The Effect of Yoga on Intraocular Pressure Using the “iCare HOME2” Tonometer

Abstract

Background Various yoga positions may have an unfavorable impact on intraocular pressure (IOP) and may therefore be seen as a potential risk factor for the progression of glaucoma. The new “iCare HOME2” is a handheld self-tonometer for IOP measurements outside clinical settings. This is the first study to evaluate the immediate effect of common yoga postures on the IOP of healthy and glaucomatous eyes using the “iCare HOME2” self-tonometer and to compare the time of IOP recovery in both groups.

Methods This is a single-center, prospective, observational study including 25 healthy and 25 glaucoma patients performing the following yoga positions: “legs up” (Viparita Karani), “bend over” (Uttanasana), “plough pose” (Halasana), and the “down face dog” (Adho Mukha Svanasana) for 90 s each, with a 2-min break in between. IOP was measured with the “iCare HOME2” before, during, and after each position.

Results IOP significantly increased in all eyes in all positions (p < 0.05), showing no statistically significant difference between healthy or glaucomatous eyes (p > 0.05). The mean rise in IOP in healthy subjects was 1.6 mmHg (SD 1.42; p = 0.037), 14.4 mmHg (SD 4.48; p < 0.001), 7.5 mmHg (SD 4.21; p < 0.001), and 16.5 mmHg (SD 3.71; p < 0.001), whereas in glaucoma patients, IOP rose by 2.8 mmHg (SD 2.8; p = 0.017), 11.6 mmHg (SD 3.86; p < 0.001), 6.0 mmHg (SD 2.24; p < 0.001), and 15.1 mmHg (SD 4.44; p < 0.001) during the above listed yoga positions, repsectively. The highest increase in IOP was seen in the down face position, reaching mean IOP values above 31 mmHg in both study groups. IOP elevation was observed immediately after assuming the yoga position, with no significant change during the following 90 s of holding each pose (p > 0.05). All IOP values returned to baseline level in all individuals, with no significant difference between healthy and glaucoma participants.

Conclusion Our data show that common yoga positions can lead to an acute IOP elevation of up to 31 mmHg in healthy as well as glaucoma eyes, with higher IOP values during head-down positions. Given that IOP peaks are a major risk factor for glaucomatous optic neuropathy, we generally advise glaucoma patients to carefully choose their yoga exercises. If and to what extent practicing yoga leads to glaucoma progression, however, remains unclear and warrants further research.

Zusammenfassung

Hintergrund Einige Yoga-Positionen haben einen erhöhenden Effekt auf den Intraokular Druck (IOD) gezeigt und könnten demnach als potenzieller Risikofaktor für die Progression eines Glaukoms erachtet werden. Das „iCare HOME2“ ist ein Handtonometer, das für die Ermittlung des Augeninnendrucks außerhalb klinischer Rahmenbedingungen eingesetzt werden kann. Dies ist die erste Studie, die den Effekt von 4 geläufigen Yoga-Positionen auf den IOD von gesunden und Glaukomaugen mit einem „iCare HOME2“ untersucht und die Erholungszeit zwischen den Gruppen vergleicht.

Methodik Dies ist eine monozentrische, prospektive, Beobachtungsstudie mit 25 gesunden und 25 Glaukompatienten, welche die folgenden Yoga-Positionen durchführen: „Umkehrhaltung“ (Viparita Karani), „stehende Kopf-Knie-Stellung“ (Uttanasana), „Pflugstellung“ (Halasana), „herabschauender Hund“ (Adho Mukha Svanasana). Jede Pose wird für 90 s gehalten, mit einer 2-minütigen Pause dazwischen. IOD-Werte werden mit einem „iCare HOME2“ vor, während und nach jeder Position gemessen.

Resultate Der IOD stieg in allen Augen in allen Positionen signifikant an (p < 0,05), ohne signifikanten Unterschied zwischen gesunden und glaukomatösen Teilnehmern (p > 0,05). Während den oben aufgeführten Yoga-Stellungen betrug der durchschnittliche IOD-Anstieg in gesunden Probanden 1,6 mmHg (SD 1,42; p = 0,037), 14,4 mmHg (SD 4,48; p < 0,001), 7,5 mmHg (SD 4,21; p < 0,001) und 16,5 mmHg (SD 3,71; p < 0,001), und bei Glaukompatienten 2,8 mmHg (SD 2,8; p = 0,017), 11,6 mmHg (SD 3,86; p < 0,001), 6,0 mmHg (SD 2,24; p < 0,001) und 15,1 mmHg (SD 4,44; p < 0,001). Der höchste IOD-Anstieg konnte im „herabschauenden Hund“ nachgewiesen werden, wobei in beiden Untersuchungsgruppen Druckwerte über 31 mmHg erreicht wurden. Es erfolgte jeweils ein umgehender IOD-Anstieg, ohne eine weitere signifikante Erhöhung, solange die Position gehalten wurde (p > 0,05). Die IOD-Werte kehrten bei allen Teilnehmern auf den Ausgangswert zurück, ohne signifikanten Unterschied zwischen beiden Gruppen (p > 0,05).

Schlussfolgerung Herkömmliche Yoga-Positionen führen zu einem akuten IOD-Anstieg in gesunden und Glaukompatienten, wobei höhere Augendruckwerte in Kopfüberpositionen verzeichnet wurden. Angesichts der akuten IOD-Spitzen und dem hiermit verbundenen Risiko einer Glaukomprogression, empfehlen wir den Glaukompatienten ihre Yoga-Übungen mit Vorsicht auszuwählen. Inwiefern das Praktizieren von Yoga jedoch zu einer glaukomatösen Nervenschädigung führt, bleibt ungewiss.

Key words

intraocular pressure - yoga-sports - glaucoma - iCare HOME2 - self-tonometer

Schlüsselwörter

Augendruck - Yoga - Glaukom - iCare HOME2 - iCare home

• References

• 1 Kim YW, Park KH. Exogenous influences on intraocular pressure. Br J Ophthalmol 2019; 103: 1209-1216
• 2 Wagner IV, Stewart MW, Dorairaj SK. Updates on the Diagnosis and Management of Glaucoma. Mayo Clin Proc Innov Qual Outcomes 2022; 6: 618-635
• 3 Stein JD, Khawaja AP, Weizer JS. Glaucoma in Adults-Screening, Diagnosis, and Management: A Review. JAMA 2021; 325: 164-174
• 4 Matlach J, Bender S, König J. et al. Investigation of intraocular pressure fluctuation as a risk factor of glaucoma progression. Clin Ophthalmol 2019; 13: 9-16
• 5 Quérat L, Chen E. Monitoring daily intraocular pressure fluctuations with self-tonometry in healthy subjects. Acta Ophthalmol 2017; 95: 525-529
• 6 Ismail AMA, Abd Elfatah Abo Saif HF, El-Moatasem Mohamed AM. Effect of Jyoti-Trataka on intraocular pressure, autonomic control, and blood glucose in diabetic patients with high-tension primary open-angle glaucoma: a randomized-controlled trial. J Complement Integr Med 2022; 19: 1013-1018
• 7 Udenia H, Mittal S, Agrawal A. et al. Yogic Pranayama and Diaphragmatic Breathing: Adjunct Therapy for Intraocular Pressure in Patients With Primary Open-angle Glaucoma: A Randomized Controlled Trial. J Glaucoma 2021; 30: 115-123
• 8 Jasien JV, Jonas JB, de Moraes CG. et al. Intraocular Pressure Rise in Subjects with and without Glaucoma during Four Common Yoga Positions. PLoS One 2015; 10: e0144505
• 9 Baskaran M, Raman K, Ramani KK. et al. Intraocular pressure changes and ocular biometry during Sirsasana (headstand posture) in yoga practitioners. Ophthalmology 2006; 113: 1327-1332
• 10 Hirooka K, Shiraga F. Relationship between postural change of the intraocular pressure and visual field loss in primary open-angle glaucoma. J Glaucoma 2003; 12: 379-382
• 11 Prata TS, De Moraes CG, Kanadani FN. et al. Posture-induced intraocular pressure changes: considerations regarding body position in glaucoma patients. Surv Ophthalmol 2010; 55: 445-453
• 12 Carlson KH, McLaren JW, Topper JE. et al. Effect of body position on intraocular pressure and aqueous flow. Invest Ophthalmol Vis Sci 1987; 28: 1346-1352
• 13 Barkana Y, Dorairaj S. Re: Tham et al.: Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis (Ophthalmology 2014; 121:2081–2090). Ophthalmology 2015; 122: e40-e41
• 14 Quérat L, Chen E. iCare Home vs. Goldmann applanation tonometry: Agreement of methods and comparison of inter-observer variation at a tertiary eye centre. Eur J Ophthalmol 2023; 33: 312-318
• 15 Grouven U, Bender R, Ziegler A. et al. [Comparing methods of measurement]. Dtsch Med Wochenschr 2007; 132 (Suppl. 1) e69-e73
• 16 de Barros DS, Bazzaz S, Gheith ME. et al. Progressive optic neuropathy in congenital glaucoma associated with the Sirsasana yoga posture. Ophthalmic Surg Lasers Imaging 2008; 39: 339-340
• 17 Bertschinger DR, Mendrinos E, Dosso A. Yoga can be dangerous–glaucomatous visual field defect worsening due to postural yoga. Br J Ophthalmol 2007; 91: 1413-1414
• 18 Chetry D, Singh J, Chhetri A. et al. Effect of yoga on intra-ocular pressure in patients with glaucoma: A systematic review and meta-analysis. Indian J Ophthalmol 2023; 71: 1757-1765
• 19 Klein BE, Klein R, Knudtson MD. Intraocular pressure and systemic blood pressure: longitudinal perspective: the Beaver Dam Eye Study. Br J Ophthalmol 2005; 89: 284-287
• 20 Friberg TR, Sanborn G, Weinreb RN. Intraocular and episcleral venous pressure increase during inverted posture. Am J Ophthalmol 1987; 103: 523-526
• 21 Goldmann H. [Out-flow pressure, minute volume and resistance of the anterior chamber flow in man]. Doc Ophthalmol 1951; 5 – 6: 278-356
• 22 Bill A. The aqueous humor drainage mechanism in the cynomolgus monkey (Macaca irus) with evidence for unconventional routes. Invest Ophthalmol 1965; 4: 911-919
• 23 Liu J, De Francesco T, Schlenker M. et al. Icare Home Tonometer: A Review of Characteristics and Clinical Utility. Clin Ophthalmol 2020; 14: 4031-4045
• 24 Mudie LI, LaBarre S, Varadaraj V. et al. The Icare HOME (TA022) Study: Performance of an Intraocular Pressure Measuring Device for Self-Tonometry by Glaucoma Patients. Ophthalmology 2016; 123: 1675-1684
• 25 Sawada A, Yamamoto T. Posture-induced intraocular pressure changes in eyes with open-angle glaucoma, primary angle closure with or without glaucoma medications, and control eyes. Invest Ophthalmol Vis Sci 2012; 53: 7631-7635
• 26 Iliev ME, Goldblum D, Katsoulis K. et al. Comparison of rebound tonometry with Goldmann applanation tonometry and correlation with central corneal thickness. Br J Ophthalmol 2006; 90: 833-835
• 27 Segal P, Gebicki L, Janiszewski S. et al. Intraocular pressure during pressure breathing. II. Glaucoma. Am J Ophthalmol 1967; 64: 965-968
• 28 Cramer H. [Yoga in Germany – Results of a Nationally Representative Survey]. Forsch Komplementmed 2015; 22: 304-310
• 29 Cramer H, Ward L, Steel A. et al. Prevalence, Patterns, and Predictors of Yoga Use: Results of a U.S. Nationally Representative Survey. Am J Prev Med 2016; 50: 230-235