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Effect of Mindfulness Meditation on Intraocular Pressure and Trabecular Meshwork Gene Expression: A Randomized Controlled Trial

Published:October 22, 2020DOI:https://doi.org/10.1016/j.ajo.2020.10.012

      Highlights

      • Meditation decreases intraocular pressure in primary open angle glaucoma.
      • Diurnal fluctuation of intraocular pressure decreases with meditation.
      • Mindfulness meditation has a direct impact on trabecular meshwork gene expression.
      • Upregulation of neuroprotective and downregulation of proinflammatory genes are seen.
      • Increased expression levels of NOS 1 and 3 possibly play important roles in IOP reduction.

      Purpose

      To evaluate the effect of mindfulness meditation (MM) on intraocular pressure (IOP) and trabecular meshwork (TM) gene expression in patients with medically uncontrolled primary open angle glaucoma (POAG).

      Design

      Parallel arm, single-masked, randomized controlled trial.

      Methods

      Sixty POAG patients with IOP ≥21 mm Hg taking maximal topical medication and scheduled for trabeculectomy were included in this study at a tertiary eye care center in India. Thirty patients (Group 1) underwent 3 weeks of 45-minute daily MM sessions in addition to medical therapy while Group 2 continued medical therapy only. Primary outcome was change in IOP (ΔIOP) after 3 weeks of MM. Secondary outcomes were probability of success, percentage of reduction in IOP, effect on diurnal variations of IOP, changes in quality of life (QoL), and changes in gene expression patterns in TM.

      Results

      At 3 weeks, a significant decrease in IOP was seen in Group 1 (20.16 ± 3.3 to 15.05 ± 2.4mm Hg; P = .001), compared to Group 2 (21.2 ± 5.6 to 20.0 ± 5.8mm Hg; P = .38). ΔIOP was significantly higher in Group 1 than in Group 2 (5.0 ± 1.80 vs. 0.20 ± 3.03mm Hg; P = .001). Analysis of gene expression revealed significant upregulation of nitric oxide synthetase (NOS1 and NOS3) and neuroprotective genes with downregulation of proinflammatory genes in Group 1 in comparison to Group 2 (P = .001).

      Conclusions

      MM was associated with significant decrease in IOP and changes in TM gene expression, indicating its direct impact on ocular tissues.
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