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Stress and Eye Pressure
Stress and Eye Pressure
From the perspective of what is reported in the self tonometry community, most can agree with this doctor's comments. However, the part relating to things like stressful jobs not having an impact, is probably not correct. Here is another excellent example as reported by renowned glaucoma specialist Dr Robert Ritch of the New York Eye & Ear Infirmary, which illustrates effects of both transitory and life change stresses;
Over the years I have had a number of patients who were well controlled for long periods whose IOP rose 10 mmHg for several weeks after the death of a spouse. I also had a lawyer whose IOP was 20 mmHg consistently except when after she got out of arguing in front of a jury, it was 40 mmHg.
Examples of IOP and Stress from the FitEyes Self-Tonometry Community
In recent weeks my eye pressure have been higher, on average. I presume that situation coincides with the meetings and discussions about my new business venture. We had casual conversations for a while, but the beginning of serious meetings and the financial negotiations, correlates closely with the increased average eye pressure values. (Of course, there could be something else that changed around this time that I'm overlooking, so I'll try to keep an open mind.)The Timoptic, which had been working so well when I used only 1 drop in my right eye every 3-5 days, seemed to become ineffective during this recent period (beginning the last week of October through yesterday). I even switched to a brand new bottle of Timoptic just to rule out the question of whether there was a problem with the medication itself. The switch made no difference.
My IOP can fluctuate rapidly (within seconds) depending upon the situation, my thoughts, and feelings. During one period of IOP measurements several years ago, the first 2 measurements were in the mid-high teens. Then just as I was taking a third measurement, my husband called to me, saying that an ambulance was at his niece's house next door. That measurement was in the low 30s. After we checked and found that everything was OK, I took my IOP again and it was back down to low 20s.
- Laughing ( light-heartedness )
- Enjoying company of friends and family ( probably laughing involved )
- 1 or 1/2 drink of alcoholic beverage ( perhaps increasing the chance of feeling light-hearted )
- A light schedule at work ( perhaps these are all different ways of saying the same thing? )
There are many such examples, and they illustrate that there can be an immediate reaction to stress (which can correspondingly resolve appropriately), and there can also be a prolonged elevation of IOP resulting from a chronically unresolved stress state. In the latter case, it may take a concerted effort and lifestyle changes to bring pressures down.
Tonometry measurements on doctor visits will in many cases result in lower pressures on successive measurements as the patient relaxes (or when taken by a technician versus the doctor).
Eye pressures following a visual field test have been demonstrated as being higher as shown by this study; Elevation of intraocular pressure in glaucoma patients after automated visual field testing
Measurements taken at home are usually lower on immediate successive measurements. As in the first point, this demonstrates anticipation anxiety on initial measurements and therefore, demonstrates an effect of stress.
- Doctor office visits have been reported to be higher than 'at home' before-and-after measurements by those who self monitor. This might be due to discrepancies in the type of tonometers being used, but some have reported taking their tonometers into the doctors office to do side-by-side comparisons in order to rule this out. Additionally, there have been other comparisons such as in Non-contact tonometers... they get no respect. Note this quote:Comparative Analysis of Intraocular Pressure Measurements with Different Ophthalmologic Devices
- Myth: The NCT is not accurate. I've actually found them to be quite accurate, especially the newer models. I've had 4 NCTs over the years. Two that I'd call "first generation" and my two present identical machines, used in our two pre-test rooms. I've compared IOP measurements from these NCTs with Goldmann readings on thousands of patients, and they are consistently within 1-2 mms.
I usually measure my eye pressure many times per day at home with my Reichert AT555 tonometer. Today I measured my eye pressure throughout the day, as usual, and it averaged about 12 mmHg. Just before my eye doctor appointment I measured my eye pressure again. It was 13.0 in my right eye and 12.0 in my left eye.Then I left for my appointment and I took my tonometer from my house to my doctor’s office. At the doctor’s office, we measured my IOP six times using both a Goldman applanation tonometer and my AT555 side by side. The Goldman tonometry was done by the doctor. I did the AT555 measurements exactly like I do at home. My doctor observed all my AT555 measurements. In short, my eye pressure (right eye) went from 13 at home (immediately before leaving) to 20 in the doctor’s office and then back to 12 when I returned home.
Effects of Meditation on Eye Pressure
Mechanisms by which stress might elevate eye pressure
- The body under stress releases higher amounts of cortisol (a natural steroid), and it is known that steroids can have a dramatic effect on IOP in susceptible individuals. There are many other hormones and chemicals released by the body during stress which could have an effect on raising IOP – including an increase in aqueous fluid production.
- Stress can dilate the pupils and this can have an effect on eye pressure in some individuals - especially those with narrow angles.
- The production of aqueous fluid in the eye can be heightened under stress.
- Stress affecting the facial muscles, and among them, the extraocular or orbital eye muscles (those outside the eye) have been shown to cause increases of IOP. Here is an excerpt from an article alluding to this, intraocular pressure responses among ocular-hypertensive subjects.
- Several animal and human investigations have indicated that intraocular pressure (IOP) levels may be associated with extreme drug-induced changes in the extraocular muscles. Further, recent data suggest that, among individuals with normal IOP level, moderate increases in facial muscle (EMG) activity around the eye while the eye is open are associated with increases in IOP.
Effects of stress on glaucoma as a whole
Jacqueline wrote 6-22-2019:
I worried about nutrition a lot, despite the fact that I own an organic / biodynamic farm and eat incredibly healthy. I added many supplements, worried every day about my situation, slept in a tilted bed, got blue blocking screen on my computers, and then I worried more.
Since getting the 7CR, I am able to make immediate and longer term assessments about what affects IOP. Given the high quality of my diet, I see that food was not an issue. I eat organic, farm-raised, nothing refined. I eat meat maybe twice a week (ours), eggs, whole grains, raw dairy and a lush amount of veggies and fruits daily, raw nuts, honey, olive oil and coconut oil. That’s my diet in a nutshell.
But stress surely was a biggie. I have realized that charting stress was not simple at first. It takes a lot of self-perception to catch myself in stressful thoughts, which I chart-note aside the IOP for that hour. In the past five months I have learned a lot about myself.
When I am stressing about a real-or-imagined thing, I have an internal heckler that has a good deal to say about every thought. If I choose to continue on with that worrisome thought, my IOPs will rise. When I have the presence of mind to opt out of that one-sided conversation, my IOP readings drop. When working in the garden, I can listen to reworking of an argument I had five years ago or I can choose to see the beauty of the flowers around me. Between February and April I made steady progress.
I was about to check-in in early May because I had gotten my IOPs down to a more healthy place, but that same week we got rear-ended while stopped in traffic and I pulled some muscles where the seat belt yanked. My IOPs were strangely calm the rest of that day but the very next day they went right back up to my February normals, mid-20s day and high teens at night with a few spikes even higher.
For the next month I had Feldenkrais sessions with my physical therapist and cranio-sacral sessions with my osteopath. The first few weeks they made some difference but I was physically hurting still so I couldn’t maintain the results. By the fourth week I saw 8-10 pt drops in IOP during the afternoon following the sessions, from 25 down to 15-16. And I got a lot better.
The past few weeks I have stabilized more. Average now is mid-teens when I wake up. If I have a meeting or am rushed, I may hit the low 20s briefly, but I can immediately (no kidding!) decrease my IOP 3-4 points in 15 minutes by doing calm and slow deep breathing, clearing my mind of extraneous thoughts, letting go of any imaginable transgression (forgiveness is very powerful), and relaxing my body. Within the hour I am able to get back into mid-teens and even lower.
Last week I discussed my IOP charts with my doctor and we agreed that I could decrease the brimonidine that I had been taking 3x day for the past few years. My new schedule is to take them when I wake up. I don’t take the afternoon drops if my readings are mid-teens which is becoming my new normal. I rarely take them in the evening because IOPs are usually 12-15 and have been as low as 10. After all that time in the mid-20s months ago, I now have entire days in mid-teens.
Access to my IOPs has been a game-changer for me. I have been able to develop a communication with my own body and psyche that are very useful.