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Editors Selection IGR 22-1

Miscellaneous: Meditation affects gene expression and lowers IOP

Comment by Niklas Telinius & Miriam Kolko on:

91995 Effect of Mindfulness Meditation on Intraocular Pressure and Trabecular Meshwork Gene Expression: A Randomized Controlled Trial, Dada T; Bhai N; Midha N et al., American Journal of Ophthalmology, 2021; 223: 308-321

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In the present study, 60 patients scheduled for trabeculectomy were randomised to either three weeks of daily mindfulness mediation (MM) or observation and then reassessed before surgery. MM resulted in a significant IOP reduction, with mean IOP decreasing from 20.16 ± 3.3 mmHg to 15.05 ± 2.4 mmHg. This resulted in the cancellation of the surgery in half of the cases. IOP was unchanged in the observation group and all patients underwent surgery. The patients who were able to avoid surgery continued for an additional six weeks with MM and maintained a low IOP (12.8 ± 1.47 mmHg). The study confirms the researchers' previous results of MM lowering IOP and seeks to elucidate the mechanisms involved. The trabecular meshwork (TM) from all patients undergoing trabeculectomy was harvested for Real-Time PCR (RT-PCR) analysis of 18 selected genes. All genes were significantly altered, ten genes down-regulated and 8 genes up-regulated. The relative changes in the expression of all 18 analyzed genes provide many indications for possible mechanisms leading to the observed IOP lowering effect. In particular, nitrogen oxide (NO) regulation seemed a plausible candidate.

Despite the fact that the gene changes found in TM following MM provide indications of the mechanisms behind IOP reduction, functional studies are needed before one can further explain the pathways involved.

There are still many questions about MM's potential place as adjunctive therapy for glaucoma patients. For example, it will be relevant to investigate whether the IOP lowering effect is lasting? So far, data only support an effect of up to nine weeks. Another concern is the amount of MM needed to be effective. In this study, patients underwent a rather intense MM plan consisting of 45 minutes daily with a certified yoga instructor, which does not seem realistic for all patients. Future studies will need to address how effective shorter programs are. Finally, it will be interesting to see if the impressive results from MM can be reproduced by other researchers.

Overall, the present study is very interesting with an exciting potential. In conclusion, the authors are thus congratulated on having opened our eyes to alternative ways of lowering IOP.

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