Modifiable factors in the management of glaucoma: a systematic review of current evidence

Methodological quality of the review: Low confidence


Authors: Hecht I, Achiron A, Man V, Burgansky-Eliash Z


Region: Not reported


Sector:  Glaucoma


Sub-sector: Risk factors

Equity focus: None specified

Review type: Other review

Quantitative synthesis method: Narrative synthesis

Qualitative synthesis method: Not applicable


Primary open-angle glaucoma (POAG) is a chronic optic neuropathy affecting millions of people worldwide and represents a major public health issue. Environmental factors, behaviours, and diet are intimately related to patient health and may play a role in the pathogenesis and progression of glaucoma


Review the literature, focusing on the last three years, regarding modifiable lifestyle (MLS) interventions in the management of primary open-angle glaucoma.

Main findings:

In total the authors included 12 studies in the review. Most were cross-sectional or retrospective in nature, and four were randomized controlled trials.

The authors found that sleeping with the head elevated and avoiding the worst eye-dependent side during sleep may slightly lower intraocular pressure and reduce visual field loss. Some food supplements and moderate aerobic exercise may also reduce intraocular pressure up to 2.0 and 3.0 mmHg, respectively. The authors also reported that frequency of coffee intake may be associated with disease progression. Potential negative effects are associated with weight-lifting and yoga exercises.

The authors concluded that certain lifestyle habits could influence glaucoma progression, yet no specific interventions are currently supported by robust evidence. Awareness of the possible influences of certain habits should help guide clinical advice and is important to help patients avoid adverse outcomes and take an active role in the management of their disease.


The authors included studies which relate to effects of different MLS interventions on patients affected by POAG. Study population included: POAG patient groups; studies examining any objective outcome measure relating to POAG; examining any MLS such as diet change, food supplements, sleeping position, caffeine intake, physical activities; studies written in English; full publications; studies published between 2013 and 2016.

The authors searched Cochrane Library and MEDLINE, PubMed,, metaRegister of Controlled Trials, WHO International Clinical Trials Registry Platform and google scholar. Additional records were identified by hand-searching bibliographies narrative synthesis to synthesize all included evidence.

Applicability/external validity:

Applicability and external validity were not explored by the authors.

Geographic focus

Not reported by the authors

Summary of quality assessment:

Overall, there is low confidence in the findings of this review as important limitations were identified. Although the authors used appropriate methods to synthesize evidence, they did not conduct thorough searches of the literature to ensure that all relevant studies were included in the review, which can impact on the overall findings. It is also not clear if bias was avoided whilst extracting data from the studies included, and the level of risk of bias of included studies.

Publication source:

Hecht I, Achiron A, Man V, Burgansky-Eliash Z (2017) Modifiable factors in the management of glaucoma: a systematic review of current evidence. Graefes Arch Clin Exp Ophthalmol. 2017 Apr;255(4):789-796.