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)