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    Novel treatment options for IOP involve range of independent factors

    Effects of lifestyle, systemic factors, body position, alternative therapies can play role

    Educating patients about potential lifestyle changes can be an important adjunct to the medication(s) that clinicians prescribe when it comes to managing glaucoma, said Cynthia Mattox, MD, FACS.

    Patients ask about lifestyle all the time, said Dr. Mattox, who is director, Glaucoma and Cataract Service, and vice chairman, clinical services for New England Eye Center, Boston, as well as associate professor of ophthalmology, Tufts University School of Medicine, Boston.

    There is evidence supporting what may be beneficial, what may be harmful, and what may not make a difference.

    For example, consuming dark-green leafy vegetables can reduce glaucoma risk by 30%, and may be even more helpful in those patients who are prone to having paracentral visual field loss.1

    A high beta-carotene intake, as well as other sources of retinol equivalents, was shown in the Rotterdam study2,3
    to be associated with “a two-fold decreased incidence of incident glaucoma,” she said.

    Conversely, calcium and iron supplementation “may be harmful to our patients, especially in patients who don't have a deficiency,” she added, with similar findings for magnesium.The role of antioxidants in food is less clear cut, but Dr. Mattox recommends advocating moderation.


    Beneficial behaviors

    Regular aerobic exercise is good in general, and may have a moderating effect on IOP levels. However, it is not uncommon to find a slight IOP rise in previously active patients who are newly sedentary (for example, from an injury), according to Dr. Mattox.

    “It’s advisable for our glaucoma patients to avoid prolonged Valsalva maneuvers,” she said.

    Clinicians should advise patients to avoid being upside down for long periods to minimize choroidal expansion.

    There is some suggestion that in certain patients with certain phenotypes and a paracentral visual defect, that low body mass index may play a role.

    “A lot of our patients take herbal supplements,” Dr. Mattox said. “The rationale for some supplements is that they may protect retinal ganglion cells from toxicity or apoptosis.”

    They may also reduce caspase 3 and 9, and inhibit gene expression. Some supplements have been reported to reduce IOP in animal models, “but the evidence is soft,” she said.

    There is little evidence about the benefits of acupuncture, but the rationale for its incorporation into patients’ lifestyle is that acupuncture stimulates the release of neurochemicals. One study did not find any pressure effect on IOP from patients undergoing acupuncture, nor were the researchers able to study if acupuncture can protect the optic nerve, Dr. Mattox noted.

    Systemic factors

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