Can Yoga Positions Cause An Eye Pressure Problem?




Ophthalmologist Carolina Valdivia discusses yoga positions and their potential impact on intraocular pressure in glaucoma patients and glaucoma suspects.







Question MarkA 45 year-old woman from New South Wales, Australia writes:

Hi Dr. Valdivia. I have been very recently diagnosed as a glaucoma suspect, but at the moment my eyes are healthy. I am not taking any medication for it.

I practice yoga and my eye specialist has told me that because I am a glaucoma suspect I should not attempt any fully inverted yoga poses (legs above the head, for example: headstand) and to limit time spent in semi-inverted yoga poses and postures (head below the heart, for example: downward dog).

My question is, how many seconds can I safely hold the semi-inverted yoga poses and postures before I create an eye pressure problem?

Thanks for your great work!



Thank you for your question and for your interest in glaucoma-eye-info.com.

Carolina Valdivia, MDThe term glaucoma suspect describes a person with one or more risk factors that may lead to glaucoma, such as an eye pressure problem, but has no recognizable optic nerve damage or visual field loss. You currently are not taking medication to control your intraocular pressure (IOP) at this time.

Because you are a glaucoma suspect, your ophthalmologist will monitor you regularly for any sign of an eye pressure problem and will work with you to try to keep your intraocular pressure within a normal range. Part of this is determining what is a normal eye pressure for you. This entails assessing your intraocular pressure at different times of the day and on different days. This will enable your ophthalmologist to develop a profile that can be used to evaluate if you are developing an eye pressure problem in future visits.

You are a person that practices yoga and apparently enjoys it a great deal. Recommendations given by your ophthalmologist that you avoid inverted yoga poses and to limit those yoga poses and postures that cause your head to be below your heart appear to have caused some anxiety, as following these instructions will cause a disruption in your regular yoga practice routines. However, remember that your ophthalmologist gave you these instructions specifically because these types of yoga positions can cause an eye pressure problem. You currently do not have to take medication. Your ophthalmologist's goal is to keep it this way for as long as possible.

The list below identifies some things that are known to cause high intraocular pressure that is transient (it comes and goes).

  • Abrupt or sustained physical exertion, such as lifting a heavy object.
  • Squatting.
  • Bending over, while standing or sitting, so that the head is below the heart.
  • Straining during defecation.
  • Playing a brass or woodwind musical instrument.
  • Wearing constrictive clothing around the neck.
  • Various acrobatic or gymnastic maneuvers.
  • Certain yoga positions.

Several scientific studies have specifically investigated the effects of yoga positions on generating high intraocular pressure in adults. The concern has been that not only do certain yoga positions carry a risk of creating a transient eye pressure problem, these positions often are held for extended periods, which carries the risk of sustained high intraocular pressure.

The table below presents combined (meta-analysis) data obtained from 12 published studies looking at the effects of various yoga positions on intraocular pressure (IOP). Particular emphasis is given to inverted yoga poses and those that are semi-inverted. Participants in the studies were free of ocular disease, were between the ages of 22-63 years, and ranged from intermediate to advanced levels of proficiency. Average intraocular pressure at a seated position for this combination of studies was 15.2 mmHg.

YOGA POSE

AVERAGE IOP AFTER
INITIATION

INCREASE IN IOP

Salamba Sirsasana
(headstand)
33.6 mmHg
+18.4 mmHg
Urdhva padmasana
(Inverted Lotus)
33.2 mmHg
+18.0 mmHg
Parsva Sirsasana
(side headstand)
33.5 mmHg
+18.0 mmHg
Parivrttaikapada Sirsasana
(Revolved Split-Legged
Headstand)
33.9 mmHg
+18.7 mmHg
Pincha Mayurasana (peacock
feather pose)
31.5 mmHg
+16.3 mmHg
Eka Pada Viparita Dandasana (one-legged inverted-staff
pose)
28.2 mmHg
+13.0 mmHg
Utthita Pada Sirsasana
(extended-leg headstand
pose)
33.7 mmHg
+18.5 mmHg
Valsalva Maneuver
(attempting to forcibly exhale
while keeping the mouth and
nose closed)
38.1 mmHg
+22.9 mmHg
Adho Mukha Vrksasana
(handstand)
34.8 mmHg
+19.6 mmHg
Salamba Sarvangasana
(Shoulder Stand)
25.4 mmHg
+10.2 mmHg
Urdhva Dhanurasana
(wheel pose)
22.4 mmHg
+7.2 mmHg
Halasana (plow pose)
19.0 mmHg
+3.8 mmHg
Adho Mukha Svanasana
(downward-facing dog)
19.9 mmHg
+4.7 mmHg
Setu Bandha Sarvangasana
(bridge pose)
24.3 mmHg
+9.1 mmHg
Urdhva Mukha Svanasana
(upward-facing dog)
14.5 mmHg
-0.7 mmHg
Viparita Karani
(legs-up-the-wall pose)
14.0 mmHg
-1.2 mmHg
Virasana (hero pose)
13.8 mmHg
-1.4 mmHg
Padmasana (lotus pose)
13.7 mmHg
-1.5 mmHg
Meta-analysis by Carolina Valdivia Cáceres, MD and Ángela Pattatucci Aragón, Ph.D., 2011.

As you can see, all tested inverted yoga poses significantly increase intraocular pressure, at least doubling it. Additionally, poses tested that involve placing the head below the heart also showed increases, ranging from 3.8 to 13.0 mmHg. The controversial valsalva maneuver caused the greatest increase in intraocular pressure and in some studies also caused temporary disruptions in visual acuity. Four other yoga poses and postures showed minor decreases in intraocular pressure for the group.

Spikes in high intraocular pressure appear to be immediate upon entering yoga poses and postures. Thus, there appears to be no safe period of time for you to practice either inverted yoga poses or semi-inverted yoga positions. In some studies, a decrease by as much as 14% was observed in intraocular pressure after holding yoga poses and postures for 3-4 minutes, as the body adapts to the pose. However, an eye pressure problem still exists. This level held until the yoga poses and postures were sustained for approximately 12 minutes, when intraocular pressure rose again, in some cases beyond the mark of the original spike.

The high intraocular pressure is a transient phenomenon, meaning that eye pressure returns to normal within 60 seconds of ending yoga poses and postures.

These data suggest that the greatest risk of damage to the optic nerve or visual field for a glaucoma patient or a glaucoma suspect is from practicing inverted yoga poses for sustained periods. Indeed, there are several clinical reports of progressive visual field damage associated with the regular practice of inverted yoga poses.

Although the spikes in high intraocular pressure are much lower for yoga positions in which the head is below the heart, this does not necessarily mean that an eye pressure problem does not exist or that there is less risk associated with these yoga poses and postures. Again, the most significant risk appears to come when the yoga positions are sustained for long periods through regular practice. For example, performing the halasana (plow pose) for extended periods over successive days still could carry substantial risk for damage in a glaucoma patient or a glaucoma suspect.

The good news is that many yoga positions either have no effect or in some cases even result in minor reductions in intraocular pressure. These can be practiced safely for a glaucoma patient or a glaucoma suspect. Author and yoga instructor Clarissa Adkins provides several excellent suggestions in her article Yoga Poses for Glaucoma. You can also speak to your yoga instructor about modifying yoga poses and postures in your routines so that your eyesight is protected.

Remember, glaucoma is a very serious disease that can lead to blindness. Although being a glaucoma suspect does not necessarily mean that you will develop glaucoma, you are a significantly higher risk than the general population. Data presented above suggest that there is no safe period of time for you to perform semi-inverted yoga poses. It is not a good idea to try to push your luck with this.

Good luck and keep exercising. Healthy exercise helps to maintain intraocular pressure within a normal range.

Carolina Valdivia, MD

My goal in answering your questions is to provide you with information, clear up misconceptions, and to explain options so that you can have an informed conversation with your doctor. However, under no circumstances should my response to your question be considered a substitute for ongoing consultation and examination with your doctor. Since I have not examined you, I only can speak in terms of generalities, whereas your doctor has sufficient clinical details to evaluate your case specifically.




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