Beneficial effect of mindfulness based stress reduction on optic disc perfusion in primary open angle glaucoma: A randomized controlled trial

BACKGROUND AND AIM: Glaucoma is one of the leading causes of visual impairment worldwide. Next to intraocular pressure (IOP), vascular factors play a major role in glaucoma. Mindfulness-based stress reduction (MBSR) has been shown to reduce the IOP, normalize the stress biomarkers, modulate gene expression, and also improve the quality of life. This study was aimed to assess the effect of MBSR in optic disc perfusion of patients with primary open angle glaucoma (POAG). EXPERIMENTAL PROCEDURE: POAG patients with controlled IOP (<21 mmHg) were randomised in to intervention group (n = 30) and control group (n = 30). Both the groups continued their routine glaucoma medications while the intervention group practiced 45 min of MBSR every day in addition. IOP and optic disc perfusion using OCT-Angiography were recorded at baseline and at 6 weeks for both the groups. RESULTS: The mean age of the participants were 53.23 ± 8.4yr in intervention and 50.23 ± 7.3yr in the control group (p = 0.06). All the baseline parameters were comparable in both groups. After MBSR, in the intervention group there was a significant reduction of IOP (p=0.001), increase in circum-papillary vessel density in superior quadrant (15.8%–17.4%, p=0.02) and nasal quadrant (14.2%–16.5%, p=0.01), increase in circum papillary vascular perfusion, in superior quadrant (38.9%–41.1%, p<0.001), in temporal quadrant (42.2%–44.5%, p<0.001), in inferior quadrant (40.1%–43.8%, p<0.001), and in nasal quadrant (40.6%–42.8%, p<0.001). There was also a significant increase in Flux Index after 6weeks (0.38–0.40, p<0.001). CONCLUSION: MBSR can reduce barotrauma and improve optic disc perfusion in POAG patients and serve as a useful adjunct to the standard medical therapy.