June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
The Efficacy of Mindfulness Meditation in Medically-Treated Glaucoma
Author Affiliations & Notes
  • Abdelaziz Abdelaal
    Harvard Medical School, Boston, Massachusetts, United States
    Doheny Eye Institute, Los Angeles, California, United States
  • Mohamed Fayez Fouda
    Faculty of Medicine Tanta University, Egypt
  • Mohamed Elmallahy
    Faculty of Medicine Tanta University, Egypt
  • Ali Monir
    Faculty of Medicine Tanta University, Egypt
  • Mohamed Elhabib
    Faculty of Medicine Tanta University, Egypt
  • Abdul Rhman Hassan
    Faculty of Medicine Tanta University, Egypt
  • Heba Fouda
    Faculty of Medicine Tanta University, Egypt
  • Basant Katamesh
    Faculty of Medicine Tanta University, Egypt
  • Basel Abdelazeem
    McLaren Health Care Corp, Flint, Michigan, United States
    Michigan State University, East Lansing, Michigan, United States
  • Hashem Abu Serhan
    Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Footnotes
    Commercial Relationships   Abdelaziz Abdelaal None; Mohamed Fouda None; Mohamed Elmallahy None; Ali Monir None; Mohamed Elhabib None; Abdul Rhman Hassan None; Heba Fouda None; Basant Katamesh None; Basel Abdelazeem None; Hashem Abu Serhan None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 4318. doi:
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      Abdelaziz Abdelaal, Mohamed Fayez Fouda, Mohamed Elmallahy, Ali Monir, Mohamed Elhabib, Abdul Rhman Hassan, Heba Fouda, Basant Katamesh, Basel Abdelazeem, Hashem Abu Serhan; The Efficacy of Mindfulness Meditation in Medically-Treated Glaucoma. Invest. Ophthalmol. Vis. Sci. 2023;64(8):4318.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Poor patient compliance to medical therapy (MT) has deemed glaucoma difficult to manage. The implementation of mindfulness meditation (MM) may provide better intraocular pressure (IOP) control. This meta-analysis tested the hypothesis that MM can result in a clinically significant reduction in IOP (≥2 mmHg) compared to MT alone.

Methods : We analyzed 488 eyes, reported in ten randomized controlled trials, following a systematic search of nine databases [protocol: CRD42022316151]. The difference in IOP between MM and MT was our primary outcome. The magnitude of IOP change was assessed based on the type and severity of glaucoma, baseline IOP, duration of MM training, follow-up period, and laterality. Secondary outcomes included quality of life (QoL) and stress markers (cortisol and β-endorphin). STATA Software was used to pool the crude mean difference (MD) across studies, using the random- (REML method) or fixed-effects (inverse-variance method) models based on heterogeneity. The sensitivity analysis was not remarkable and no publication bias was observed. The certainty of evidence was measured using the GRADE framework.

Results : Compared to MT alone, MM resulted in both statistically and clinically significant reductions in IOP [MD=-2.19; 95%CI:-3.50: -0.88; I2=96.45%]. This reduction was highest at 3 weeks [MD=6.03; 95%CI:-6.65: -5.56; I2=0%]; however, it diminished as the follow-up period increased. IOP reduction was observed only in patients who have had 30 hours of training or more [MD=-1.28; 95%CI: -1.60: -0.96; I2=0%]. High baseline IOP (>21mmHg) showed the greatest benefit [MD=-2.48; 95%CI: -3.79: -1.17; I2=86.61%], while normal baseline IOP exhibited no change [MD=-1.76; 95%CI:-4.14: 0.61; I2=98.47%]. IOP change was similar between the right and left eyes. However, unilateral cases had a greater reduction [MD=-2.95; 95%CI:-4.92: -0.98; I2=94.77%] than bilateral cases [MD=-1.82; 95% CI:-3.53: -0.11, I2=96.31%]. Significant improvements were noted in cortisol [MD=-51.01; 95%CI: -98.23: -3.78, I2=97.20%], β-endorphin [MD=9.53; 95%CI:4.38: 14.69; I2=92.20%], and QoL [MD=5.70; 95%CI: 2.82: 8.58].

Conclusions : Our findings, of moderate certainty, support our hypothesis that adjuvant MM can provide better control of glaucoma. This effect is modifiable based on several factors. More trials are needed to study the effect of MM based on the type and severity of glaucoma.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.


IOP change in MM vs MT

IOP change in MM vs MT


IOP change based on laterality

IOP change based on laterality


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