Informal Survey: Risk Factors for Glaucoma

Dave posted Oct 25 2019:

I would like us to have a discussion about the most important risk factor for glaucoma. To kick off that discussion I thought it would be fun to start with a quiz. There's only one question. Here it is:
What is the risk factor that has the strongest association with the development of glaucoma?
I'm asking the question in the most general way. It isn't limited to a certain race or geography or group, etc. Just think of it in the broadest terms possible.
All responses are welcome. You can even ask a related question instead of giving an answer if you prefer. This is all just for fun and for our own self-improvement.

Here are the responses from our email discussion group:

Stress 12
Heredity 14
Circulation 6
Myopia 4
Caffeine 2
Environmental Toxins 2
Age/aging 4
Digenstive Disorders 1
Diabetes 1
High relative IOP 2
Steroids 4
Strong Emotions 2
Shingles 1
Diet 1

Dave's Response to the survey:

I am very impressed with all the replies. This is shaping up to be an interesting discussion. All the responses have been good. I see lots of good ideas and input. We can explore all of these.

One of the most interesting responses to me is: aging.

Aging is interesting because it is indeed one of the most important risk factors for glaucoma, yet possibly one of the most misunderstood. In fact, age is not even mentioned on the Wikipedia page for glaucoma. Here's a study on risk factors that also does not mention age.

Risk Factors for Primary Open Angle Glaucoma (POAG) Progression https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899511/

However, here are the well-established (mainstream) risk factors and age is at the top of the list:

• Age
• Being of African American or Hispanic descent
• Eye injury
• Thin corneas
• Elevated eye pressure
• Family history of glaucoma

This (mainstream) list is not as complete as the one FitEyes members have generated in this discussion, but it does underscore the fact that age cannot be neglected in the discussion of risk factors for glaucoma.

When I think about age as a risk factor, I'm personally thinking of biological age (and the process of aging, which is variable) more than chronological age, which marches on ceaselessly. However, when age is mentioned as a glaucoma risk factor it is described only in terms of chronological age. Chronological age as a glaucoma risk factor is useful for screening and for large scale management of health care, but it is not very useful for me as an individual who has been diagnosed with glaucoma.

However, biological age as a risk factor is very interesting because we can influence our biological age through lifestyle. We can even reverse our aging process. With this in mind, I think a discussion around age as a risk factor becomes very interesting. It leads us into discussions of nutrition, exercise, stress and many of the other things mentioned in this thread, as well as throughout all of FitEyes. This perspective on aging ties a lot of these different factors together into a unified perspective.

If our goal is to slow or reverse our aging process, and the aging process is one of the most important risk factors for glaucoma, it gives us a focus for our stress management, our nutrition, our exercise, our meditation practice, etc.

Here's a concrete example. We could utilize the sitting-rising test (SRT) that is often used to assess aging. The SRT can  provide us with insights on the connection between mobility and health and can encourage us to get back in shape. If we score less than 10, we can work on improving our strength, flexibility and balance. We can measure our progress.

In a Brazilian study that used the SRT we learned how this simple test relates to aging:

• Those who scored 0-3 were 6.5 times more likely to die during the study than those who scored 8-10
• Those who scored 3.5 to 5.5 were 3.8 times more likely to die
• Those who scored 6 to 7.5 were 1.8 times more likely to die

Knowing that age is an important risk factor in glaucoma, we can also understand how something like the SRT might also be useful in determining our risk for glaucoma progression. That statement is based on connecting a number of dots rather than on a direct study of the SRT and glaucoma, but it is not a stretch. It's this simple:

• age is one of the most important risk factors in glaucoma
• there are simple lifestyle changes we can make that dramatically influence how we age
• we can measure the impact of the changes we make through assessments ranging from blood lab tests to simple at-home tests like the SRT

I like the fact that this perspective is empowering. It completely shifts age as a risk factor from being something we can't do anything about, to something we can do something about.

There are a growing number of doctors who now say aging is a treatable disease. That's a novel perspective, and one that takes a moment to wrap your head around. I'm not a big fan of calling aging a disease, but I actually do like the perspective of some of those doctors who are saying that aging is a treatable disease. I translate that statement as saying that lifestyle (including nutrition and dietary supplements) is a powerful treatment for the diseases of aging; if we optimize our lifestyle, we can avoid or reverse many of the chronic diseases of aging.

Because all the chronic diseases of aging have so much in common, when we reverse our aging process through lifestyle, we are addressing all of these diseases, including glaucoma. This becomes a powerful perspective.

I know an 80+ year old woman with Type 2 diabetes who completely reversed her diabetes this year and no longer requires insulin. She looks more than 10 years younger and everyone remarks how much younger and healthier she looks now! She also has glaucoma. The steps she took to reverse her diabetes, and which reversed her aging process by at least 10 years, also had a very beneficial effect on her glaucoma. (She no longer requires glaucoma eye drops, but there are several factors responsible for that, not just her lifestyle changes.)

This person relied extensively on home blood glucose monitoring to track her progress. Likewise, in the FitEyes community, I a continued focus on IOP is important (even for those with NTG). Many people mentioned IOP in this thread. It remains the #1 most important medically treatable risk factor. Unlike blood lab tests, for example, IOP can easily and painlessly be measured at home (even multiple times per day).

But the day may come when aging becomes the #1 treatable risk factor for glaucoma. Or, if it doesn't displace IOP as the most important treatable risk factor, maybe it becomes equally important. I'm speculating. But what is beyond speculation is the importance of learning about and practicing lifestyle habits that help us avoid all the diseases of aging as we get older chronologically.

Some of the most important factors include:

• nutrition: dietary supplements

• exercise: flexibility - yoga and stretching exercises, balance, strength

• meditation (or regular daily periods of a quiet mind, free of thoughts)

• screen time

• outdoor time

• amount of time we spend seated

• relationships & community (including FitEyes)

• joy and purpose

 

Dave added this 10-26-2019:

When I was younger I had great vision and I had probably never heard of glaucoma. I had also never visited an ophthalmologist, although I had seen an optometrist once or twice.

One day, out of curiosity, I made an appointment with an astrologer who was visiting the USA from India. He warned me that I would experience problems with my eyes, and he said, "particularly your right eye." At the time I thought the problems might be something related to eye injuries so I began being more diligent about wearing safety glasses when I should, etc. However, the danger turned out to be glaucoma (many years later). And, exactly as the astrologer predicted, it affected my right eye much more than my left eye. This story was my first ever blog post on FitEyes: http://www.fiteyes.com/PanditOjhaConsultation1992

Sleeping position and genes are not the only things that can affect one eye more than the other. Injury (even subtle injury) could be a factor. But even stress does not affect both eyes equally. If you do careful enough research with your own tonometer, many of you will see that stress affects IOP in one eye more than the other. If you become good enough at unbiased self-observation, you may notice that you contract the muscles in response to stress much more in one eye than in the other. You may blink differently with one eye. We tend to have a dominant eye (like we have a dominant hand), and we therefore use that eye differently.

When it comes to genes, I like to remind people that DNA is not destiny. Our diet, stress and lifestyle affect genetic expression. It is possible that a disease-related gene is never expressed. Furthermore, think about the fact that even in those who have a strong genetic predisposition toward glaucoma, in most (but not all) cases aging causes the actual manifestation of the condition. And if not aging, then something like stress, injury, drugs, etc.

Here's another thought: there is a difference between a specific cause of glaucoma for any individual and the risk factors for glaucoma in general.

There's a lot of interest here in "what specifically caused my own glaucoma." For some of us, it is often impossible to know for sure. For others, there is a much more clear cause.

For all of us, aging might be one of the most important risk factors. Heredity is a known risk factor. IOP remains the most important medically treatable risk factor, even for those with NTG. And while those statements remain generally true for all of us, any one of us could be impacted by a specific, unique causal event such as a steroid drug or a particularly stressful period.

But here's another thought -- when our biological age is younger, we have a better chance of rebounding from damaging or stressful events. (And, by definition, our DNA is healthier too.) When our biological age is older, those same factors can lead to serious problems. The take-away, for me, is that I can practice the things I listed in my last message (good eating, exercise, meditation, stretching, etc.) and slow or reverse my biological aging, which will give me greater resilience to anything that happens (or has happened).

We are not in control of many things that happen to us. Many of the specific causes for glaucoma that people have listed here were out of their control. But a healthy lifestyle is something we can do something about. If we make that choice and maintain regular healthy habits, we can slow and even reverse all of the chronic diseases of aging, including glaucoma.