Will Mindfulness/Meditation Go Mainstream in Eye/Vision Care?

This train of thought began in earnest four years ago, when Tanuj Dada and colleagues at The Center for Ophthalmic and Medical sciences in New Delhi, India gave a presentation at the ARVO meeting on a randomized clinical trial on the effect of yoga and meditation based intervention in lowering intraocular pressure.

Along the way, Dada and colleagues published their findings in the Journal of Glaucoma in 2018, teaming up with Berhnard Sabel. We blogged about that at the time, noting that Sabel was familiar to our group (VHG) from the days when Don Getz invited him to give a presentation about visual field restoration. As a result of this study, Medical Xpress heralded meditation as an effective new therapy to reduce eye pressure in primary open-angle glaucoma.

More impressively, the study prompted the American Academy of Ophthalmology in 2019 to place a news article on its website noting that mindfulness meditation may help fight glaucoma.

The article quotes Dr. Kevin McKinney, a glaucoma specialist in Portland, Oregon who noted that many ophthalmologists think that stress reduction is useful for glaucoma management. “In my practice, I see that glaucoma patients who manage stress better tend to have better outcomes. But the idea that stress reduction lowers IOP hasn’t been validated in a study of this size before,” he said. Based on the study’s findings, McKinney said that he will add meditation to the list of strategies he recommends to patients to reduce stress, including regular exercise, healthy sleep habits and other forms of mindfulness-based stress reduction.

It is fair to surmise that adding meditation as an adjunct to more traditional therapies will get a boost from the the article that Dada and colleagues just published on the subject in the American Journal of Ophthalmology. From the section on methodology, here is how the mindfulness meditation (MM) was conducted daily over the three week period:

MM was performed for 45 minutes under a certified YOGA instructor. MM is simply observing the breath by focusing our attention on the natural relaxed flow of air going in and out of the body. Prior to this the person sits on a chair with back spine straight/erect. To be mindful is to be present in the moment , it is a state of awareness in a non-judgmental way and heightens our patience, compassion and kindness. Emphasis is on noticing the rise and fall of our chest and abdomen while inhalation and exhalation respectively. Also observing the sensation in our nostrils as we draw cool air in and exhale out warm air. The breath should be long and deep and try to keep the exhalation longer than inhalation and a pause after inhalation and exhalation. It is very easy to get distracted by thoughts but we do not resist them we just draw our focus to our breath again.”

I posted this study on ODs on Facebook, posing the question as to whether docs who considered themselves mainstream were ready to add MM to their toolkit. Many responded in the affirmative, and some offered that they were doing this already. Others indicated that 45 minutes per day didn’t seem like something that their patients would comply with. Perhaps that’s the point, outside the strictures of a randomized controlled study – realistically one might begin with just 5 or 10 minutes per day and build up, as is advised in layperson articles about the subject.

One of the doctors responding on ODs on Facebook acknowledged that she is quick to dispense “lifestyle guidance” of this nature to her patients, but slow to adopt it herself. I call this the Hypocritic Oath, in contrast to the Hippocratic Oath which incorporate the notion of “Primum non nocere”, or First do no harm”. And certainly mindfulness meditation can do no harm. I pondered why collectively we, in vision therapy and rehabilitation, have been comparatively slow to adopt the principles of MM in our field. Sure, it has been selectively talked about and written about. But we seem to largely pay it lip service.

Informal mediation jump-starts my day each morning, the pandemic having changed my ritual to a coffeehouse in town that still affords a mindful place to read.

The Green Planet, Arnold Avenue, Point Pleasant Beach, NJ

As I contemplated why we aren’t more insistent that our patients adopt principles of MM in a wellness approach to care, it occurred to me that perhaps we’re waiting to be the perfect role model for our patients. Or waiting for the perfect study to be published. But if we’re honest with ourselves, we’ll admit that we adopt many practices that fall short of perfection. Paradoxically that may turn out to be healthier than striving to be flawless.

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