Warnings about too much pressure on the optic nerve caused by head-down poses such as headstands rang out in 2007 when researchers reported the risk in The British Journal of Ophthalmology.

It’s a message that isn’t promoted loudly enough despite two important facts. One is that the optic nerve can be vulnerable to the kind of eye pressure imposed by some yoga poses – the other is that 50 per cent of people with glaucoma haven’t been diagnosed and don’t know they have the condition, Geoff Pollard, national executive officer of Glaucoma Australia, says.

A potential cause of vision loss that occurs when the optic nerve is damaged, glaucoma affects one in 200 40-year-olds, with the incidence rising with age. Although early detection and treatment can halt or slow its progression and preserve eyesight, the disease can fly under the radar.

“People often rely on their vision as a guide to eye health rather than getting their eyes checked – they think that if there are no obvious vision problems, they’re OK,” he says. “Yet the changes that lead to glaucoma happen inside and at the back of the eye and can be very subtle.”

His advice? Have regular eye checks that include checking for glaucoma from the age of 40 onwards – and if there’s a family history of the disease (which increases the risk tenfold) – get your eyes checked for glaucoma 10 to 15 years before the age when your relative was diagnosed.

But eyes aren’t the only parts of the body that can run into trouble with yoga.

Although the health benefits attributed to yoga keep mounting – easing stress and improving blood pressure are among them – injuries related to yoga are rising too, says Caitlin Reid, a Sydney-based yoga teacher and accredited exercise physiologist.

“Not only are more people practising yoga but the numbers of yoga poses – or asanas – have increased. Originally, there were only a handful of poses and now there are thousands. Then there’s Instagram – people are posting pictures of themselves in amazing poses and this can drive less experienced people to try these poses before they’re ready,” she says.

The most common yoga-related problems? Injuries to the lower back, shoulder or rotator cuff, wrist or hand, according to a 2014 report in The International Journal of Yoga, while a 2013 review of adverse events linked to yoga singled out headstands, shoulder stands, variations of the lotus position and postures that involve putting one or both feet behind the head as the most likely to cause trouble.

As for yoga styles that might pose a risk, Reid suggests care with Bikram – “hot yoga” – which is done in a room heated to 40 degrees.

“The warm environment makes it easier to get into yoga pose and to get deeper into a pose – but this can also lead to ligament strains caused by overstretching,” she says.

The way to avoid injuries in any style of yoga is to err on the side of caution: don’t run before you can walk, Reid says.

“People often see the instructor doing a difficult pose and try to do the same but good instructors will suggest gentler options – so always do the easiest version of a pose until you understand it before you progress to the harder version.

“We need to get over this idea of feeling awkward about doing an easier version of a pose and trying to keep up with people who are more experienced. The whole point of yoga is to listen to your body so if you feel yourself getting tired or have difficulty with a pose just go into child’s pose and rest.

“Tell the instructor about any medical condition you have, no matter how small and about any injuries – even if it was five years ago. A good instructor will also point out if a pose is unsuitable for people with certain conditions such as back pain.”

I you’re already diagnosed with glaucoma, can you still do yoga? Yes, Reid and Pollard say – just avoid any poses where your head is below your waist, including downward dog and standing forward bend, until you’ve talked to your optometrist or ophthalmologist.

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The discovery, in three major studies, could help identify people at higher risk of the disease and lead to earlier screening and treatments.

All three studies, published today in Nature Genetics, identify gene sequence variations of the ABCA1 gene, which is involved in the regulation of cellular cholesterol and lipid metabolism, as playing a role in the eye disease.

Professor Jamie Craig, of the South Australian Health and Medical Research Institute and joint leader of the Australian project, says the finding is significant.

“It’s rock solid that this is an important result because it has been found in three different ways,” says Craig, who is also from Flinders University’s Centre for Ophthalmology and Eye Vision Research.

“All the papers were done in different populations with different strategies and all identified the same gene.

“It has been shown to be involved in eye pressure in normal people and tells us for sure it is contributing to glaucoma at least partly through intraocular pressure pathways.”

Glaucoma is the leading cause of irreversible blindness in the world.

It is caused by damage to the optic nerve, usually, but not always due to the eye pressure inside the eye (intraocular pressure) being too high, as the eye fluid does not drain properly.

People with a close relative with the disease are about 10 times more likely to contract the condition.

Early diagnosis of glaucoma is crucial because, if treated early enough, damage to vision can be prevented, says Craig.

Trio of studies

The Australian study, which also involved US researchers who replicated the findings, looked at potential gene targets in primary open-angle glaucoma (POAG).

POAG is the most common type of glaucoma and involves the progressive loss of peripheral vision until the central vision is affected.

The study included a cohort of 1155 patients from the Australian and New Zealand Registry of Advanced Glaucoma with severe POAG, and 1992 matched controls.

Genetic testing identified variants of three genes, ABCA1, AFAP1 and GMDS, which significantly increased the risk in Australians and Americans of European descent.

A second UK-led study, of which Craig is a co-author, involved genetic screening of 35,296 subjects including people with Asian and European descents drawn from across seven countries.

They found four new genes associated with high eye pressure and glaucoma. One of the genes is the ABO gene, which determines blood group, and higher eye pressure appears to be linked to blood group B.

The study also found a genetic change in the ABCA1 gene is associated with an increased risk of developing both high eye pressure and glaucoma.

The third Chinese study is unique says Craig because it is the first large-scale study of POAG in an Asian population.

It identified variants near two genes — ABCA1 and PMM2 — which are associated with glaucoma risk in people from China and Singapore.

Genetic risk

Craig says the findings may in the future be used to develop risk profiles that will allow doctors to know whether a person has high-risk of their glaucoma being severe.

“We are looking at ways to add up a genetic risk profile,” says Craig. “So if you can say if you’ve got a larger load of these variant genes, your risk is high.”

Craig says the ageing population means there is a “potential tsunami of people beyond 90 now going blind in the last years of their life”.

“Sometimes it is the one thing that means they can’t live independently.”

He says if you can identify those people at high-risk of severe glaucoma it can be treated more aggressively early in their life to save their sight.

However, he cautions it will take several years of experiments before the exact role of the genes identified in these studies is known, and these steps need to be taken before new treatment strategies can be planned.

Article Source

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WHEN Darcy Ferreira was old enough to open his eyes, people would comment on how big and beautiful they were.

But when he was just 11-months-old, the Wahroonga youngster woke up one morning with a cloudy right eye. Concerned mum Mandy took him straight to the doctor.

“It turned out he had glaucoma in both eyes from birth, which we were unaware of,” Ms Ferreira said.

“The pressure in his eye had gotten got so high that the lenses had split apart and let fluid into his eye.

“It was very scary — he was operated on two days later to keep damage to a minimum, and we were able to save his sight because we got on to it so early.”

The now 17-month-old still has eye drops daily for the illness affecting one in 10,000 Australian babies.

Ms Ferreira urged parents to take caution: “It’s something you think that affects old people, not little babies — but it does.’’

This month is JulEYE month, raising awareness for the Royal Australian and New Zealand College of Ophthalmologists Eye Foundation.

The not-for-profit organisation is educating parents about eye disease, because, despite 75 per cent of vision loss being preventable or treatable, many Australians are still not finding out if eye disease is part of their family history and if their children’s eyesight is at risk.

Source

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EXERCISE can protect the eye against disease and reverse the impact of ageing, offering hope of tackling vision loss and blindness.

For the first time Melbourne researchers from the Centre for Eye Research Australia have shown the protective effects of exercise on vision.

The findings indicate physical exercise could provide a safe, non-invasive and cost-effective way to prevent glaucoma.

It’s the most common form of irreversible blindness, which one in eight Australians over 80 will develop.

Worldwide there are an estimated 60 million glaucoma cases.

Dr Vicki Chrysostomou and colleagues found that exercise could be beneficial not just in preventing the eye disease, but perhaps also as a treatment.

Dr Chrysostomou said they found exercise both before the injury and after the injury was protective.

“In animal models we have shown that exercise is still protective, even if it’s after injury or damage to the retina, which is quite exciting,” she said.

“It indicates that exercise can be used not only as a preventative measure before injury, but also as a therapeutic aid applied after injury and that’s more relevant in a clinical situation because patients already have eye disease.”

She said exercise would not be a viable option for all patients, but they had begun researching the exact mechanisms of its protective effect in the hope of finding a way to mirror the effect with drugs.

“The exercise pill may not actually be as science fiction as it sounds,” she said.

Dr Chrysostomou said the benefit of exercise on many aspects of our health had been well established, but until now there had been no evidence that it could have a positive effect on vision.

“It has been shown that exercise can protect nerve cells in the brain during ageing, after injury and in neurogenerative diseases like Alzheimer’s disease so we wanted to find out if it also had a protective effect on vision,” she said.

As part of the study they got old mice to swim 60 minutes a day for five days a week over a six-week period.

Then they looked at how the mice responded to an optic nerve injury, which mimics what occurs in glaucoma.

Their findings, published in the Neurobiology of Ageing journal, found the eyes had an improved function after the injury in animals that had been exercised in comparison to those that had normal sedentary conditions.

“We have also found that exercise almost completely reversed age-related vulnerability of the optic nerve to injury so that exercised aged mice had a similar functional response to injury as non-exercised young mice.”

Dr Chrysostomou said they need to establish the type, amount and duration of exercise that is most beneficial.

The team is also hoping to extend their trial to humans.

Lucie.vandenBerg@news.com.au

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And while Australia’s developed health system often ensures prompt treatment for those affected, this isn’t always the case, especially for Indigenous Australians.

Peggy Giakoumelos reports.

The Fred Hollows Foundation says Aboriginal and Torres Strait Islanders are 12 times more likely to develop cataracts that results in blindness, while surgery rates are seven times lower than the national average.

Jaki Adams-Barton is the Manager of the Fred Hollows Foundation’s Indigenous Australia Program.

She says there are a number of risk factors for developing cataracts.

They include age, family history, diabetes, previous eye trauma or simply getting older.

While cataracts cannot be prevented from developing or slowed down from progressing once they appear, they can be easily treated with surgery.

The Fred Hollows Foundation says it’s crucial that people have regular eye checks, something Indigenous Australians are less likely to do.

“Aboriginal and Torres Strait Islander people don’t have a history or a regime of getting their eyes tested. We know that around 30 per cent of Aboriginal and Torres Strait Islander adults have never had an eye test in their adult life. So if people can’t get diagnosed then they can’t get the treatment that they need. But then we also know that for remote and regional patients getting into surgery in terms of transport and location can be quite troublesome.”

Alexander Dennis is a resident of the NSW town of Walgett.

He was in his 40s when he began to lose his sight, but it wasn’t until three years ago that his vision became so impaired that he had to stop one of his greatest loves – playing music.

Now in his 50s, Alexander Dennis was one of 30 Indigenous patients to recently have cataract surgery at Bourke Hospital in outback NSW.

His surgery was performed as part of a pilot program run by the Outback Eye Service, The Fred Hollows Foundation, and funded by the NSW Department of Health.

He described the impact of the surgery on the Foundation’s website.

“The doctors told me that I need to go get the cataracts off my eyes because it was very hard for me to see. I couldn’t drive, I couldn’t cook which is terrible because I like cooking. When I took my pad off my eye it was magic. I’m getting teary. I saw my wife, first. I just wanted to see her beautiful face and colours I could see the colours, green trees it was pretty amazing.”

Konrad Pesudovs is the Foundation Chair of Optometry and Vision Science at Flinders University in South Australia.

He says there have been various funding programs in place over the years to deliver cataract surgery to remote communities, but distance still means many people in remote Aboriginal communities fail to get treatment in a timely manner.

“There are a number of barriers to delivery. The primary one is remote location. A lot of indigenous Australians that are more than 1000km away from the nearest place where they could have cataract surgery, for example and other interventions. So the delivery of surgical interventions is essentially extremely difficult for those people. There are services that exist that fly people in for surgery and bring them in by road and so forth, but you need to get in a number of steps in a process lined up to ensure that these things occur. There’s quite a lot of qualitative research that’s been done around barrier to health care. These sort of things are substantial and they definitely affect the prevalence that we see.”

But Konrad Pesudovs says even when performed at a later stage, cataract surgery remains one of the major success stories of modern medicine.

“It’s one of the miracles of the 20th Century, that we now enjoy in the 21st Century. It’s extremely successful, it’s incredibly predictable. It is serious surgery where it’s possible to go blind but it’s so rare, that minor complications occur, and incredibly rare that serious complications occur . However in order to achieve those success rates you need a proper surgical suite. So that’s why it’s so difficult to have a mobile surgical delivery for example.”

Source.

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And, Dr David Manning hopes the surgery will become available to public patients in the region within the next few months.

He began carrying out the 20-minute procedure on patients at Hunter Valley Private Hospital and Charlestown Private Hospital in February.

It involves implanting a tiny piece of titanium, called an iStent, into the eye.

The device creates a channel for fluid to bypass the site of blockage in the eye and lower the pressure to help prevent further vision loss.

Glaucoma, the leading cause of irreversible blindness world wide, is caused when the optic nerve is damaged by a build-up of fluid.

Dr Manning said he had been ’’badgering’’ for three years to get the procedure approved in Australia – and it finally happened on February 10.

Since then he has carried out the procedure seven times.

Speaking to the Newcastle Herald yesterday for World Glaucoma Week, he said he was hopeful the iStent would become available to the Hunter’s public patients later in the year.

“The procedure is minimally invasive and of glaucoma is reduced through safer surgery,’’ he said.

Dr Manning, who works privately and as a visiting medical officer for Hunter New England, said he did his training for this new surgery in Armenia.

Over four days he carried out the operation 150 times with another specialist.

The first patient he operated on in Australia was Carol Hall, who is 72 and lives in Cardiff.

Since having the iStent implanted in her right eye a fortnight ago her intraocular pressure has gone down to a healthier level.

Next week she will go in to have the device put in her left eye.

“I didn’t have a choice, I was going to go blind if I didn’t have it,” Miss Hall said.

“The glaucoma was very well advanced; I hadn’t been to see an eye specialist in nine years.’’

Miss Hall urged people to not put off getting their eyes checked.

“Glaucoma is a thing that creeps up on you, you don’t get any warning,’’ she said.

‘‘Dr Manning said if I didn’t have the iStent put in I would have gone blind in five years.’’

Source.

Dr Manning is one of 5 Ophthalmologists who have come together to create iLaser Vision.

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