoma patients who were taking IOP-lowering medication; however, one group was assigned randomly assigned MBSR for three weeks while the other was not. Measurements of IOP and inflammation markers, like cortisol and IL-6, were taken pre-and post-intervention and compared between the two groups.
Is mindfulness effective in treating glaucoma or not? Hesitatingly, yes. The findings showed a significant decrease in IOP, cortisol, and IL-6 in the mindfulness group compared to the control, meaning that a combination of mindfulness and IOP-lowering medication was more effective than just IOP-lowering medication. Additionally, the observed decrease in IOP was highly correlated to the lowered cortisol and IL-6. The mechanism proposed is as follows: mindfulness reduces inflammation, causing reductions in IOP and the severity of glaucoma, leading to decreases in stress and improvement in quality of life. However, it is important to note that the study compared mindfulness with IOP medication to IOP medication by itself and the benefits seen are attributed to the combination of MBSR and medication.
Though the Dada et al study is the first of its kind to provide evidence linking mental stress and glaucoma, several limitations and doubts remain regarding using mindfulness as a supplement to traditional glaucoma treatments. The conclusions drawn from the study were based on the assumption that inflammation markers circulate around and affect eye tissues, a claim that requires extensive verification. In addition, IOP was measured once during the day, limiting the conclusions of the study. Lastly, the intervention was only conducted over a three-week period and long-term changes in IOP resulting from mindfulness meditation are yet to be observed.
Leading glaucoma specialists displayed mixed reactions to this study. Dr. Kevin McKinney, a glaucoma specialist at Eye Health Northwest in Portland, OR commented that he “would want to see whether the same effect [namely, lowered IOP] could be maintained over a longer period of time” and that “With our current level of understanding, I would not recommend using meditation as a substitute for current glaucoma treatment. But it might be a very useful addition.” (4). Nevertheless, he states that “In my practice, I see that glaucoma patients who manage stress better tend to have better outcomes.” (Vimont 2019). It seems that clinicians are interested in retained lower IOP as a result of mindfulness, which would be the goal of long-term treatment for glaucoma. Another ophthalmologist and cataract surgeon, Dr. Ravi Goel from Cherry Hill, NJ, comments that “Techniques to reduce stress and increase mindfulness meditation would be welcome additions to an ophthalmologist’s tool kit. Afterall, the visual system is critical to a patient’s overall quality of life…” (Vimont 2019). Although the literature is incomplete regarding definitive evidence of mindfulness reducing IOP, the general consensus is that reducing stress could be beneficial for glaucoma patients.
Could mindfulness replace traditional treatments for glaucoma? Not yet. Would glaucoma patients benefit from supplemental mindfulness-based stress reduction? Most certainly. Though skeptics reasonably question the pathways between stress reduction and physical improvements in various diseases, positive outcomes are undeniably seen as a result of mindfulness-based interventions. As a relatively cost-effective and innocuous complement to traditional treatments, mindfulness could certainly ameliorate the devastatingly harmful effects of glaucoma.
References
Glaucoma, as the second leading cause of blindness impacting 65 million people (Tham et al. 2014), is characterized by high intraocular pressure (IOP) within the eye, damaging the optic nerve. Patients with glaucoma also have a significantly lower quality of life (Gupta et al. 2011) than control populations, suggesting that glaucoma is linked to elevated stress and inflammation. To determine the effect of MBSR on IOP and inflammation, Dada et al. (2018) conducted a randomized controlled trial with glaucoma patients.
The trial compared two groups (180 total eyes) of glaucoma patients who were taking IOP-lowering medication; however, one group was assigned randomly assigned MBSR for three weeks while the other was not. Measurements of IOP and inflammation markers, like cortisol and IL-6, were taken pre-and post-intervention and compared between the two groups.
Is mindfulness effective in treating glaucoma or not? Hesitatingly, yes. The findings showed a significant decrease in IOP, cortisol, and IL-6 in the mindfulness group compared to the control, meaning that a combination of mindfulness and IOP-lowering medication was more effective than just IOP-lowering medication. Additionally, the observed decrease in IOP was highly correlated to the lowered cortisol and IL-6. The mechanism proposed is as follows: mindfulness reduces inflammation, causing reductions in IOP and the severity of glaucoma, leading to decreases in stress and improvement in quality of life. However, it is important to note that the study compared mindfulness with IOP medication to IOP medication by itself and the benefits seen are attributed to the combination of MBSR and medication.
Though the Dada et al study is the first of its kind to provide evidence linking mental stress and glaucoma, several limitations and doubts remain regarding using mindfulness as a supplement to traditional glaucoma treatments. The conclusions drawn from the study were based on the assumption that inflammation markers circulate around and affect eye tissues, a claim that requires extensive verification. In addition, IOP was measured once during the day, limiting the conclusions of the study. Lastly, the intervention was only conducted over a three-week period and long-term changes in IOP resulting from mindfulness meditation are yet to be observed.
Leading glaucoma specialists displayed mixed reactions to this study. Dr. Kevin McKinney, a glaucoma specialist at Eye Health Northwest in Portland, OR commented that he “would want to see whether the same effect [namely, lowered IOP] could be maintained over a longer period of time” and that “With our current level of understanding, I would not recommend using meditation as a substitute for current glaucoma treatment. But it might be a very useful addition.” (4). Nevertheless, he states that “In my practice, I see that glaucoma patients who manage stress better tend to have better outcomes.” (Vimont 2019). It seems that clinicians are interested in retained lower IOP as a result of mindfulness, which would be the goal of long-term treatment for glaucoma. Another ophthalmologist and cataract surgeon, Dr. Ravi Goel from Cherry Hill, NJ, comments that “Techniques to reduce stress and increase mindfulness meditation would be welcome additions to an ophthalmologist’s tool kit. Afterall, the visual system is critical to a patient’s overall quality of life…” (Vimont 2019). Although the literature is incomplete regarding definitive evidence of mindfulness reducing IOP, the general consensus is that reducing stress could be beneficial for glaucoma patients.
Could mindfulness replace traditional treatments for glaucoma? Not yet. Would glaucoma patients benefit from supplemental mindfulness-based stress reduction? Most certainly. Though skeptics reasonably question the pathways between stress reduction and physical improvements in various diseases, positive outcomes are undeniably seen as a result of mindfulness-based interventions. As a relatively cost-effective and innocuous complement to traditional treatments, mindfulness could certainly ameliorate the devastatingly harmful effects of glaucoma.
References
- Dada T, Mittal D, Mohanty K, Faiq MA, Bhat MA, Yadav RK, Sihota R, Sidhu T, Velpandian T, Kalaivani M, et al. Mindfulness Meditation Reduces Intraocular Pressure, Lowers Stress Biomarkers and Modulates Gene Expression in Glaucoma. 2018;27(12):1061–1067.
- Gupta V, Dutta P, Ov M, Kapoor KS, Sihota R, Kumar G. Effect of Glaucoma on the Quality of Life of Young Patients. 2011;52(11):8433.
- Loucks EB, Schuman-Olivier Z, Britton WB, Fresco DM, Desbordes G, Brewer JA, Fulwiler C. Mindfulness and Cardiovascular Disease Risk: State of the Evidence, Plausible Mechanisms, and Theoretical Framework. 2015;17(12).
- Tham Y-C, Li X, Wong TY, Quigley HA, Aung T, Cheng C-Y. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. 2014 Nov [accessed 2019 Mar 29]. https://www.ncbi.nlm.nih.gov/pubmed/24974815
- Vimont C. Mindfulness Meditation May Help Fight Glaucoma. 2019 Feb 12 [accessed 2019 Mar 29]. https://www.aao.org/eye-health/news/mindfulness-meditation-may-help-fight-glaucoma
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