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 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.
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 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.
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.
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
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 fatty acids, found in oily fish (eg. salmon) and chia, has been shown to lower rates of glaucoma.7
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.
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 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
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 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 is linked with raised eye pressure.15 Maintaining a healthy weight is beneficial to prevent many diseases, not just glaucoma.
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
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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.