yoga therapy for glaucoma caused by ocular … therapy for glaucoma caused by ocular hypertension...
TRANSCRIPT
YogatherapyforGlaucomacausedbyOcularHypertensionByPaulaSchirrmacher2015
YogatherapyforGlaucomacausedbyOcularHypertension
ByPaulaSchirrmacher
TTCLevel2AanandaYogaIndia,Mysore
Tableofcontents
Introduction 2
1.ScientificBackground 3
1.1DifferentTypesandtheirSymptoms 4
1.2Diagnosis 6
1.3Complications 7
1.4ManagementthroughYoga 8
2.TheCase 9
2.2TheTherapySequence 10
References 13
IntroductionMostactivitiesinourdailylifearebasedonoureyesight-whetherwewalkdowna
street,readthenewspaperortheexpressionsinthefacesaroundus.
Thisleadsustotheconclusionthatwecancapturethewholeuniversewiththisone
sense.Wedon'tbelievewhatwehaven'tseen!Eventhough,thisconclusionmight
bewrong,justimaginethefearinonesheartiftheangleofvisionisslowlygetting
smallerandsmaller.Andonedayitmightgettotallydarkaroundyou...
Glaucoma, the "silent thief of sight", is the second-leading cause of blindness and
affectsonein200peopleaged50andyounger.Inhigherageandseveralethnicsthe
riskevenincreases.Andallthesepeoplefeelhelpless–theirdoctortellsthemthat
they don’t know a cure for the disease and strongmedications and surgeries can
onlypreventorslowdownaggravation.ThecommonopiniononGlaucoma is that
thereisnothingtodoforthepatienthimself–nolifestyle,nutritionchangesorwork
onhisstresslevel.Heisnolongerresponsibleforhisownhealth.Butrealresearch
ontheeffectoflifestyleandespeciallystresslevelontheeyepressure(whichcauses
Glaucomainmostofthecases)nevertookplace.Whatiftheeyepressureisjustlike
thebloodpressure:verysensitivetostressandlifestyleandonlyalackofresearch
makes theGlaucomapatients feel sohelpless?Suchquestionsbegin to rise in the
glaucomacommunityandeventhoughnobroadresearchcanproveyettheeffectof
aYogatherapyoneyepressure,severalindividualobservationsgivebighope.
1.Scientificbackground
Glaucoma doesn't describe one disease but it is a group of ocular (eye) disorders
thatresultinadamageoftheopticnerve.Eventhoughtheunderlyingcauseisstill
unclear,itisoftenassociatedwithanincreasedfluidpressureintheeye(intraocular
pressure).
Tounderstandhowintraocularpressureworkslet'shavealookonthestructureof
theeye:
The process of seeing startswith the
light passing through the cornea.
Then, the expansion of the pupil
decides how much light enters the
eyeball,where it gets focused by the
lens. The vitreous gel, a clear mass,
keeps theeye in its round shapeand
fills the eyeball. The focused light
passes through it until it reaches the
back of the eye, where it gets
detected by the retina, a light-
sensitive tissue. The optic nerve
connectstheretinawiththebrainand
transportsthegiveninformation.
Butthereisonemoreveryimportantpartoftheeye:Afluidisproducedtonourish
thetissuesintheeyechambers,totakeawaythemetabolismwasteproductsandto
return them to the blood circulation. Tomaintain a round shape of the eye, the
pressureofthisfluidmuststayatacertainlevel,whichistheresultofthebalance
betweenproductionanddrainage.
The fluid leaves the chamber at the
open angle where the cornea and iris
meet. High eye pressure (ocular
hypertension) is always a result of a
too slow drainage whereas the fluid
production stays constant. The exact
reason for the reduced passage
throughthemeshworkdrainisnotyet
understood by science - as the
drainage angle stays "open" in an
Open-Angle Glaucoma, which is the
mostcommontypeofGlaucoma.
Therangeofthevaluesofintraocularpressureisrelativelywideasthetoleranceto
pressureisindividual.Thatiswhyboundaryvaluesaredifficulttoset,butaconstant
abnormalhighpressure(above21mmHg)ofthefluidintheeyemightaffecttheeye
nervewhichleadstoalossofeyesightthatiscalledGlaucoma.
1.1DifferentTypesandtheirSymptoms
There are several types of Glaucoma with very different symptoms and causes.
Basically,everyeyediseasewithadamageoftheeyenerveiscalledGlaucoma.The
fourmajorformswillbepresentedinthischapter.
ThemostcommononeistheOpen-AngleGlaucoma,wheretheanglebetweeniris
andcorneaisaswideas itshouldbe . Itaccountsforat least90%ofallglaucoma
casesanddevelopsslowlyandisalifelongcondition.
The loss of eye sight comes inmost of the cases barely notable from the edges,
slowlyreducingtheangleofsight.Animpressionoftheeffectofthe"silentthiefof
sight"isgiveninthepicturesbelow.
In case of a Closed-Angle Glaucoma
blockeddrainage canals result in a sudden rise in intraocular pressure. The closed
anglebetweenirisandcorneaisamedicalemergencyandsymptomsare
• Hazyorblurredvision
• Theappearanceofrainbow-coloredcirclesaroundbrightlights
• Severeeyeandheadpain
• Nauseaorvomiting(accompanyingsevereeyepain)
• Suddensightloss
In Normal-Tension Glaucoma the optic nerve is damaged even though the eye
pressure isnotveryhigh.Westilldon'tknowwhysomepeople’sopticnervesare
damagedeventhoughtheyhavenormalpressurelevels.Thelossofsightoccursvery
slowly as in the Open-Angle Glaucoma so the loss of sight, which is the only
symptom,canbebarelynoticedbythepatient.
Congenital Glaucoma occurs in babies when there is incorrect or incomplete
developmentoftheeye'sdrainagecanalsduringtheprenatalperiod.This isarare
conditionthatmaybeinherited.
As the Types ofGlaucoma are so different, this thesiswill onlywork on themost
commoncase,theOpen-AngleGlaucoma.
1.2Diagnosis
Earlydetection,throughregularandcompleteeyeexams,istheonlywaytoprotect
yourvisionfromdamagecausedbyglaucomaasthesymptomsarebarelynotableby
the patient himself. A complete eye exam includes five common tests to detect
glaucoma.
Tonometry measures the pressure within the eye. To numb the eye during the
measurement,eyedropsareused.Thenadoctorortechnicianusesadevicecalleda
tonometertomeasuretheinnerpressureoftheeye.Asmallamountofpressureis
appliedtotheeyebyatinydeviceorbyawarmpuffofair.
Ophthalmoscopy helps thedoctor examine theopticnerve for glaucomadamage.
Eyedropsareusedtodilatethepupilsothatthedoctorcanseethroughtheeyeto
examinetheshapeandcoloroftheopticnerve.Thedoctorlightsandmagnifiesthe
opticnerve.Damagecanbenoticedbyitsshapeorcolor.
Perimetry isavisual fieldtestthatproducesamapofthecompletefieldofvision.
Thistestwillhelptodeterminewhetheryourvisionhasbeenaffectedbyglaucoma.
Duringthistest,thepatientlooksstraightaheadandindicateswhenamovinglight
passeshisperipheral(orside)vision.
Gonioscopyhelpsdeterminewhethertheanglewherethe irismeetsthecornea is
openandwideornarrowandclosed.Duringtheexam,eyedropsareusedtonumb
theeye.Ahand-heldcontactlensisgentlyplacedontheeye.Thiscontactlenshasa
mirrorthatshowsthedoctoriftheanglebetweentheirisandcorneaisclosedand
blocked (a possible sign of angle-closure or acute glaucoma) orwide and open (a
possiblesignofopen-angle,chronicglaucoma).
Pachymetry is a simple, painless test to measure the thickness of the cornea. A
probecalledapachymeter isgentlyplacedonthe frontof theeye (thecornea) to
measure its thickness. Pachymetry can help your diagnosis, because corneal
thickness has the potential to influence eye pressure readings. With this
measurement,thedoctorcanbetterunderstandthelevelofocularpressure.
1.3Complications
If left untreated, Glaucoma will cause progressive vision loss, normally in these
stages:
• Blindspotsintheperipheralvision
• Tunnelvision
• Totalblindness
1.4ManagementthroughYoga
Common medicine knows no cure for Glaucoma - it is treated by eye drops or
surgeriestolowertheintraocularpressureandslowdownorstopthelossofsight.
Damagedpartsoftheeyenervecannotberecovered.
First researches are going on which find signs for a relation between intraocular
pressureandstressormentaltension. AbroaderstudybytheLondonInstituteof
Ophthalmologyshowsthatitisnotahighintraocularpressurealonethatraisesthe
riskforGlaucoma,butavaluecreatedoutoftheintraocularpressureandtheblood
pressure.Thisleadstotheconclusionthatregularphysicalexerciseslowertheriskof
Glaucomabykeeping thisvalue lowandmaybeeven theaggravationofapresent
Glaucomacanbeprevented.
Now,itwillbediscussedhowYogacanshowawaytowardsselfhealingforpeople
sufferingfromaGlaucoma.
LearningYogameanscreatingaconnectionwithyourbodyandyourmindthrough
yourbreathwhichraisesselfawarenessandbringsbodyandmindbacktobalance.
While a regular asana practice provides physical exercises to lower the blood
pressureandtohelpdealingwithmentalproblems,pranayamaandmeditationwork
strongly against stress, high blood pressure and psychic tension. Yoga also knows
kryasandmudrasthatcleancertainpartsofthebodyandactivatesthem.Thekryas
Trataka,SutraNetiandJalaNetiworkonUpanaVayu,whichisrelatedtothefacial
movementsandNasikagraDrishtiandShambhaviMudrastimulatetheAjnaChakra
betweentheeyebrows.
Nevertheless,YogaprovidessomerisksforpeoplesufferingfromGlaucoma.Asthe
intraocular pressure should not rise during the practice, all full inversions like
Sarvangasana, Sirsasana, PincaMayurasana andAdhoMukhaVrikshasana need to
beavoided.Oneshouldalsobecarefulwithallasanasthatcanelevatethepressure
intheveinsoftheneck(asthiscanincreasetheintraocularpressure)aswellasmild
inversions(wheretheheart ishigherthanthehead,butnotthefeet):Chakrasana,
Dhanurasana,Halasana,Matsyasana,AdhoMukhaSvanasanaandothers.
ArecentstudybytheNewYorkGlaucomaResearchInstituteshowsthatintraocular
pressure rises immediately after getting into a mild inversion like Adho Mukha
Svanasanaandthebaselineoftheeyepressurestaysslightlyraisedeven10minutes
aftercomingoutoftheposition.Incaseofintraocularhypertension,thisneedstobe
avoided, as rising the pressure of the eye affects the eye nerve immediately. This
leads to theconclusionthatpeoplewithanacutehigh intraocularpressureshould
notevenperformtheseasanasforashortduration-forexamplewithinaflowlike
SuryaNamaskara.Inthiscase,variationsneedtobecreated.
Also,somekryaslikeKapalbhatiandVamanaDhoutiaswellasBastrikaPranayama
cancreatealotofpressureinthehead.Theyneedtobeavoidedinitiallyandincase
of an acute high eye pressure even Brameri Pranayama should only be practiced
carefullyandforashorterduration.
2.1TheCase
Thefocusofthisthesiswillbethespecialcaseofa23yearoldstudent.Let’sname
him Finn. He is looking at you through thick glasses, thewhite of his eyes always
slightlyred,withagreyshadowonhisview–barelynotable.Heisintrovertedand
willtalktoyouonlyinaverycalmandquietvoice.Heisphysicallyactiveandloves
cycling,buthisspinalrotationandhipopeningisextremelylimitedforhisage,which
couldberelatedtoblockedemotionsandalackofworkonhisfears.
Sincehisearlychildhood,Finnwearsglasseswhichbecamethickereveryyear,but
theocularhypertensionwasfirstnoticedthreeyearsagoinaroutinecheck.Itcame
along with the huge lifestyle change ofmoving out of hismothers place and the
beginningofhisstudiesinaforeigncity.
Ashis studiesdidn’tprogress thewayheplanned,examsbegan toputhimunder
moreandmorestress.Toworkonhisstresslevel,hisworriesaboutthehealthofhis
eyesandageneralmentaltension,hesawapsychologistregularlyforoverayear.
Strongmedicaments intheformofeyedropsandtwosurgeriescouldn’t lowerhis
ocularhypertensionwhichpressesonhiseyenerve.Ashecan’tmeasurehisocular
pressurehimself,hecan’tbesureabout the relationbetweenhis lifestyleand the
pressure in his eyes. But the regular measurements of the ophthalmologist show
thatocularpressurerisesduringtheendofthesemesterwhentheexamsputhim
underextremestress.
2.2TheTherapySequence
Whilekeepingtheimportantfactsofchapter1.2inthemind,anindividualsequence
can be designed according to Finns needs. The following program should be
maintainedforat least threeweeksand includesa30minpractice in themorning
beforebreakfastandabout20minpracticebeforelunchanddinner.
AsFinnisalreadyphysicallyactive,thefocusofthetherapywillnotbeonasanasbut
onpranayama,kryasandmeditationtocleanthebodyandworkagainstthestress.
Asanaswillonlybepracticedinthemorning.Thiswillhelptobringhisbodybackto
balanceandtoreliefmentaltensionslikeanxietyandblockedemotionsbyfocusing
ontwistingandbalancingpositions.
HisdaywillstartwithactivatingUdanaVayubyJalaNetiandhewillcontinuewith
Trataka:
• Eyemovementvertical(5times),horizontal(5times),diagonal(5timeseach
direction)andround(5timeseachdirection)
• Palmingandashortobservationofthebodyreactionsinbetween
SixroundsofaSuryaNamaskaraVatiation(rightandleft)willfollow,wherehewill
bendhiskneesinPadahastasanasothathisbackisstraightandparalleltothefloor.
Hecangazeslightlyfronttomakesurethathisheadstaysabovetheheartlevel.To
get the feeling of straightening and stretching the back without the inversion of
AdhoMukha Svanasana, hewill go to an active AdhoMukha Virasana. The other
positionsofSuryaNamaskaracanbeperformedasusual.
After these six rounds of Surya Namaskara, some balancing and twisting asanas
follow:
• Garudhasana(5breaths)
• TrikonasanaVariation(5breaths)
• VirabhadrasanaB(5breaths)
• Bhujangasana(5breaths)
• ArdhaMatsyendrasana(5breaths)
• Savasana(3min)
IntheafternoonandeveningFinnwilllearndharana/dhyana.Asheneverpracticed
YogaorMeditationbefore,theprogramwillbeverybasicinthebeginningandcan
bechangedaccordingtohisefforts.
ThefollowingsequenceshouldbepracticedbeforelunchandbeforedinnerandtheTratakakryashouldbeaddedbeforetheeveningpractice:
• Eyemovementvertical(5times),horizontal(5times),diagonal(5timeseach
direction)andround(5timeseachdirection)
• Palmingandashortobservationofthebodyreactionsinbetween
Eveningandafternoon:
• FullYogicBreathing(10rounds)
• Brameri(ifcomfortable5rounds)
• Nadi Suddi without retention but observing the natural gap between
inhalationandexhalation(10rounds)
• LearningtoapplyNasikagraDrishtiandShambhaviMudrawithclosedeyes,
sothatthereisnostrainontheeyemuscles(holdingeachonefor5breaths)
• Learningdharanabycountingdownfrom108,ifcomfortableincoordination
withthebreath(startwith3minandincrease)
Note:Theobjectofdharanashouldbechanged to theMantraSoHamas soonas
countingdowndoesn’t createanydifficultiesanymore.SoHam-Meditationcanbe
connectedtoNasikagraDrishtiand/orShambhaviMudra.Ifthisiscomfortabletoo,
the object of concentration/meditation can switch to an animal or nature
phenomenonwhichrepresentsclarityandeyesight.
Oneobject of concentration shouldbemaintained for at least aweek so that the
concentrationontheanimalornaturephenomenonwillbereachedearliest inthe
thirdweek.
Especiallywhile dealingwith extreme stress (for example during exam time) Yoga
nidraisadvisedbeforesleeping.
References
TeachersTrainingManualLevel1–BarathShetty,YogaIndia
TeachersTrainingManualLevel2–BarathShetty,YogaIndia
AsanasPranayamaMudraBandha–SwamiSatyanandaSaraswati
Yoga Therapy for common Ailments – Directorate of Distance Education under
SwamiVivekanandaYogaAnusandhanaSamsthana(www.svyadde.com)
Baskaran M et al. – Intraocular pressure changes and ocular biometry during
Sirsasana(headstandposture)inYogapractitioners.Ophthalmology2006
www.about-vision.com
www.yoga.about.com
www.wikipedia.org
AmericanGlaucomaSociety(www.americanglaucomasociety.net)
Artwork byHolly Fischer (www.open.umich.edu/education/med/resources/second-
look-series/materials)
National Eye Institute, National Institutes of Health
(www.nei.nih.gov/health/glaucoma)