Physical activity and exercise in primary open-angle glaucoma: a scoping review

Background Glaucoma is one of the leading causes of irreversible blindness, with intraocular pressure (IOP) reduction being the only therapeutic target to date. However, growing interest surrounds physical activity (PA) and exercise as a complementary strategy, potentially influencing glaucoma incidence, severity, and progression. Objective This scoping review aims to systematically map existing evidence on the role of PA and exercise in primary open-angle glaucoma (POAG) across four dimensions: prevalence/incidence, disease progression, disease severity, and quality of life. Methods A systematic search was carried out in the following databases, which included articles up to 13/6/2024: MEDLINE via PubMed, Embase via Elsevier, and SPORTDiscus via EBSCOhost. Studies were included if they assessed the effects of PA and exercise on POAG related outcomes (ophthalmological markers, systemic markers, and quality of life). All study designs were considered, including randomized controlled trials (RCTs), non-randomized, and observational studies. Study characteristics, demographics, and primary outcomes were extracted in tables and summarized narratively. Results 18 studies were included, of which 14 were observational and 4 RCTs. PA, particularly aerobic exercise, reduced IOP and improved ocular perfusion pressure. Higher levels of PA and exercise were associated with lower glaucoma prevalence, lower glaucoma incidence and less glaucoma progression. No studies addressed disease severity or quality of life. Limitations were short follow-up time, small sample size, incomplete outcome measures, and reliance on self-reported data, or suboptimal glaucoma labels. Conclusions The extracted studies underline that PA and exercise show potential to reduce glaucoma progression, possibly both via IOP reduction and IOP-independent mechanisms including improvement of ocular perfusion pressure. However, more evidence is needed before recommending PA and exercise as adjunct treatment strategies. Future research should focus on longer-term, adequately powered RCTs with comprehensive outcome measures that include both IOP and non-IOP related outcomes and quality of life. These efforts are crucial to understand the full therapeutic value of PA and exercise in glaucoma prevention and management. Key Points: 1) Physical activity and exercise affect glaucoma through mechanisms beyond intraocular pressure, suggesting a key role in both prevention and disease progression. 2) Emerging evidence supports a paradigm shift, positioning exercise as a potential non-pharmacological therapy for glaucoma. 3) This review highlights significant research gaps and methodological limitations that must be addressed before establishing exercise at the forefront of future glaucoma management.