Yoga and Eye Pressure

 

This exchange is part of an email conversation I have been having with a reader.

[Reader] I am a yoga teacher and I recently came across your website, FitEyes.com.

[Dave] How long have you been teaching yoga? What is your approach to inverted postures, given that you have glaucoma? Have you ever measured your intraocular pressure while inverted? How about immediately after? I checked my intraocular pressure after a few minutes of the plow (plough) and it was sky high. (The plow was always my favorite posture.)

[Reader] I have been doing yoga and meditation for about 30 years and teaching for about 13 years, mainly in the Desikachar approach, which is breath centered. On inversions, I have stopped doing headstand, shoulderstand and plough (plow) after I was diagnosed with glaucoma. My intraocular pressure roughly doubled during shoulderstand and the recent studies suggest that is about what happens for most people when they do headstand. It is still an open question within the medical world as to whether short term spikes in intraocular pressure cause damage to the optic nerve; my opthalmologist, who is also an academic, has no problems with me doing any yoga pose. However, to be on the safe side, I now only do bridge pose which gives some of the benefits of shoulderstand without elevating intraocular pressure as much. I still do standing forward bends and downward facing dog.

[Dave] Dr. Ritch is doing some research on yoga and glaucoma and I have been corresponding with the researcher on his team who is in charge of the project. In that regard I would like to ask you some questions. What is your view of effort in yoga in general (and specifically in the asanas themselves)? What are the most common mistakes you see beginning or intermediate students make and what instructions do you give for correcting those mistakes?

[Reader] Dr Ritch, in a private email communication to me, suggested standing forward bends and downward facing dog were likely to be less of a problem for elevating intraocular pressure. I have also been corresponding with the researcher on Dr. Ritch's team that you mentioned.

Your questions about yoga are quite broad - it would need a long essay to answer them fully. The most common "mistake" beginners make (and sometimes long term practitioners) is to impose a mind based model of how the posture should look on the body rather than listening to the body. UG Krishnamurti has called this type of yoga "an imposition on the life force" and I agree with him. Beginners usually but not always try too hard to get it right. At the same time the tamasic approach to asana of anything goes and lets just roll around on the floor for a while is also counter-productive. My approach focuses on the breath and letting the breath lead movements in asana. The breath, being the language of the body, is also a valuable feedback mechanism for the practitioner in terms of striking the balance between effort and relaxation. Patanjali says, "sthira sukham asanam" - posture should be steady and comfortable. The poles to work between are effort/relaxation, focus/letting go, strength/flexibility. I do give some instructions on anatomical and alignment issues basically so people don't hurt themselves and get the most benefit out of the asanas but that is subservient to a relaxed focus on the breath.

[Dave] Thanks for sharing your insights. I understand and agree with your recommendations. In my own words, I would say that yoga should be done without any strain. It should be done with the gentle intent to do it correctly, but performed without effort or strain. Effort is such a subtle issue. I believe that for glaucoma patients, the greatest emphasis should be placed on performing the techniques without any strain, effort or discomfort.

My intraocular pressure research shows that even the slightest, most subtle (nearly undetectable) effort or strain during yoga (and meditation) will dramatically affect intraocular pressure. I do not fully understand the subtleties yet, but the dramatic connection between strain and intraocular pressure is undeniable in my own large research dataset. My speculation is that those glaucoma patients who use effort in yoga (and meditation) may be the ones who suffer damaging effects from the inversion postures, while those who do the asanas correctly and without any effort, strain or discomfort may be more likely to receive the benefits. Therefore, in any scientific research on yoga and intraocular pressure and glaucoma progression, I would like to see the scientists consider (and quantify) the level of strain each individual yoga practitioner uses in their performance of the asanas. I don't think the conclusions can be valid unless we know that information.