Mindfulness Meditation Reduces Intraocular Pressure, Lowers Stress Biomarkers and Modulates Gene Expression in Glaucoma: A Randomized Controlled Trial

Background: Reducing intraocular pressure (IOP) in primary open angle glaucoma (POAG) is currently the only approach to prevent further optic nerve head damage. However, other mechanisms such as ischemia, oxidative stress, glutamate excitotoxicity, neurotrophin loss, inflammation/glial activation, and vascular dysregulation are not addressed. Because stress is a key risk factor affecting these mechanisms, we evaluated if mindfulness based stress reduction (MBSR) can lower IOP and normalize typical stress biomarkers. Methods: In a prospective, randomized trial 90 POAG patients (180 eyes; age>45▒y) were assigned to a waitlist control or mindfulness meditation group which practiced daily for 21 days. We measured IOP (primary endpoint), quality of life (QOL), stress-related serum biomarkers (cortisol, β-endorphins, IL6, TNF-α, BDNF, ROS, TAC) and whole genome expression. Results: Between-group comparisons revealed significantly lowered IOP in meditators (OD: 18.8 to 12.7, OS 19.0 to 13.1▒mm Hg) which correlated with significantly lowered stress-biomarker levels including cortisol (497.3 to 392.3▒ng/mL), IL6 (2.8 to 1.5▒ng/mL), TNF-α (57.1 to 45.4▒pg/mL), ROS (1625 to 987 RLU/min/104 neutrophils), and elevated β-endorphins (38.4 to 52.7▒pg/mL), BDNF (56.1 to 83.9▒ng/mL), and TAC (5.9 to 9.3) [all P values Conclusion: A short course of MBSR by meditation in POAG, reduces IOP, improves QOL, normalizes stress biomarkers and positively modifies gene expression. Mindfulness Meditation can be recommended as adjunctive therapy for POAG.