Modifiable factors in the management of glaucoma: a systematic review of current evidence

Graefes Arch Clin Exp Ophthalmol. 2017 Apr;255(4):789-796. doi: 10.1007/s00417-016-3518-4. Epub 2016 Oct 14.


Purpose: Primary open angle glaucoma is a chronic optic neuropathy affecting millions of people worldwide and represents a major public health issue. Environmental factors, behaviors, and diet are intimately related to patient health and may play a role in the pathogenesis and progression of glaucoma. This study aims to review the literature, focusing on the last three years, regarding modifiable lifestyle interventions in the management of primary open angle glaucoma.

Methods: Electronic databases were searched for studies published between January 2013 and July 2016 on the topic of lifestyle interventions in primary open angle glaucoma.

Results: Sleeping with the head elevated and avoiding the worst eye-dependent side during sleep may slightly lower intraocular pressure and reduce visual field loss. Some food supplements and moderate aerobic exercise may also reduce intraocular pressure up to 2.0 and 3.0 mmHg, respectively. Frequency of coffee intake may be associated with disease progression. Potential negative effects are associated with weight-lifting and yoga exercises.

Conclusions: Certain lifestyle habits could influence glaucoma progression, yet no specific interventions are currently supported by robust evidence. Awareness of the possible influences of certain habits should help guide clinical advice and is important to help patients avoid adverse outcomes and take an active role in the management of their disease.

Keywords: Caffeine; Diet; Exercise; Glaucoma; Sleeping position.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Cognitive Behavioral Therapy / methods*
  • Disease Progression
  • Exercise Therapy / methods*
  • Glaucoma, Open-Angle* / complications
  • Glaucoma, Open-Angle* / physiopathology
  • Glaucoma, Open-Angle* / therapy
  • Humans
  • Intraocular Pressure / physiology*
  • Life Style*
  • Optic Nerve Diseases* / diagnosis
  • Optic Nerve Diseases* / etiology
  • Optic Nerve Diseases* / prevention & control
  • Prognosis
  • Sleep / physiology*