The Glaucoma Research Foundation (GRF) Patient Summit highlights the latest in glaucoma treatment advances, giving patients practical information to help them live their best lives with the condition. In this eighth recording from the fourth annual Summit, several glaucoma specialists discuss how diet and exercise, alternative therapies, and dealing productively with your emotions can help on your glaucoma journey.*

Diet and exercise (1:26)

Ahmad A. Aref, M.D., of Illinois Eye and Ear Infirmary, associate professor of ophthalmology at the University of Illinois College of Medicine, points out that, despite great medical advances in treating intraocular (internal) eye pressure, or IOP, tools for healthy blood flow to the optic nerve are lacking. Diet and exercise, he says, can shine in this area.

Coffee (2:21)

A regular cup of coffee has roughly 150 mg of caffeine, whereas most Starbucks coffee drinks contain 235 mg (in a Tall size) or more. Studies show a small temporary rise in IOP after a regular cup of coffee, and the effect lasts 1-2 hours, on average. Aref says such a small rise (1-2 mmHg) in IOP won’t increase glaucoma risk or affect disease status in most people. “If we’re talking about a single cup of coffee, I think we’re probably okay.”

Flavonoids (6:09)

Flavonoids are antioxidant plant compounds that give color to fruits and vegetables and are also found in dark chocolate and hot caffeinated tea. Studies have shown that flavonoids can reduce the risk of disease development, and possibly improve the visual field.

Nitric oxide (8:00)

Nitric oxide (NO), a vasodilator, is found not just in medications but also in foods such as:

• Iceberg lettuce,
• Celery,
• Beets, and
• Sweet potatoes.

Eating more nitrate-rich foods has been linked to a 20%-30% decrease in glaucoma development in people at risk.

Exercise (9:07)

Cardiovascular exercise (aerobics), resistance training (free weights, bands, etc.), and yoga and breathing exercises all have different effects on eye pressure and glaucoma risk.

• Cardiovascular (aerobic) exercise appears beneficial for reducing IOP, as it may help to expand the drainage canal.
• Heavy resistance exercise, conversely, can dramatically raise IOP for several seconds before returning to baseline.

Aref says eye pressure rising to 40-70 mmHg for a few seconds after a heavy lift may not make a difference for most people, even those with early glaucoma, but people with advanced glaucoma should “be careful about doing these heavy-duty resistance exercises.” Eye pressure that high, even for several seconds, could increase the risk of irreversible vision loss.

Lifestyle modifications (14:38)

According to Monica Ertel, M.D., Ph.D., assistant professor of ophthalmology at the University of Colorado, certain other lifestyle changes can help support good eye health and preserve your vision, as well. 

Sleep

One of these changes is how you sleep. Lying flat causes IOP to rise, but raising your head by 20 degrees can help prevent overnight increases, Ertel says. A foam wedge placed underneath the mattress is preferable to using extra pillows.

IOP increases in the eye on the side you’re sleeping on. If you have severe disease, Ertel recommends sleeping on your back with pillows on each side to prevent you from rolling over. IOP also increases when sleeping on your stomach, as well as when your hand or pillow touches your eye.

Smoking

Insufficient blood flow is another contributor to glaucoma. You can help increase blood flow by quitting smoking. Multiple studies indicate that cigarette smoking is harmful to retinal fibers and significantly increases the risk of glaucoma.

Marijuana, however, may have some protective qualities. Tetrahydrocannabinol (THC), an active ingredient in marijuana, can reduce IOP, but only for a few hours. Another of its active ingredients, cannabidiol (CBD), can actually increase IOP. Due to its side effects, Ertel says, “Most eye organizations have recommended against the use of marijuana in glaucoma.” 

Alternative therapies (18:20)

Complementary therapies can be useful when they go hand-in-hand with standard treatments.

Ayurvedic medicine, for instance, is a traditional Indian medicine that involves restoring balance in the body. Yoga, acupuncture, massage, and herbs and spices may be used. Ertel recommends using herbs as part of a diet and not as highly concentrated supplements, to avoid potential side effects.

Meditation can lower stress and anxiety associated with chronic disease. Increased stress can raise cortisol hormone that can raise IOP. Meditation can reduce stress hormones and IOP, and improve oxygen flow in the eye and brain. 

Managing emotions (22:05)

Adjusting to vision loss can be challenging, and may bring up various emotions—both unpleasant and pleasant, says Michael C. Smith, PsyD., a clinical psychologist at The Chicago Lighthouse Low Vision Clinic. It’s imperative, he says, to allow yourself to experience both types of emotions and to express them in healthy ways. Acceptance of your diagnosis is important, but the end goal is to live healthily with glaucoma from moment to moment. 

This can be challenging if not all your family members and friends are supportive, but Smith urges patients to “[f]ocus on living a healthy, engaged, and meaningful life.”

*Glaucoma Research Foundation. (2022, August 16). Living with Glaucoma: Presentations and Panel Discussion [Video file]. Retrieved from https://www.youtube.com/watch?v=xuN7ovO_TQE