More physical activity may lead to slower visual field loss in glaucoma

Older adults with suspect or manifest glaucoma experienced slower rates of visual field loss if they engaged in more walking and more time spent doing moderate to vigorous physical activity compared with patients who had a sedentary lifestyle, according to a study.

Perspective from L. Jay Katz, MD

The longitudinal, observational study included 141 patients with glaucoma between the ages of 60 and 80 years. The patients wore accelerometers for 1 week to measure their average steps per day, general activity level and minutes of non-sedentary activity. Measurements were taken throughout the study period to determine visual field loss.

The average number of steps per day was 5,613, and the unadjusted average rate of visual field loss, measured by pointwise visual field sensitivity, was 0.36 dB per year.

Each increase of 1,000 steps per day was associated with less sensitivity loss over time, and each 10-minute increase in moderate to vigorous physical activity was associated with a slower annual rate of visual field decline (+0.003 dB per year).

A faster decline in sensitivity was found with older age, non-white race, history of cataract surgery, history of glaucoma surgery and worse baseline severity.

“These findings suggest the need for clinical trials examining the association between physical activity and glaucomatous [visual field] loss to determine if interventions to increase physical activity may have a beneficial role in patients with glaucoma,” the study authors wrote. – by Robert Linnehan

Disclosures: Lee reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Perspective

L. Jay Katz, MD

This feeds into the whole issue of patients who would like to have the ability to modify something in their lifestyle that might help in the outcome of their care. This research project suggests that leading a more active life, exercising, or walking seems to be beneficial in slowing the rate of deterioration of disease. People have talked in the past about exercise lowering eye pressure and maybe having some role in improving ocular circulation by enhancement of cardiovascular activity. It has been thought that having underperfusion of the optic nerve is a risk factor for glaucoma development and progression. People with very low blood pressure have a higher prevalence of glaucoma. Also, with exercise there may be a release of certain endogenous molecules that have a beneficial effect on resuscitating or enhancing the metabolic activity of retinal ganglion cells and neurons that comprise the optic nerve that may be damaged by glaucoma. They may be more resistant to dying or be more functional with the release of these substances after regular exercise.
I’m not sure how the investigators chose their parameter cutoffs, but nevertheless there is a dividing line that seems to demarcate patients into subgroups that suggests there is a benefit to being physically active. That is exciting, and as the authors stated, there should be more research to confirm their preliminary findings. The message that exercise may be helpful in stabilizing glaucoma may be shared with our patients. Apart from their conventional glaucoma care that lowers intraocular pressure, there may be a cardiovascular and ocular benefit of being physically active.

L. Jay Katz, MD

Director Emeritus Wills Eye Glaucoma Service, Wills Eye Hospital

Philadelphia

Disclosures: Katz reports no relevant financial disclosures.

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Sources/Disclosures

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Source:

Lee MJ, et al. Ophthalmology. 2018;doi:10.1016/j.ophtha.2018.10.012.