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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, PhD

doi: 10.1097/IJG.0000000000001088
Original Study: PDF Only

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 if mindfulness based stress reduction (MBSR) can lower IOP and normalize typical stress biomarkers.

Methods: In a prospective, randomized trial 90 POAG patients (180 eyes; age>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, BDNF, ROS, 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 values < 0.001]. These changes correlated well with gene-expression profiling. Meditators improved in QOL (P-value < 0.05).

Conclusion: A short course of MBSR 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, All India Institute of Medical Sciences, New Delhi-110029, India

Laboratory for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences, New Delhi-110029, India

Medical Biotechnology Laboratory, Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi-110007, India

§NYU Langone Eye Center, Department of Ophthalmology, NYU School of Medicine, NYU Langone Health, New York University, New York, USA

Department of Physiology, All India Institute of Medical Sciences, New Delhi-110029, India

Integrated Health Clinic, Department of Physiology, All India Institute of Medical Sciences, New Delhi-110029, India

#Ocular Pharmacology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi-110029, India

**Department of Biostatistics, All India Institute of Medical Sciences, New Delhi-110029, India

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

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

FUNDING: This study was supported by funds and grant from the Ministry of AYUSH, Government of India, via Grant No: Z.28105/230/2015-HPC (EMR)-AYUSH-B. However, the funding authority had no role to play in the design of the study and collection, analyses and interpretation of data and in writing the manuscript.

COMPETING INTERESTS: All 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), Muneeb A. Faiq: muneeb1983@gmail.com and Rima Dada: rima_dada@rediffmail.com

Received May 13, 2018

Accepted September 7, 2018

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