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.
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.
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).
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: firstname.lastname@example.org).
Received May 13, 2018
Accepted September 7, 2018