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Intraocular pressure (IOP) lowering is the primary focus of glaucoma management. However, many patients often want to know what else they can do to reduce their glaucoma risk or help control their disease. Below is a summary of lifestyle and dietary factors that may be beneficial for some patients with glaucoma. It is vital to remember that the following dietary advice is to be used along with your usual glaucoma therapy, not instead of it. Please consult with your ophthalmologist with any queries.

Lifestyle and Glaucoma

People with glaucoma should not be concerned about the vast majority of activities, and should generally continue to do the things they love. However, those with more advanced glaucoma should consider limiting the following activities:

Yoga

Yoga positions, especially those with the head below or at level with the heart, can be associated with increased IOP. 1 Yoga practitioners with glaucoma can continue their yoga but it is best to avoid these positions.

Wind instruments

Some wind instruments, e.g. bagpipes, trumpet, trombone, are associated with increasing pressure around the face and upper airways – this causes raised IOP and can be harmful in glaucoma. These should be used with caution among people with glaucoma (especially advanced glaucoma).

Other wind instruments played with less force e.g. flute, clarinet, are quite safe.

Swimming

Swimming goggles have been shown to increase IOP while they are on.2 Smaller goggles that sink inside the eye socket are of most concern. Larger snorkelling-type goggles are safer with less impact on eye pressure and should be worn in preference to smaller ones. However, repeated use of goggles has not been proven to be a risk for glaucoma.

Neck ties

If you wear closed collars (with ties for example) be careful not to have them too tight as this increases pressure in the veins of your head and neck and thus increases eye pressure too.

Air travel

Flying has no effect on someone with glaucoma, other than a mild temporary elevation in IOP which is generally safe.

Diet and Glaucoma

Fruit and Vegetables

Antioxidants and nitrates may reduce glaucoma risk and are found in fruits and vegetables. It is best to eat plenty of fruits and vegetables, especially those that are rich in Vitamin A and C, carotenes and nitrates. These include green leafy vegetables, carrots, cruciate vegetables, berries, citrus fruits and peaches. 3,4

Carbohydrates

Recent studies have shown that low-carbohydrate diets could not be conclusively associated with risk of Primary open-angle glaucoma (POAG). However, higher consumption of fat and protein from plant –based sources substituting for carbohydrates may reduce your risk of early peripheral field loss23.

Vitamin B3

While the evidence is not too strong, it appears that Vitamin B3 might be beneficial in preventing glaucoma, and low levels of B3 might be harmful. 5,6 This does not necessarily mean oral supplements be taken – most Australians get sufficient B3 in a standard diet. Foods rich in B3 include turkey, chicken, peanuts, mushrooms, liver and tuna, and Vegemite.

Omega-3 acids

Omega -3 fatty acids, found in oily fish (eg. salmon) and chia, has been shown to lower rates of glaucoma.7

Caffeine

Drinking coffee or other caffeinated drinks can raise your eye pressure for about two hours.8 Caffeine is thought to increase the production of fluid (aqueous) within the eye. This short-term increase does not cause any problem for most people, but those with a strong family history or advanced glaucoma should consider reducing their caffeine intake if it exceeds the equivalent of 3-5 cups of coffee per day. 9 De-caffeinated drinks may be considered as a safer option.

Tea

Caffeine levels in tea are low and there is no additional risk from consuming tea. In fact, tea drinkers (one cup per day) may have lower rates of glaucoma compared with non-tea drinkers. 10 Tea contains flavonoids that may reduce glaucoma risk by improving blood flow to the optic nerve. 11

Dark chocolate

Dark chocolate also contains flavonoids and has been proven to be beneficial in patients with vascular and cardiovascular diseases. Further research is required to see whether there is any benefit for glaucoma patients. 12

Alcohol

Red wine consumption in moderation may be associated with reduced glaucoma risk, but further studies are required to confirm this. 13 Grapes have a number of antioxidants that may improve blood flow to the optic nerve.14

Water

Water is the essence of life and it is very important to stay well hydrated. However too much volume of water in a short interval may transiently increase eye pressure. We suggest more frequent, smaller volumes spread over a greater time period.

Obesity

Obesity is linked with raised eye pressure.15 Maintaining a healthy weight is beneficial to prevent many diseases, not just glaucoma.

Oral Supplements

There are no proven benefits for using dietary supplements in glaucoma patients. 16 Some patients with glaucoma will also have macular degeneration. These patients may be advised to take oral supplements to protect their macula.

As always, moderation is the best approach and this should be applied to all of the above dietary suggestions.

Exercise and Glaucoma

There is evidence to suggest that regular moderate to vigorous-intensity exercise such as brisk walking or jogging can reduce intraocular pressure which could be beneficial for people with glaucoma 17-21

However before embarking on an exercise program to improve your eye health, consult with your ophthalmologist. People with less common eye conditions namely pigmentary dispersion syndrome (PDS) or pigmentary glaucoma (PG) may be at risk of raised intraocular pressure and worsening glaucoma when engaging in jogging or jarring types of exercise.22

References

1. Jasien JV, Jonas JB, de Moraes CG, Ritch R. Intraocular Pressure Rise in Subjects with and without Glaucoma during Four Common YogaPositions. PLoS One. 2015 Dec 23;10(12):e0144505.
2. Paula AP1, Paula JS, Silva MJ, Rocha EM, De Moraes CG, Rodrigues ML. Effects of Swimming Goggles Wearing on Intraocular Pressure, Ocular Perfusion Pressure, and Ocular Pulse Amplitude. J Glaucoma. 2016 Oct;25(10):860-864.
3. Giaconi JA, Yu F, Stone KL, et al. The association of consumption of fruits/vegetables with decreased risk of glaucoma among older African-American women in the study of osteoporotic fractures. Am J Ophthalmol. 2012;154(4):635–44. 

4. Kang JH, Willett WC, Rosner BA, Buys E, Wiggs JL, Pasquale LR. Association of dietary nitrate intake with primary open-angle glaucoma: a prospective analysis from the nurses’ health study and health professionals’ follow-up study. JAMA Ophthalmol. 2016;134(3):294–303
5. Jung KI, Kim YC and Park CK. Dietary Niacin and Open-Angle Glaucoma: The Korean National Health and Nutrition Examination Survey. Nutrients. 2018; 10.
6. Williams PA, Harder JM, Foxworth NE, et al. Vitamin B3 modulates mitochondrial vulnerability and prevents glaucoma in aged mice. Science. 2017; 355: 756-60.
7. Wang YE, Tseng VL, Yu F, Caprioli J and Coleman AL. Association of Dietary Fatty Acid Intake With Glaucoma in the United States. JAMA ophthalmology. 2018; 136: 141-7.
8. Avisar R, Avisar E and Weinberger D. Effect of coffee consumption on intraocular pressure. 2002. Ann Pharmacother 36: 992–995.
9. Kang J, Willett W, Rosner B, et al. Caffeine consumption and the risk of primary open-angle glaucoma: a prospective cohort study. Invest Ophthalmol Vis Sci 2008;49:1924– 1931.
10. Wu CM, Wu AM, Tseng VL, Yu F, Coleman AL. Frequency of a diagnosis of glaucoma in individuals who consume coffee, tea and/or soft drinks. Br J Ophthalmol. 2017. 310924 [Epub ahead of print]
11. Milea D, Aung T. Flavonoids and glaucoma: revisiting therapies from the past. Graefes Arch Clin Exp Ophthalmol. 2015;253(11):1839–40. 

12. Al Owaifeer AM, Al Taisan AA. The role of diet in glaucoma: a review of the current evidence. Ophthalmol Ther. 2018;7:19-31
13. Kojima S, Sugiyama T, Kojima M, Azuma I, Ito S. Effect of the consumption of ethanol on the microcirculation of the human optic nerve head in the acute phase. Jpn J Ophthalmol. 2000;44(3):318–9. 

14. Luna C, Li G, Liton PB, Qiu J, Epstein DL, Challa P, et al. Resveratrol prevents the expression of glaucoma markers induced by chronic oxidative stress in trabecular meshwork cells. Food Chem Toxicol. 2009;47:198–204.
15. Kim HT, Kim JM, Kim JH, et al. Relationships between anthropometric measurements and intraocular pressure: the Korea National Health and Nutrition Examination Survey. Am J Ophthalmol. 2017;173:23–33. 

16. Garcia-Medina JJ, Garcia-Medina M, Garrido-Fer- nandez P, et al. A two-year follow-up of oral antioxidant supplementation in primary open-angle glaucoma: an open-label, randomized, controlled trial. Acta Ophthalmol. 2015;93(6):546–54.
17. 1.Karabatakis VE, Natsis KI, Chatzibalis TE, et al. Correlating intraocular pressure, blood pressure, and heart rate changes after jogging. Eur J Ophthalmol. 2004;14:117–122.
18. Kiuchi Y, Mishima HK, Hotehama Y, Furumoto A, Hirota A, Onari K. Exercise intensity determines the magnitude of IOP decrease after running. Jpn J Ophthalmol. 1994;38:191–195.
19. Qureshi IA, Xi XR, Wu XD, Zhang J, Shiarkar E. The effect of physical fitness on intraocular pressure in Chinese medical students.
20. Zhonghua yi xue za zhi= Chinese medical journal; Free China ed 58 (5), 317-322, 1996
21. Williams PT. Relationship of Incident Glaucoma versus Physical Activity and Fitness in Male Runners. Med Sci Sports Exerc. 2009 August ; 41(8): 1566–1572.
22. Haynes WL1, Johnson AT, Alward WL. Effects of jogging exercise on patients with the pigmentary dispersion syndrome and pigmentary glaucoma. Ophthalmology. 1992 Jul;99(7):1096-103.
23.Hanyuda, A., Rosner, B.A., Wiggs, J.L. et al.2020 Low-carbohydrate-diet scores and the risk of primary open-angle glaucoma: data from three US cohorts. Eye 34, 1465–1475.