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    Lifestyle modifications may help control glaucoma progression

     

    Body position

    Dr. Ou advises patients to avoid certain yoga poses. “We all know that headstands and shoulder stands are bad for your patient,” said Dr. Ou. “They raise IOP.”

    The evidence on less strenuous poses, such as downward-facing dog, is less clear, she said. In one recent study on 4 common yoga poses, IOP increased but returned to baseline within a couple of minutes after the participants returned to sitting.

    Counseling a yoga instructor with early glaucoma, Dr. Ou measured the patient’s IOP as she performed the poses in Dr. Ou’s office. IOP increased transiently, and Dr. Ou told the patient to avoid shoulder stands and headstands, to modify other poses, and to look for ways to demonstrate inversions without performing them.

    “We just don’t have good data to guide patients about optic nerve damage and ganglion loss,” Dr. Ou said. “Unfortunately, you can’t make mice do yoga. This question may remain a little unanswered.”

    Sleeping position also may affect IOP. Some studies have shown that lateral decubitus increases IOP in the dependent eye–the eye closest to the pillow, but the case is not settled, said Dr. Ou.

    “There have been studies that looked at whether the dependent eye or the nondependent eye had worse structural changes and there’s some debate in the field,” she said.

    Another study showed that elevating the head of the head of the bed resulted in a 2 mm Hg lower IOP, but if the neck was flexed IOP was 2 mm Hg higher. “The hypothesis is that this neck flexion creates a situation where you’re compressing neck veins and leads to increased episcleral venous pressure,” Dr. Ou added.

    The bottom line? “You could consider advising sleeping with the head of the bed elevated,” said Dr. Ou. “This is still difficult and not super practical. There is controversy about recommendations and a lot of patients spend most of their sleep in the lateral decubitus position.”

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