Glaucoma is a condition in eye, affecting sixty five million people worldwide making it a second leading cause for blindness.

Five years ago, being a house surgeon at medical school in the department of ophthalmology, gave me numerous exposures to cases of glaucoma. In Glaucoma, there is a cumulative increase in the fluid pressure in the eyeball resulting in the loss of peripheral vision of the eye. We were in charge of measuring the intra ocular pressure of patients with glaucoma, with a device called tonometry after instilling local anesthetic eye drops over the eye because the pressure in the eye is measured by slightly pressing the eyeball with this device. Usually the fluid ‘aqeous humor’ is produced by ciliary epithelium cells in the eye and is pumped out through a mesh like structures called the trabecular meshwork making the eyeball maintain its intraocular pressure at a normal range. However, if there is an increase in production or decrease in the outflow of the aqeous humor, it will result in building up of pressure of aqeous humor in the anterior chamber of the eyeball, resulting in glaucoma. In glaucoma, we will elicit a rise in intra-ocular pressure of more than 20 mmHg whereas in normal subjects we get an intraocular pressure below 15 mmHg with the tonometry device. Open angle glaucoma is a type of glaucoma, where there is a building up of intra ocular pressure in the eyeball, due to lack of outflow of the aqeous humor without a physical cause. This result in the condition called primary open angle glaucoma, where the patient can experience severe pain in eyes, peripheral loss of vision, nausea or vomiting and redness in the eye. Glaucoma is commonly observed in patients are who are more than forty year old, with diabetes mellitus or if they are on medications like steroid or even if they have a family history of glaucoma running in family. If we confirm glaucoma with our investigations, we prescribe medications like prostaglandin analogues, beta blockers and so on. If it doesn’t relieve with medication, we go for surgical or laser options.

In the mean time, I had a tremendous interest in the field of mind-body interventions like guided imagery and mindfulness. Mindfulness based stress reduction was an exciting topic of discussion with friends who had the similar interest, while being at our hostel. We’ve been practicing mindfulness meditation a month before our university exams as an excellent tool for reducing exam anxiety and stress, in which we had to bear stress while studying four major subjects like general medicine, surgery, pediatrics and Gynecology for university finals. An interesting observation we had was that, we experienced less stress and physical illness when we compared ourselves with our peers who were so much stressed out, having functional constipation, poor wound healing and headaches, while approaching university exams. This personal experience made us realize that mindfulness meditation had a tremendous impact on our mental and physical well being. So, what do you think mindfulness meditation can provide for the 65 million patients with glaucoma? From our personal experience, we definitely with no doubt realize that mindfulness meditation should be researched deeply as a mind-body tool and should be brought into clinical settings through community or clinical guidelines as an add on therapy for several other clinical disorders other than glaucoma. A group of researchers from All India Institute of Medical Sciences in New Delhi, India has conducted a randomized controlled trial on the effectiveness of Mindfulness meditation on primary open angle glaucoma which appeared in the Journal of Glaucoma in the late 2018. Mindfulness meditation is known very much for decreasing the mind wandering effect of the default mode network of the brain, helping patients to relax, reduce anxiety, stress and to improve quality of life. Moreover, the healthy impact of mindfulness on physiology is studied in terms of biochemical parameters like reduction of cortisols, inflammatory markers, glutamate excitotoxicity and altering of immune cell signaling. It is also correlated in neuroscience with increased blood flow to certain regions of the brain, increased neurotrophin levels and decreases psycho-physiological stress response. However, in this study, they accessed the benefits of mindfulness meditation on primary open angle glaucoma by using parameters like QOL (quality of living) for socio-psychological profiling, Intra ocular pressure measurement and Visual field testing for clinical correlation; Cortisol, Tumor necrosis factor, Beta endorphins, Interleukin 6 and Reactive oxygen species measurement for biochemical profiling and whole genomic profiling to study the impact of mindfulness meditation on gene expression.

The experimental model these researchers designed is so simple and scientific. They conducted a 21 day mindfulness meditation for 90 participants, starting from 8.oo am for one hour, under the supervision of a meditation teacher. For the first 15 minutes, patients were physically trained for relaxation and for the next 45 minutes they were trained for mindfulness meditation by guiding them to practice mindfulness. After the 21 days of intervention period, they discovered that; there was an improvement in quality of life when accessed with WHO questionnaire for QOL assessment, decrease in intraocular pressure in more than 75 % of participants by at least more than 25 % reduction in intra ocular pressure and there was a decrease in cortisol and beta endorphin in the mediators. This finding of reduction in intra ocular pressure is an added advantage for glaucoma patients who are struggling with pain, while on medications for reducing the raised intraocular pressure. It is well known that cortisols are usually produced in body in response to stress and beta endorphins are produced in response to pain in glaucoma. In the very same study it was also found out that these cortisols and beta endorphins levels were reduced with mindfulness meditation. Moreover, it was also found out that there was decrease in Tumor necrosis factor, interleukin 6 and Reactive oxygen species responsible for inflammation that made the glaucoma even worse. When coming to whole genomic profiling, around expression of 105 genes where studied in the randomized controlled trial in which they discovered that there was at least an up-regulation of 54 healthy genes and a down-regulation of 55 inflammation triggering  genes. However, there were no changes observed in the visual field in pre and post mediation settings. From the above study it is intriguing that mindfulness must be tested on other clinical disorders as well and should be brought out as an add on therapy or an mind-body intervention in clinical guidelines.