Metabolic syndrome and eye diseases.

Glaucoma Medical Therapy: Principles and Management

Meditation is an ancient behavioral intervention, however, its benefits for achieving holistic health have been highlighted in recent times with rigorous scientific studies revealing its benefits in many chronic diseases. It has been specially found useful in neurodegenerative diseases and recent evidence points to the positive effects of meditation in preserving gray and white matter in the adult brain. It is also a potential therapy to downregulate processes implicated in brain aging and confer "neuroprotection"-something we all look forward to for our glaucoma patients. In the current review, we evaluate the benefits of meditation practice for the glaucoma patient and support for its candidature as adjunctive therapy for glaucoma patients. It has multiple potential benefits for normal-pressure and high-pressure glaucoma patients including a reduction in intraocular pressure, increasing cerebral blood flow and oxygenation, and decreasing action of the sympathetic nervous system with a corresponding increase in parasympathetic nervous system activity. Meditation leads to a "relaxation response" mediated by nitric oxide with decrease in the stress hormone cortisol, increase in neurotrophins and mitochondrial energy production, and improves the overall quality of life of glaucoma patients. It can also benefit caregivers of glaucoma patients and health care providers. It appears that meditation can function as a multifaceted management approach for glaucoma using the natural potential of the human body and target not only the eye but the patient behind the eye to ameliorate this "sick eye in a sick body" condition.

Meditation: A Polypill for Comprehensive Management of Glaucoma Patients.

Objectives 
To compare the anterior ocular segment biometry among Type 2 diabetes mellitus (DM) with no diabetic retinopathy (DR) and non-proliferative diabetic retinopathy (NPDR), and to evaluate the correlation of anterior ocular segment biometry with HbA1c level.


Methods 
A cross-sectional study was conducted in Hospital Universiti Sains Malaysia, Kelantan from November 2013 till May 2016 among Type 2 DM patients (DM with no DR and DM with NPDR). The patients were evaluated for anterior ocular segment biometry [central corneal thickness (CCT), anterior chamber width (ACW), angle opening distance (AOD) and anterior chamber angle (ACA)] by using Anterior Segment Optical Coherence Tomography (AS-OCT). Three ml venous blood was taken for the measurement of HbA1c.


Results 
A total of 150 patients were included in this study (DM with no DR: 50 patients, DM with NPDR: 50 patients, non DM: 50 patients as a control group). The mean CCT and ACW showed significant difference among the three groups (p < 0.001 and p = 0.015 respectively). Based on post hoc result, there were significant mean difference of CCT between non DM and DM with NPDR (mean difference 36.14 μm, p < 0.001) and also between non DM and DM with no DR (mean difference 31.48 μm, p = 0.003). The ACW was significantly narrower in DM with NPDR (11.39 mm SD 0.62) compared to DM with no DR (11.76 mm SD 0.53) (p = 0.012). There were no significant correlation between HbA1c and all the anterior ocular segment biometry.


Conclusion 
Diabetic patients have significantly thicker CCT regardless of retinopathy status whereas ACW was significantly narrower in DM with NPDR group compared to DM with no DR. There was no significant correlations between HbA1c and all anterior ocular segment biometry in diabetic patients regardless of DR status.

/pdf/correlation-of-the-anterior-ocular-segment-biometry-with-3oizzensvk.pdf

Correlation of the anterior ocular segment biometry with HbA1c level in type 2 diabetes mellitus patients.

How to cite this article: Dada T, Mahalingam K, Gupta V. Allostatic Load and Glaucoma: Are We Missing the Big Picture? J Curr Glaucoma Pract 2020;14(2):47-49.

/pdf/allostatic-load-and-glaucoma-are-we-missing-the-big-picture-1g6op9xvlh.pdf

Allostatic Load and Glaucoma: Are We Missing the Big Picture?

To study the prevalence and systemic control and evaluate the adequacy of therapy of diabetes mellitus (DM) and hypertension (HT) in glaucoma patients visiting a tertiary care eye facility at a university hospital. Consecutive cases with primary open-angle glaucoma (POAG) or primary angle-closure glaucoma (PACG) attending the outpatient services were evaluated for the presence of DM and HT and any systemic/ocular medications being taken were recorded. Of 615 glaucoma cases evaluated, 281 (45.7 %) were POAG and 334 (54.3 %) were PACG. The mean age was 58.19 ± 10.8 years with males comprising 60.5 % of the study group. Two hundred and ninety-two (47.5 %) glaucoma patients had HT and 181 (29.4 %) had DM, including 97 (15.8 %) patients who had both. One hundred and thirty-three (47.3 %) patients with POAG and 159 (47.6 %) patients with PACG had HT. Ninety-seven (34.5 %) POAG patients and 84 (25.1 %) PACG patients were diabetics. One hundred and sixty-one (55.1 %) HT patients had blood pressure above control levels and 88 (48.6 %) diabetics had uncontrolled blood sugars. Twenty-eight (9.6 %) patients with HT were found to be taking combined systemic and topical β-blocker therapy. A large majority of adult glaucoma patients had concurrent systemic disease, which was not adequately controlled. Patients were using systemic medications with known interactions with ocular hypotensive medications. This study highlights the unmet need for better coordination between ophthalmologists and physicians to improve the overall health of glaucoma patients.

Prevalence of diabetes mellitus and hypertension among Indian glaucoma patients and evaluation of systemic therapy.

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Prevalence of diabetes mellitus and hypertension among Indian glaucoma patients and evaluation of systemic therapy.