Glaucoma surgeons often field questions from patients regarding health and lifestyle practices. Examples of inquiries include the following:

  • “Are there vitamins or supplements I can take to prevent glaucoma?”
  • “What kind of exercises can I perform?”
  • “Can stress affect my glaucoma?” and
  • “Does marijuana help with glaucoma?”

Patients may receive short answers or generalized guidance such as, “Eat healthy, exercise regularly, and try to relax.” Understandably, they may feel uncertain about these vague instructions and unclear on what is best for their eye health. The challenge for glaucoma specialists is that it can be difficult to answer the questions definitively. We practice evidence-based medicine, meaning that any recommendation we make to patients is supported by substantial data. Research on lifestyle and glaucoma, however, is limited.

To make the situation more complex, we still do not fully understand glaucoma. It is not just one eye condition but a group of eye conditions that damage the optic nerve. Some patients have increased IOP, whereas others have normal IOP and abnormal blood flow to the optic nerve. Until we understand glaucoma well enough to make conclusive lifestyle recommendations, some general wellness principles can be adopted by patients looking to optimize their health.

Nutritionist and wellness expert Nancy Lin, PhD, separates healthy living into five pillars: (1) physical, (2) nutritional, (3) environmental, (4) mental/emotional, and (5) spiritual. This article reviews each pillar as it relates to glaucoma and provides recommendations based on the information that is currently available.

PHYSICAL

Patients with glaucoma should strive to follow three key physical recommendations: (1) keep their head above their heart, (2) avoid sustained Valsalva maneuvers, and (3) perform aerobic exercise.

IOP fluctuates throughout the day. A study of healthy individuals showed that, during business hours or the time when patients with glaucoma were examined in the clinic, their IOP did not exceed 20 mm Hg.1 Overnight, however, IOP increased to the middle 20s mm Hg. Such elevations in IOP appear to occur nocturnally because of the head and body positions during sleep. To minimize this effect, patients with rapid visual field progression despite adequate IOP control in clinic can try to keep their heads elevated when sleeping by either stacking pillows or elevating the head of the bed.2

Patients with glaucoma should avoid exercises during which their head is below their heart, such as the downward dog yoga pose and headstands.3 I once saw a patient with advanced glaucoma who mentioned he regularly did headstands. I asked him if he could do one in the clinic so that we could measure his IOP. When he was inverted, his IOP increased from 15 to 33 mm Hg.

Patients with glaucoma should also avoid a sustained Valsalva maneuver (a forceful exhalation against a closed airway), which can increase IOP. Patients with advanced glaucoma or with a high risk of progression should steer clear of lifting heavy weights, playing wind instruments such as the saxophone or the didgeridoo, straining to defecate, etc.

Aerobic exercise is advisable for patients with glaucoma. Any type of cardiovascular activity—jogging, biking, tennis, pickle ball, etc—is beneficial not only for eye health but also for overall health.

NUTRITIONAL

Some dietary modifications can help optimize health for glaucoma and in general.

To Consume

Flavonoids have been shown to prevent glaucomatous progression and increase blood flow to the optic nerve, making them ideal for patients with glaucoma.4 These chemicals are found in fruits and vegetables, especially red and purple produce such as berries, red onions, and radishes. Other foods rich in flavonoids include legumes, lentils, chickpeas, caffeinated teas, and dark chocolate.

Another valuable dietary component for patients with glaucoma is nitric oxide (NO). Studies have shown that NO may play a role in the regulation of IOP by increasing outflow.5,6 NO can be found in dark, leafy green vegetables such as spinach and kale as well as in celery, beets, citrus, eggplant, and dark chocolate.

Patients with glaucoma can also consider regular consumption of omega-3, especially docosahexaenoic and eicosapentaenoic acids. These fatty acids can be found in walnuts, seafood (eg, wild salmon, tuna, sardines, oysters), and sea algae.

To Avoid

Saturated fats, trans fats, and complex carbohydrates have been shown to decrease blood flow and build plaque on the arteries. In general, individuals should monitor their consumption of red meat, processed meats, dairy products, fried foods, potatoes, bread, rice, and pasta. Life is short, but patients looking to address their overall health can watch their intake of these foods.

A big point of discussion regarding healthy habits for glaucoma has centered on the consumption of coffee. The research is conflicting: Coffee has been shown to increase IOP in the short term, but it also provides the benefit of increased blood flow.7 One or two cups of coffee per day is likely acceptable, but patients with severe glaucoma may want to limit their caffeine intake.

ENVIRONMENTAL

Smoking is a concern for both eye and general health. Cigarettes and cigars contain nicotine, which is associated with elevated IOP.8 Secondhand smoke exposure can produce harmful effects as well. Vaping and chewing tobacco can also increase IOP.9 In addition, smoking can cause irritation and dry eye.10 Patients with glaucoma may already experience these side effects from their eye drops, and smoking may exacerbate the problem.

The use of marijuana is probably the leading hot topic regarding lifestyle and glaucoma. Studies have shown that marijuana may lower IOP, but the duration of action is short (about 3–4 hours).11 A sustained effect would require continuous use, which would prohibit driving and working and thus be unsustainable. Data on this subject are accumulating, but marijuana use currently is not recommended for glaucoma. Note: Patients who smoke marijuana should not do so before an eye care appointment to avoid artificially low IOP readings.

Long-term lead exposure may be a risk factor for glaucoma. Patients who work or have worked in industries such as painting, toy making, furniture building, jewelry making, cosmetics, food, and plumbing may consider undergoing a blood test to evaluate potential lead exposure.

MENTAL/EMOTIONAL

Mental and emotional well-being are important considerations. Studies of stress and glaucoma are lacking, but evidence suggests that stress and anxiety can increase heart rate and IOP. Further, the stress hormone cortisol is known to increase IOP.12 Yoga, breathing exercises, and meditation may all help to increase blood flow and decrease IOP.

SPIRITUAL

I tell my patients that any spiritual pursuit that brings them into their Zen mode and lowers their stress levels is advisable for several reasons, including potential benefits for glaucoma.

SUMMARY

Patients with glaucoma can maintain a normal lifestyle. Moderation is key, as are patients’ partnerships with their physicians. Glaucoma is often referred to as the silent thief of sight. Physicians may see subtle changes in the office that patients may not notice at home, and vice versa. Open lines of communication are essential for all members of the care team.

1. Liu JHK, Mansouri K, Weinreb RN. Estimation of 24-hour intraocular pressure peak timing and variation using a contact lens sensor. PLoS One. 2015;10(6):e0129529.

2. Buys YM, Alasbali T, Jin YP, et al. Effect of sleeping in a head-up position on intraocular pressure in patients with glaucoma. Ophthalmology. 2010;117(7):1348-1351.

3. Chetry D, Singh J, Chhetri A, Katiyar VK, Singh DS. Effect of yoga on intra-ocular pressure in patients with glaucoma: a systematic review and meta-analysis. Indian J Ophthalmol. 2023;71(5):1757-1765.

4. Loskutova E, O’Brien C, Loskutov I, Loughman J. Nutritional supplementation in the treatment of glaucoma: a systematic review. Surv Ophthalmol. 2019;64(2):195-216.

5. Ramdas WD. The relation between dietary intake and glaucoma: a systematic review. Acta Ophthalmol. 2018;96(6):550-556.

6. Kang JH, Willett WC, Rosner BA, et al. 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.

7. Kim J, Aschard H, Kang JH, et al. Intraocular pressure, glaucoma, and dietary caffeine consumption. Ophthalmology. 2021;128(6):866-876.

8. Lee CS, Owen JP, Yanagihara RT, et al. Smoking is associated with higher intraocular pressure regardless of glaucoma. Ophthalmol Glaucoma. 2020;3(4):253-261.

9. Golla A, Chen A, Tseng VL, et al. Association between e-cigarette use and visual impairment in the United States. Am J Ophthalmol. 2022;235:229-240.

10. Stapleton F, Abad JC, Barabino S, et al. TFOS lifestyle: impact of societal challenges on the ocular surface. Ocul Surf. 2023;28:165-199.

11. Green K. Marijuana smoking vs cannabinoids for glaucoma therapy. Arch Ophthalmol. 1998;116(11):1433-1437.

12. Abe RY, Silva TC, Dantas I, et al. Can psychologic stress elevate intraocular pressure in healthy individuals? Ophthalmol Glaucoma. 2020;3(6):426-433.