Hello! I’m Dr. David Richardson. My practice is in Southern California with a specialty in cataract and glaucoma treatment and surgery.

So I’ve been talking about a Holistic Approach to Glaucoma therapy, which essentially, by “holistic”, I mean whole body, taking into account the things other than controlling intraocular pressure. They can be beneficial for glaucoma. Now, in a recent video, I talked about how the research on exercise and glaucoma is pretty much all over the place, in terms of whether it’s beneficial or not. I wasn’t able to give real solid guidelines then. And since then, a study has appeared that is currently in press (it’s not actually up at the time of this video and published), but the results are accessible now online, at least for physicians who have access to these journals through subscriptions.

In this study, although it still doesn’t tell us the answer, it provides some really useful information. So I’d like to review that study today. Let’s get going!

So this study is what’s called a “observational or longitudinal observational study”, which essentially means that a group of patients were chosen (we’ll talk about what types of patients and what was done) and they were watched for a period of time. And then correlations were made between what activities the patients did and glaucoma. So, in this case the study looked at patients who either had glaucoma or were glaucoma suspects…so, ocular hypertension or other reasons such as enlarge cupping that made the physicians, who were treating these patients, believed that they were likely to develop glaucoma. These patients were given pedometers or accelerometers (actually), which had a piezoelectric crystal in them that allowed for assessing activity. Now what the study involved was just one week of assessing this activity. So for one week, these patients, who were older patients—as I said with glaucoma or possible glaucoma— (they) were asked to wear this accelerometer. And then the study authors followed these patients for about five years after the study, looked at the visual fields from before the study (years in most cases), as well as after the wearing of the accelerometer and correlated activity with visual field loss…specifically, the rate of visual field loss. And what they were looking at—they were looking for rather—a correlation between level of activity and decreased rate of visual field loss. And they found it using multiple parameters. So the things that they looked at included a number of steps taken per day, the amount of moderate-to-severe (in this study was mostly moderate) physical activity, as well as time spent off the couch.

And what they found was that essentially the more steps taken per day, the slower the rate of associated visual field loss, to the point where essentially for every thousand extra steps taken per day there was a significant, albeit small decrease, in the rate of field loss…now, small but as I’ve said significant. So what they found was essentially for every 5,000 additional steps per day, there was a reduction of approximately ten percent in the rate of visual field loss. So that’s a significant amount of reduction for what is a relatively modest amount of exercise. Now they also found that the more moderate to severe exercise that was performed during the week, the slower the rate of visual field loss.

Now it should be stated that this was a correlation. The study could not show causation. In other words, we don’t know whether exercise—so the amount of activity performed—is actually resulting in a lower rate of visual field loss or whether it’s that people who have more aggressive visual field loss are less likely to be active. They might think, “Well, why would that be?” Well, other studies have shown the more severe the visual field loss, the less likely it is for patients with glaucoma to be active. And it makes sense from the perspective that if your visual field is restricted—so you’re more likely to bump into things, you’re more likely to have accidents based on not seeing things—you may start to restrict your activities. We know this is the case with driving, as well as, (you know) just getting out and about. So the study can’t differentiate between which is causing the other. That being said, there are other studies, in fields outside of glaucoma that have shown pretty strongly that exercise does benefit neurologic disorders. So since glaucoma is essentially a condition that  impacts the optic nerve, which is a central nervous a part of the central nervous system, it would be reasonable to suspect that those things that are good for central nervous system conditions would also be beneficial for glaucoma.

So assuming that there is a causal relationship does this mean that we should all be going out and joining CrossFit gyms? Well, I mean I personally like CrossFit and I think it’s a great form of exercise but no, I don’t think that’s what’s going to be necessary for most with glaucoma.

What I do think, of course, is that getting out and walking is a beautiful, low cost, and low threshold way to get out and exercise for one’s general health. But the study actually went further than exercise as well as walking. The study actually found that just time off the couch, just to be non-sedentary provided a benefit! So essentially for every 2.5 hours off the couch, there was a decrease of 10% in the rate of visual field loss. So again, get off the couch. Do what you can. It’s not necessary to be overly vigorous. We talked about in the other video how certain types of strenuous exercise can actually increase the pressure in the eye; but just getting off the couch is unlikely to cause pressure elevation and at least with this study was correlated with a reduction in the rate of visual field loss.

What do I recommend or what will I recommend based on this this study for my patients? Pretty much what I was recommending before: Be active, get off the couch, aerobic exercise…I think it would be reasonable to actually either download an accelerometer/pedometer app so an activity app onto one’s smartphone or Smart Watch. And for those who don’t have a smartphone or Smart Watch there are inexpensive pedometers. I found one on amazon.com for less than $30, which was well rated. My father wears one and it’s actually quite motivating. And he counts his steps every day and is motivated to reach a certain goal and when he reaches that then he’s motivated to reach the next. So it’s a great way of providing  encouragement to get up and about. And then of course what I’ve always been saying in these videos is, it’s good for your cardiovascular health And what’s good for your cardiovascular health is probably good for your optic nerve health.

So anyway I wanted to update you with the results of that study. Most likely by the time this is published or online, the actual study will have been published, and the abstract should be available for review. And I look forward to sharing other research as it comes out with you.

References

  1. Lee MJ, Wang, J, Friedman DS, et. al. Greater Physical Activity Is Associated with Slower Visual Field Loss in Glaucoma. Presented at: The Association for Research in Vision and Ophthalmology Annual Meeting, May 7–11, 2017, Baltimore, Maryland. (Ophthalmology article in press as of 12/12/2018).
  2. Ramulu PY, Maul E, Hochberg C, et al. Real-world assessment of physical activity in glaucoma using an accelerometer. Ophthalmology. 2012;119:1159e1166.
  3. Nguyen AM, Arora KS, Swenor BK, et al. Physical activity restriction in age-related eye disease: a cross-sectional study exploring fear of falling as a potential mediator. BMC Geriatr. 2015;15:64.
  4. Ramulu PY, Hochberg C, Maul EA, et al. Glaucomatous visual field loss associated with less travel from home. Optom Vis Sci. 2014;91:187e193.
  5. Koščak Tivadar B. Physical activity improves cognition: possible explanations. Biogerontology. 2017;18:477e483.
David Richardson, MD

David Richardson, MD

Medical Director, San Marino Eye

David Richardson, M.D. is recognized as one of the top cataract and glaucoma surgeons in the US and is among an elite group of glaucoma surgeons in the country performing the highly specialized canaloplasty procedure. Morever, Dr. Richardson is one of only a few surgeons in the greater Los Angeles area that performs MicroPulse P3™ "Cyclophotocoagulation" (MP3) glaucoma laser surgery. Dr. Richardson graduated Magna Cum Laude from the University of Southern California and earned his Medical Degree from Harvard Medical School. He completed his ophthalmology residency at the LAC+USC Medical Center/ Doheny Eye Institute. 

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