WALKING 10,000 STEPS DAILY AND GLAUCOMA

 

In the 1960s, a Japanese company created a pedometer called ‘Manpo-kei,’ which translates to ‘10,000 steps meter.’ The number was chosen because it sounded catchy and promoted an active lifestyle. Therefore, the common 10,000 steps daily concept did not originate from any health organization guidelines. Instead, it was merely a trendy marketing idea. 

However, modern research has since validated the health benefits of walking more daily, even if 10,000 isn’t a strict requirement.

Walking 10,000 steps per day provides individuals with a specific goal. It helps people avoid a sedentary lifestyle, which is linked with health issues like heart disease, high blood pressure, high cholesterol, type 2 diabetes, certain cancers, osteoporosis, depression, and anxiety.

Studies show that increasing daily step count is associated with lower mortality risk, improved cardiovascular health, lower cardiovascular-associated mortality, a decreased cancer risk, and better metabolic function. 

Movement releases endorphins, helping to reduce stress and boost mood.

A study by Yuanbo et al, published in the recent edition of the Journal of Glaucoma, has shown that patients with primary open angle glaucoma (POAG) with average daily steps (ADS) of more than 10,000 exhibited higher papillary (optic disc) vessel density (VD) compared with those with ADS less than 10,000. This indicates that increasing daily steps, particularly exceeding 10,000 steps, may potentially enhance ocular blood flow. (1)

The study reported that papillary VD was significantly denser in the ADS >10,000 group (ADS:12782±2925) compared with that of the ADS ≤10,000 group (ADS:7418±1543).

Therefore, the 10,000 daily step routine can be a useful regimen for POAG patients to improve ocular blood flow. Vascular abnormalities have been associated with the development and progression of glaucoma. (2)

REFERENCE:

1. Liang, Yuanbo MD, PhD; Yu, Yun PhD; Wen, Xin MD; Wang, Mei MD, PhD; Lan, Yuqing MD, PhD; Pan, Xiafei MD,. Walking More Than 10,000 Steps Per Day May Be Associated With Increased Optic Disc Vessel Density in Patients With Primary Open Angle Glaucoma. Journal of Glaucoma 34(4):p 249-255, April 2025. | DOI: 10.1097/IJG.0000000000002548
2. Ahmad SS. Controversies in the vascular theory of glaucomatous optic nerve degeneration. Taiwan J Ophthalmol. 2016 Oct-Dec;6(4):182-186. doi: 10.1016/j.tjo.2016.05.009. Epub 2016 Aug 1. PMID: 29018738; PMCID: PMC5525630.

 

OPTIC NERVE STIMULATION (ONS) THERAPY

 

An innovative approach to glaucoma treatment is electrical stimulation of the retina and optic nerve.

In a study by Gall, transcutaneous electrical stimulation was applied through supra- and infra-orbital electrodes to the eyes of 82 patients diagnosed with optic neuropathies. The treated group had a significant improvement in visual field of 24% compared to baseline. This improvement persisted for at least 2 months. [1]

Another study by Ota involved five eyes of four patients suffering from POAG, who underwent transcorneal electrical stimulation. There was a significant linear relationship between changes in MD values and the number of electrical stimulation sessions, indicating partially restored visual fields (p < 0.01). [2]

However, a study by Rock in which transcorneal electrical stimulation was done the results were equivocal. Patients were randomized into three groups with no stimulation (sham), and electrical stimulation intensities below (subthreshold) or above (suprathreshold) individual phosphene thresholds. No statistically significant differences in visual fields between groups were reported. [3]

A study of optic nerve stimulation (ONS) by Erb et al involved 101 eyes in 70 patients (31 female, 39 male). The subjects included primary open-angle glaucoma (POAG, 65), normal tension glaucoma (NTG, 13), angle-closure glaucoma (ACG, 6), pseudoexfoliative glaucoma (PEX, 6), juvenile glaucoma (4), pigmentary glaucoma (4), glaucoma fere absolutum (2), and congenital glaucoma (1). [4]

The ONS treatment was conducted using the Eyetronic® device (Neuromodtronic GmbH, Potsdam, Germany) that applied electrical stimulation via goggles with embedded supraorbital and infraorbital electrodes and recorded EEG signals via an electrode cap.

The study revealed a significant change of MD by − 0.5 dB/year on average in visual field testing. MD significantly decreased from PRE 14.0 dB (median) to POST 13.4 dB (p < 0.01). 64 eyes in 49 patients showed constant or reduced MD as compared to baseline (PRE 13.4 dB vs. POST 11.2 dB). In 37 eyes of 30 patients, MD increased from PRE 14.9 dB to POST 15.6 dB.

Median MD at baseline before ONS treatment was 14 dB, more than 58% of eyes had an advanced vision loss with an MD > 12 dB, more than 80% of eyes were classified as moderate or advanced glaucoma, corresponding to an MD ≥ 6 dB.

The Eyetronic therapy involves the application of gentle electrical pulses, which stimulate the metabolism of neurons, restoring their function and stopping further cellular degeneration.

The therapy involves 10 sessions of 60 minutes each, applied over 10 consecutive days.

WEBSITE: https://eyetronic-therapie.de/en/

REFERENCES:

1. Gall C, Schmidt S, Schittkowski MP, Antal A, Ambrus GG, Paulus W, et al. Alternating current Stimulation for vision restoration after optic nerve damage: a randomized clinical trial. PLoS One. 2016;11(6):e0156134.
2. Ota Y, Ozeki N, Yuki K, Shiba D, Kimura I, Tsunoda K, et al. The efficacy of Transcorneal electrical Stimulation for the treatment of primary open angle Glaucoma: a pilot study. Keio J Med. 2018;67(3):45–53.
3. Rock T, Naycheva L, Willmann G, Wilhelm B, Peters T, Zrenner E, et al. Transcorneal electrical stimulation in primary open angle glaucoma. Ophthalmologe. 2017;114(10):922–9.
4. Erb C, Eckert S, Gindorf P, Köhler M, Köhler T, Neuhann L, Neuhann T, Salzmann N, Schmickler S, Ellrich J. Electrical neurostimulation in glaucoma with progressive vision loss. Bioelectron Med. 2022 Mar 31;8(1):6. doi: 10.1186/s42234-022-00089-9. PMID: 35361287; PMCID: PMC8969331

BREAST CANCER AND GLAUCOMA

 

PRE-PRINT:

Breast carcinoma is the most commonly occurring cancer among females. An estimated 2.3 million new cases of breast carcinoma are diagnosed annually worldwide. These patients have a potential risk of ocular complications, not only from the disease itself, but also due to side effects of medications such as corticosteroids and cytotoxic drugs used to treat breast cancers. [1] Metastases to the eye can affect almost every structure of the eye and adnexa, affecting vision and ocular motility from involvement of the extra-ocular muscles. Often, the ocular findings are the first indication of the disease involving the breast. [2]

Glaucoma can occur through diverse mechanisms in such patients. However, there are only a few case reports and studies available to understand the association between the two conditions. Glaucoma and breast carcinoma are two serious conditions affecting the morbidity and mortality of the affected patient. It would be an important exercise to assess the extent of association between these two conditions.

REFERENCES:

Łukasiewicz S, Czeczelewski M, Forma A, Baj J, Sitarz R, Stanisławek A. Breast Cancer-Epidemiology, Risk Factors, Classification, Prognostic Markers, and Current Treatment Strategies-An Updated Review. Cancers (Basel). 2021 Aug 25;13(17):4287.

Swampillai AJ, Booth AP, Cohen VML. Ciliary body and iris metastases with anterior chamber angle infiltration: a rare complication from invasive ductal breast cancer. J Glaucoma. 2020;29:e12-e15.

CATCH OUR ARTICLE COMING SOON ON: TOUCHReviews in Ophthalmology

 

THABIT IBN QURRA

 

Thābit ibn Qurra (full name: Abū al-Ḥasan Ṯhābit ibn Qurra ibn Zahrūn al-Ḥarrānī al-Ṣābiʾ) was a scholar known for his work in mathematics, medicine, astronomy, and translation. He was born in 826 or 836 and died on February 19, 901.

Thābit was born in Harran in Upper Mesopotamia, which at the time was part of the Diyar Mudar subdivision of the al-Jazira region of the Abbasid Caliphate. He spent most of his life in Baghdad.

Thābit was a well-known physician of his time and produced several medical treatises and commentaries. His works included general reference books such as al-Dhakhira fī ilm al-tibb ("A Treasury of Medicine"), Kitāb al-Rawda fi l–tibb ("Book of the Garden of Medicine"), and al-Kunnash ("Collection").

Thabit was the first to describe occlusion therapy for treating lazy eye or amblyopia. He suggested the closure of the normal eye with a patch to strengthen the lazy eye by forcing the “visual spirit” to transfer into the lazy eye: This was a leading breakthrough in ophthalmology.

REFERENCES:

• Abudawood GA, Alshareef R, Alghamdi S. Arab and Muslim scientists and their contributions to the history of ophthalmology. Saudi J Ophthalmol 2020;34:198-201.
• https://en.wikipedia.org/wiki/Th%C4%81bit_ibn_Qurra

FIBRONECTIN for NERVE REGENERATION

 

The central nervous system (CNS) projection neurons do not regenerate after axonal injury or degeneration. 

Several intra- and extra-cellular factors have been discovered that regulate axon regeneration. However, it is still difficult to find mechanisms to bypass extracellular inhibitors associated with glial scar and myelin formation (e.g., Cspg, Mag, NogoA, OMgp, Semaphorins) and help regenerate a complete axon.

As the CNS matures, the retinal ganglion cells (RGCs) lose their ability for intrinsic axon growth. This happens with a change in the initial axonal preference for an extracellular matrix (ECM) substrate to grow, conferred by integrin α and β heterodimers. Changes in the extracellular environment compromise the function of neuronal integrin subunit expression and axonal growth following injury or other deleterious events.

Lukomska and colleagues found that an ECM substrate fibronectin (Fn) which interacts with integrins was excessively present in some RGCs that survived optic nerve crush injury. It was found that Fn promotes survival and axon regeneration of axotomized adult RGCs in culture without glial scar inhibitors.

Injury-activated macrophages/microglia upregulate Fn. These cells are recruited by axon regeneration-promoting zymosan. This increases the Fn levels in the injured area.

The researchers found that Fn’s RGD motif, which interacts with Itga5 and ItgaV promotes long-term survival and long-distance axonal regeneration of adult RGCs. Some of the axons were found to reach the optic chiasm when co-treated with rpl7a gene therapy.

In conclusion, augmenting Fn levels in the damaged CNS is a promising therapeutic neuroprotective and neuroregenerative approach.

REFERENCE:

Lukomska A, Rheaume BA, Frost MP, Theune WC, Xing J, Damania A, Trakhtenberg EF. Augmenting fibronectin levels in injured adult CNS promotes axon regeneration in vivo. Exp Neurol. 2024 Sep;379:114877. doi: 10.1016/j.expneurol.2024.114877. Epub 2024 Jun 27. PMID: 38944331; PMCID: PMC11283980.

 

KAHOOK DUAL BLADE vs iSTENT: A META-ANALYSIS

 

The Kahook Dual Blade (KDB) is a modern goniotomy device. The goal for inventing the KDB device was to find a better and more efficient method for removing a complete strip of trabecular meshwork (TM) using an ab interno approach while minimizing damage to surrounding tissues.

CHECK LINK: https://ourgsc.blogspot.com/search?q=kahook

The iStent is a minimally invasive glaucoma surgery (MIGS) device devised to bypass the obstructed TM and allow the flow of aqueous from the anterior chamber into the Schlemm’s canal.

CHECK LINK: https://ourgsc.blogspot.com/search?q=iStent

A systematic review and meta-analysis comparing the KDB with iStent implantation with phacoemulsification was done by Guedes et al.

Fourteen studies were included with a total of 1959 eyes (958 phaco-KDB, and 1000 phaco-Stent including 753 phaco-iStent and 207 phaco-iStent inject).

The combined findings showed significantly higher rates of surgical success in the phaco-KDB group versus the phaco-Stent group (odds ratio: 0.68; 95% CI: 0.50 to 0.92; P = 0.01; I2 = 40%), and greater IOP reduction in the phaco-KDB group versus the phaco-Stent group at month 6 (MD: 1.13 mm Hg; 95% CI: 0.43 to 1.83; P = 0.002; I2 = 51%).

By month 12, both groups demonstrated similar IOP reduction. Subgroup analysis at month 12 showed greater IOP reduction in the phaco-KDB group versus the phaco-iStent group (MD: 1.69 mm Hg; 95% CI: 0.44 to 2.95; P = 0.008; I2 = 74%). However, compared with the phaco iStent inject group, there was no significant difference in IOP reduction (MD: −0.72 mm Hg; 95% CI: −3.69 to 2.24; P = 0.63; I2 = 64%). Medication reduction and the incidence of adverse events were comparable between groups.

RESULT:

The study concluded that KDB goniotomy may offer better surgical success compared with Stent implantation when used in combination with phacoemulsification. KDB goniotomy demonstrated better IOP reduction at month 12 compared with iStent. However, iStent inject showed a similar IOP reduction to KDB.

REFERENCE:

Guedes J, Amaral DC, de Oliveira Caneca K, Cassins Aguiar EH, de Oliveira LN, Mora-Paez DJ, Cyrino LG, Louzada RN, Moster MR, Myers JS, Schuman JS, Shukla AG, Shalaby WS. Kahook Dual Blade Goniotomy Versus iStent Implantation Combined With Phacoemulsification: A Systematic Review and Meta-Analysis. J Glaucoma. 2025 Mar 1;34(3):232-247. doi: 10.1097/IJG.0000000000002522. Epub 2024 Dec 9. PMID: 39641580.

VisiPlate Glaucoma Shunt

 

The VisiPlate is an ultrathin, multichannel, nonfibrotic aqueous shunt, which can have significant advantages in glaucoma surgery.

It shunts aqueous humor from the anterior chamber through a network of open microchannels to the subconjunctival space.

VisiPlate’s metamaterial features a highly biocompatible alumina plate coated with Parylene C.  The device has a 400-nm aluminum oxide plate coated with a 2-µm-thick layer of Parylene C.

It is corrugated into a pattern of networked microchannels, forming a hexagonal honeycomb.

The network of highly tunable rectangular microchannels rather than a large single-lumen tube provides better stability to aqueous outflow. The VisiPlate design represents a unique approach to lowering IOP; the numerous microchannels in the device enable slow and controlled outflow and provide a multitude of pathways for redundancy.

Slow outflow can create a diffuse, low-lying bleb that avoids tension and results in greater patient comfort than an elevated bleb.

Additionally, a controlled reduction of IOP minimizes the risk of early suprachoroidal hemorrhage.

VisiPlate’s thin profile is designed to limit peri-device flow and provide greater comfort and better aesthetics for the patient, with less risk of microtraumas from eyelid movement. Additionally, the nonfibrotic nature of the device minimizes foreign body response and has the potential to be effective without antifibrotic agents.

The composite structure of the VisiPlate is flexible and allows the device to conform to the curvature of the globe.

A version of VisiPlate being evaluated in early feasibility trials is approximately 5 mm wide and 8 mm long.

The implantation of the device is simple, without the need for patch grafts and gonioscopes. A scleral tunnel is created after a peritomy and the end of the device is inserted into the anterior chamber. The device is secured to the sclera. Antifibrotic agents can be used, according to the surgeon’s preference.

In a rabbit study by Kao et al, the VisiPlate demonstrated statistically significant (p<0.05) intraocular pressure (IOP) lowering of 20-40% compared to baseline at each timepoint over three months in nine implanted eyes.

A recent human VisiPlate study, known as the VITA trial, initially enrolled 15 patients and currently has 9-month data on 6 of those patients. On average, those with VisiPlate experienced a 46% drop in IOP (from 24 mmHg at baseline to 12.3 mmHg), and a reduction in average medication use from 2.1 medications at baseline to 0.7 medications.

The multichannel design provides several potential advantages over a tubular design by minimizing the risk of postoperative hypotony, avoiding peri-device flow, and diffusing aqueous in all directions in the subconjunctival space to form and sustain a low-lying bleb.

HORSE HAIR AS GLAUCOMA IMPLANT

 

Glaucoma drainage devices (GDDs) are rapidly evolving.

There are many types of implants being used or in the pipeline for the management of intraocular pressure (IOP).

However, a look into the history of GDDs shows how the process was started by using horse hair for drainage of hypopyon (pus) initially, and later for aqueous drainage in cases of absolute glaucoma.

REFERENCES:

1. Rollett M, Moreau M. Traitement de hypopyon par le drainage capillary de la chambre anterieure. Rev Gen Ophtalmol 906;25:48–9.

2. Rollett M, Moreau M. Le drainage au crin de la chambre anterieure contre l’hypertonie et la douleur. Rev Gen Ophtalmol 907;26:289–92.