Glaucoma, elevated intraocular pressure, membrane permeability and emotions

For those of us with glaucoma or ocular hypertension, our goal is for the fluid in the eye (aqeous humor) to be able to flow freely out the two exit pathways from the eye. In this context, we had a recent discussion on the benefits of fish oil and DHA for glaucoma. In this discussion, someone raised this point:

Quote: "fish oil can improve membrane permeability"

That's a useful fact on its own. But that got me thinking about what I have learned from teaching and practicing Serene Impulse (and doing so as both a glaucoma patient and a personal self-tonometry researcher).

Fish oils (including DHA) may have a small effect on IOP -- but much less of an effect than other things I have identifed as a result of mixing self-tonometry and Serene Impulse -- and also as a result of interacting with other tonometer owners in the FitEyes community.

In pursuing knowledge that will help me manage glaucoma, I have a guiding principle: don't waste your time going after the small change. Go for the stuff with the big payoff. Mental and emotional tension, which always lead to tissue contraction, are a key area where we can find that big payoff. For some background, please see this link:

http://fiteyes.com/blog/dave/the-two-most-important-facts-you-should-know-about-glaucoma

And here's another related post by Bailey:

http://fiteyes.com/blog/bstruss/mental-emotional-and-lifestyle-factors-are-the-powerful-iop-influencers

And I will expand on all of this in the present article and tie it together into an (informal) theory of elevated intraocular pressure.

Here's a key observation. Contraction appears to be the only known reasonable explanation for the observed short term IOP behavior across the many thousands of measurements coming in from people in our self-tonometry group.

Aqueous humor flows out through two pathways: trabecular meshwork and the uveoscleral pathway. Both are important. As far as I know, the proportion of fluid flowing out of the uveoscleral pathway may be up to 50%.

However, I'm not so sure that aqueous humor leaving the eye through the trabecular meshwork is rate-limited by membrane permeability.  And the aqueous humor leaving the eye through the uveoscleral pathway is certainly not limited by membrane permeability. Real life experience with fish oils shows that they have a very small effect on IOP in the short term. I do recommend taking them, but don't expect them to lower your IOP any time soon (maybe they will have an effect across decades of daily consumption, as in Japan). In the mean time, for many of us with glaucoma, our IOP will be responding every minute of every hour of every day to our state of mind and emotions. The only way to dampen this effect is with drugs or surgery... unless we go directly to the source -- the emotions.

I'd like to point out the obvious -- emotions are the primary cause of holding unnecessary tension in the tissues of the body.

If you read the link above, you know that both the trabecular meshwork and the uveoscleral pathway tissues are contractile tissues! In general, fluid flows out by going between the cells. When the tissues contract, fluid cannot flow out. (Ultimately, the fluid does cross through some cell membranes, but that does not appear to be the important factor. And cell membrane permeability due to fatty acid composition would not seem to explain the observed IOP behavior.)

In the trabecular meshwork, fluid mostly flows between cells until it gets near Schlemm’s canal. Aqueous humor flows through the intercellular spaces of the trabecular meshwork and then crosses the inner wall of Schlemm’s canal via two different mechanisms: between cells and through cells.

Regarding the uveoscleral pathway, fluid outflow is almost entirely through the gaps between cells -- the muscle cells of the ciliary process. When this tissue contracts, fluid cannot flow out.

We now understand the important fact the trabecular meshwork is a contractile tissue. It has properties similar to smooth muscle. That's been known for more than a decade. But its significance has not yet been fully appreciated, in my opinion. I'd like to urge you to take a look at this link again (especially the follow-up comments):

http://fiteyes.com/blog/dave/the-two-most-important-facts-you-should-kno...

Here's one thing I know for sure: if you get stressed, even just a very little bit, many tissues in your body will contract. I'm not talking about what we call being "stressed out." I'm talking very subtle things such as simply being a little uncomfortable. Those situations can raise IOP. We've proven that. But how can they raise IOP so quickly? Ophthalmology hasn't offered a good explanation, but I'll propose one: tissue contraction.

Think about that and then think about what we already know about stress and IOP (and stress and tissue contraction). See this link:

http://fiteyes.com/stress-and-eye-pressure-solving-the-equation

Even the skeptics are actually confirming this observation. For example, see this post:

http://fiteyes.com/stress-and-eye-pressure-solving-the-equation#comment-2518

He said,

Personaly, my IOP is often high at the dr. office, but after years I've found that if I can consciously relax my butt muscles, and my upper jaw, i can usually get a lower reading (i.e. 14-15) vs a higher reading (18-20).

That's a really important statement (and it comes from a skeptic). I can promise you the aqueous humor is not flowing of of this guy's butt muscles! By releasing tension, he is allowing many tissues in his body to relax and stop contracting unnecessarily. Most people can't release tension inside their eyes that easily, but my observations lead me to believe that we can all learn to do this. And I think managing IOP can be as simple as letting go of tension in a very deep way. ("Simple" does not mean trivial. If we have glaucoma, it likely means that we have spent a lifetime holding tension in our eyes. It has become a habit and it probably feels so "normal" that we cannot even recognize the habit. That habit of tension has become who we are! And it may take some very deep self-referral investigation to learn how to let go of this habit of contraction. This work happens through formal techniques such as Serene Impulse, which I teach. However, I do not teach Serene Impulse as a treatment for elevated IOP or glaucoma or any other medical condition. It's a spiritual technique and it can also be called a relaxation technique. On one level, it is a tool for getting in touch with things like habitual tension we hold in the body -- often for our entire lives without knowing it.)

Many people say there are no physical symptoms of elevated IOP and they give us the impression it is just impossible to feel anything related to this. Well, that's not entirely true in my experience. We can all feel it when we tense up. And we can learn to feel this even more accurately. We can refine our sense of feeling and become more aware of tension -- and this tension will in fact have some correlation to changes in IOP -- just as in the skeptic's example about his butt muscles and jaw muscles. The problem is that when our habit of contraction has existed for decades we no longer notice it. And we never let certain tissues relax (or uncontract) -- never, ever! In glaucoma patients it is possible that some tissues (maybe those which allow fluid to flow out of the eye) are contracted permanently like a knot in a muscle (neck, shoulders, etc.) that stays even after the mental tension that produced it has been gone for hours, days or even weeks. If you have never felt the tissue relax, you probably don't know it is contracted now. (Has anyone ever gone to a massage therapist and heard the remark that you are tense? Someone else has to point it out to us!)

We can extend this "theory" even further -- blood flow. Many people have glaucomatous optic nerve damage without having elevated IOP. We believe constriction of blood flow to the eye and optic nerve play an important role in this. Notice that key word -- constriction. The same factors (psychological discomfort) that lead to tension and constriction of various tissues in the body can lead to constriction of blood flow to the extremities and, it appears, even to the optic nerve.

So now we can start to speculate about a comprehensive theory of elevated IOP and glaucomatous optic nerve damage (with or without elevated IOP).

Bottom line in terms of IOP: stop diverting your efforts and start learning to feel the tension in your body. This is the emotional connection I am always talking about.

Does your IOP go up when you get excited? Well, just look for the tension in your body. It's there. It may be subtle, but I promise you it is there. Why does IOP sometimes go down after a difficult, draining, stressful day? Because we are so exhausted we can't be tense.

Why is there sometimes a paradoxical IOP rise with relaxation? That has a very clear explanation in this theory too. (In case you don't know about the paradoxical IOP rise with relaxation, feel free to discuss this with the many FitEyes members who have observed it via self-tonometry.)

I'll leave you with this concluding thought: consciousness structures the physiology. This has been known for thousands of years in traditional medical systems such as Ayurveda. Now modern science is starting to provide us with evidence in support of this principle. Subtle mental or emotional discomfort is expressed in the body as a contraction. When the contraction become habitual (e.g., because our mind tells us to continue with some way of living that our body is intelligently rejecting as unhealthy), the physical structure of our body changes over time. The knowledge I'm providing here offers a way to undo those unhealthy changes in the body. Let go of the tension, allow the body to relax (by allowing the mind to let go) and balance will start to return. And you know that glaucoma is said to be nothing more than an autoregulatory dysfunction. You have the power to restore harmonious autoregulation to the system because it responds to your habitual patterns of living/thinking/feeling.