Eyeworld

66 | EYEWORLD | SUMMER 2025 G UCOMA References 1. Lin SC, et al. The relation between exercise and glaucoma in a South Korean popula- tion-based sample. PLoS One. 2017;12:e0171441. 2. Sterling J, et al. Glucagon-like peptide 1 receptor agonist use is associated with reduced risk for glaucoma. Br J Ophthalmol. 2023;107:215–220. 3. Kaplowitz K, et al. Relationship between sleep position and glau- coma progression. Curr Opin Ophthalmol. 2019;30:484–490. 4. Dada T, et al. Mindfulness meditation reduces intraoc- ular pressure, lowers stress biomarkers and modulates gene expression in glaucoma: a randomized controlled trial. J Glaucoma. 2018;27:1061–1067. Relevant disclosures Cui: None Ertel: None Lin: None Mansouri: AbbVie, Alcon, Implandata, iStar Medical, New World Medical, Santen, Théa Pharma, Zeiss Richter: None Contact Cui: Qi.Cui@pennmedicine.upenn.edu Ertel: monica.ertel@cuanschutz.edu Lin: sl@glaucomasf.com Mansouri: kwmansouri@gmail.com Richter: gracerichter@gmail.com Additionally, his group published a study that found that an excessive amount of exercise or intensity can increase glaucoma risk compared to moderate exercise. 1 Weight loss medications Qi Cui, MD, PhD, is a clinician-scientist who has focused a lot of her research on neuro-inflam- mation—how inflammation occurs in the eye and contributes to glaucoma pathogenesis. Like many, Dr. Cui became interested in GLP-1 receptor agonists, a diabetes drug that has garnered recent interest culturally for its weight loss effects. "We started looking at this class of medi- cation and found it's protective against retinal ganglion cell death in an animal model of glau- coma we use in the lab. From there we thought about how this class of medication may be pro- tective against glaucoma for human patients." In addition to decreasing activation of in- flammatory cells in the retina, Dr. Cui said these drugs decrease insulin resistance, and insulin may be protective in the eye. GLP-1 receptor ag- onists may also improve mitochondrial function and decrease oxidative stress, both of which have been shown to be beneficial in glaucoma. Dr. Cui said there have been multiple database studies looking at patients who were on these medications for diabetes or weight loss that found a decreased likelihood that these patients developed glaucoma. 2 One important factor to research would be the safety and efficacy of the use of GLP-1 recep- tor agonist medications in a patient without di- abetes and without the need for weight loss but who has glaucoma. Dr. Cui said clinical trials are just beginning to investigate this. If Dr. Cui has a patient with suboptimal diabetic control who is at risk for glaucoma, she said she would talk to them about the possible benefits of GLP-1 receptor agonists. She would tell these patients there's substantial evidence that GLP-1 receptor agonists may be protective against glaucoma in diabetic patients and would advise that they consider these drugs to improve both diabetic control and potentially decrease their risk of developing glaucoma. Sleep Kaweh Mansouri, MD, said there is not currently conclusive evidence regarding sleep modifica- tions and glaucoma management. As noted in a 2019 review, some sleep positions "appear to be associated with higher intraocular pressure, although the association between sleep position and glaucoma progression is not as clear." 3 "We know that IOP is often at its highest during the nocturnal sleep period, and there- fore, whenever there is progression despite normal daytime IOPs, I aim to obtain nighttime IOP measurements, either through an IOP-sens- ing contact lens, an intraocular sensor, in a sleep laboratory, or by providing patients with a self-tonometer," Dr. Mansouri said, adding that glaucoma surgery generally flattens nocturnal IOP increases and seems to be protective in pa- tients at high risk for progression or document- ed progression. Dr. Mansouri said getting a good amount of high-quality sleep can help with overall health and glaucoma. Meditation and yoga "A question I get asked a lot from my patients is 'What can I do in addition to my drops in order to help my glaucoma?'" said Monica Ertel, MD. "I've made an effort to focus on nutrition changes, exercise changes but also mindfulness and meditation." When it comes to yoga and meditation, Dr. Ertel said there is more beneficial data on meditation, but she offered some advice for yogis who have glaucoma. She tells them that any time their heart is below their hips or their feet are above their head, if they're lying on the floor, this can put them at risk for optic nerve-damaging IOP spikes. These positions should be avoided or modified, Dr. Ertel said. Meditation, on the other hand, is a "no brainer," Dr. Ertel said. "There are only potential benefits and no potential risks with meditation." Dr. Ertel said meditation can reduce cortisol levels and intraocular pressure and improve things like brain-derived neurotrophic factors, inflammatory cytokines, and it changes gene regulation. 4 Research has shown a benefit from meditating as little as 30 minutes a day, and she recommended apps like Calm and Headspace for guided meditations. "It's remarkable that meditation has such a physiologic impact on our bodies, and I think it speaks to how much stress plays a role in a lot of our disease processes and how we ignore the role that stress plays," Dr. Ertel said. continued from page 65

• Cover