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Editors Selection IGR 22-4
Risk Factors: Posture-induced IOP Rise
Comment by Kaweh Mansouri on:
66308 Intraocular Pressure Rise in Subjects with and without Glaucoma during Four Common Yoga Positions, Jasien JV; Jonas JB; De Moraes CG et al., PLoS ONE, 2015; 10: e0144505
The practice of yoga for meditative and recreational purposes has become mainstream in recent decades while elderly people increasingly strive to stay physically active. Therefore, practitioners are regulary confronted with glaucoma patients who inquire about the effect of yoga excercises on their disease status.
IOP is a dynamic parameter and body position is directly related to IOP changes. Previous studies have unequivocally demonstrated that Sirsasana (headstand) produces a temporary increase in IOP by a factor of two.
Jasien et al. provide the first data on the effect of four common yoga excercises on IOP: 'downward facing dog', 'standard forward bend', 'plow', and 'legs up the wall'. Ten healthy subjects and ten patients with primary open-angle glaucoma were included and assumed each position for a duration of two minutes. All four positions produced a statistically significant IOP increase within one minute. The highest increase occurred in the 'downward facing dog' (17 to 29 mmHg in glaucoma vs. 17 to 27 mmHg in healthy subjects). IOP returned to baseline levels two minutes after returning to a seated position.
Practitioners are regulary confronted with glaucoma patients who inquire about the effect of yoga excercises on their disease status
The authors applied statistical modeling to account for confounding variables. A limitation was the preponderance of female subjects (90%) and the small sample size, that precluded sub-group analysis by glaucoma types and stages. In reality, many yoga practitioners assume positions for longer than the two minute period studied herein.
Whether the observed acute IOP elevation translates into glaucoma damage and clear practical recommendations cannot be derived from this study. Given the popularity of yoga and the potential for deletrious effects of head-down positions, the glaucoma community is encouraged to conduct a longitudinal study to evaluate this putative relationship. In the meantime, and based on available evidence, I cautiously discourage my patients from head-down positions and recommend more frequent follow-up visits.
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