Accommodative Exercises to Lower Intraocular Pressure

Abstract

Purpose: This study investigated how a conscious change in ocular accommodation affects intraocular pressure (IOP) and ocular biometrics in healthy adult volunteers of different ages.

Methods: Thirty-five healthy volunteers without ocular disease or past ocular surgery, and with refractive error between -3.50 and +2.50 diopters, were stratified into 20, 40, and 60 year old (y.o.) age groups. Baseline measurements of central cornea thickness, anterior chamber depth, anterior chamber angle, cornea diameter, pupil size, and ciliary muscle thickness were made by autorefraction and optical coherence tomography (OCT), while IOP was measured by pneumotonometry. Each subject's right eye focused on a target 40 cm away. Three different tests were performed in random order: (1) 10 minutes of nonaccommodation (gazing at the target through lenses that allowed clear vision without accommodating), (2) 10 minutes of accommodation (addition of a minus 3 diopter lens), and (3) 10 minutes of alternating between accommodation and nonaccommodation (1-minute intervals). IOP was measured immediately after each test. A 20-minute rest period was provided between tests. Data from 31 subjects were included in the study. ANOVA and paired t-tests were used for statistical analyses.

Results: Following alternating accommodation, IOP decreased by 0.7 mmHg in the right eye when all age groups were combined (p = 0.029). Accommodation or nonaccommodation alone did not decrease IOP. Compared to the 20 y.o. group, the 60 y.o. group had a thicker ciliary muscle within 75 μm of the scleral spur, a thinner ciliary muscle at 125-300 μm from the scleral spur, narrower anterior chamber angles, shallower anterior chambers, and smaller pupils during accommodation and nonaccommodation (p's < 0.01).

Conclusion: Alternating accommodation, but not constant accommodation, significantly decreased IOP. This effect was not lost with aging despite physical changes to the aging eye. A greater accommodative workload and/or longer test period may improve the effect.

Figure 1

Study design and measurements.

Figure 2

Percent change in IOP from pretest, right eye. Nonaccom, focusing without accommodation on target for 10 minutes; Accom, focusing on target through −3 diopter lens for 10 minutes; Alternating, alternating between nonaccommodation and accommodating conditions every minute for 10 minutes. Asterisk indicates p < 0.05 when compared to baseline, paired t-test. Error bars indicate standard error.

Figure 3

Ciliary muscle thickness in age groups of 20 y.o., 40 y.o., and 60 y.o. while nonaccommodating. The ciliary muscle of the 60 y.o. group was thicker within 75 μm of the scleral spur compared to the 20 y.o. and 40 y.o. groups. The ciliary muscle of the 20 y.o. group was thinner up to 50 μm from the scleral spur and thicker at distances of 125–300 μm from the scleral spur compared to the 40 y.o and 60 y.o. groups (^∗∗p < 0.00001), using linear mixed-effects models (^∗p < 0.00001).