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Mindfulness Meditation Reduces Intraocular Pressure, Lowers Stress Biomarkers and Modulates Gene Expression in Glaucoma

A Randomized Controlled Trial

Dada, Tanuj, MD*; Mittal, Deepti, MD*; Mohanty, Kuldeep, PhD*,†; Faiq, Muneeb A., PhD*,†; Bhat, Muzaffer A., MSc; Yadav, Raj K., MD; Sihota, Ramanjit, MD*; Sidhu, Talvir, MD*; Velpandian, Thirumurthy, PhD*; Kalaivani, Mani, PhD§; Pandey, Ravindra M., PhD§; Gao, Ying, MSc; Sabel, Bernhard A., PhD; Dada, Rima, MD, PhD

doi: 10.1097/IJG.0000000000001088
Original Studies

Background: Reducing intraocular pressure (IOP) in primary open-angle glaucoma (POAG) is currently the only approach to prevent further optic nerve head damage. However, other mechanisms such as ischemia, oxidative stress, glutamate excitotoxicity, neurotrophin loss, inflammation/glial activation, and vascular dysregulation are not addressed. Because stress is a key risk factor affecting these mechanisms, we evaluated whether mindfulness-based stress reduction can lower IOP and normalize typical stress biomarkers.

Materials and Methods: In a prospective, randomized trial 90 POAG patients (180 eyes; age above 45 y) were assigned to a waitlist control or mindfulness meditation group which practiced daily for 21 days. We measured IOP (primary endpoint), quality of life (QOL), stress-related serum biomarkers [cortisol, β-endorphins, IL6, TNF-α, brain-derived neurotrophic factor (BDNF), reactive oxygen species (ROS), total antioxidant capacity (TAC)], and whole genome expression.

Results: Between-group comparisons revealed significantly lowered IOP in meditators (OD: 18.8 to 12.7, OS 19.0 to 13.1 mm Hg) which correlated with significantly lowered stress-biomarker levels including cortisol (497.3 to 392.3 ng/mL), IL6 (2.8 to 1.5 ng/mL), TNF-α (57.1 to 45.4 pg/mL), ROS (1625 to 987 RLU/min/104 neutrophils), and elevated β-endorphins (38.4 to 52.7 pg/mL), BDNF (56.1 to 83.9 ng/mL), and TAC (5.9 to 9.3) (all P<0.001). These changes correlated well with gene expression profiling. Meditators improved in QOL (P<0.05).

Conclusions: A short course of mindfulness-based stress reduction by meditation in POAG, reduces IOP, improves QOL, normalizes stress biomarkers, and positively modifies gene expression. Mindfulness meditation can be recommended as adjunctive therapy for POAG.

*Dr. Rajendra Prasad Centre for Ophthalmic Sciences

Laboratory for Molecular Reproduction and Genetics, Department of Anatomy

Department of Physiology

§Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi

Institute of Medical Psychology, Otto-von-Guericke University of Magdeburg, Medical Faculty, Magdeburg, Germany

Registration No. CTRI/2014/12/005301; Dated: December 16, 2014; Registry: Clinical Trial Registry of India (registered with the World Health Organization).

Supported by funds and grant from the Ministry of AYUSH, Government of India, via grant no.: Z.28105/230/2015-HPC (EMR)-AYUSH-B.

Disclosure: The authors declare no conflict of interest.

Reprints: Tanuj Dada, MD, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India (e-mail: tanujdada@gmail.com).

Received May 13, 2018

Accepted September 7, 2018

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