WEBVTT 00:00:00.000 --> 00:00:03.020 Eye health should be part of overall athlete 00:00:03.020 --> 00:00:06.879 care, so regular eye checkups are essential and 00:00:06.879 --> 00:00:11.919 inform your ophthalmologist what type of exercise 00:00:11.919 --> 00:00:15.859 you practice. And as someone who works every 00:00:15.859 --> 00:00:19.179 day with patients affected by glaucoma, I strongly 00:00:19.179 --> 00:00:22.239 believe that prevention starts with understanding. 00:00:24.649 --> 00:00:27.329 Hi Feliciana, it's my pleasure to have you on 00:00:27.329 --> 00:00:29.710 the Edidence Strong show. If you could briefly 00:00:29.710 --> 00:00:32.369 introduce yourself. Hi Alex, thank you for the 00:00:32.369 --> 00:00:35.649 kind invitation to talk about this interesting 00:00:35.649 --> 00:00:39.409 topic. My name is Feliciana Minno. I am an ophthalmologist. 00:00:39.649 --> 00:00:43.689 I work at Terracina Hospital in my daily clinical 00:00:43.689 --> 00:00:48.490 practice. I mainly take care of patients with 00:00:48.490 --> 00:00:52.750 retinal diseases and especially glaucoma. And 00:00:52.750 --> 00:00:58.210 glaucoma is really a condition that can slowly, 00:00:58.390 --> 00:01:02.450 slowly, slowly damage vision without pain, without 00:01:02.450 --> 00:01:07.469 early symptoms. So that's why I love... this 00:01:07.469 --> 00:01:10.750 aspect of ophthalmology and that's why especially 00:01:10.750 --> 00:01:14.849 in glaucoma prevention and early detection are 00:01:14.849 --> 00:01:17.430 really really really important and alongside 00:01:17.430 --> 00:01:21.769 my clinical work i am also a researcher and one 00:01:21.769 --> 00:01:26.010 question has guided my research so i thought 00:01:26.010 --> 00:01:30.930 how does what we do with our bodies and especially 00:01:30.930 --> 00:01:35.189 physical exercise affect our eyes that's perfect 00:01:35.189 --> 00:01:38.959 so my audience is mostly strength sports athletes 00:01:38.959 --> 00:01:42.280 and coaches. So we all know that physical activity 00:01:42.280 --> 00:01:45.280 and strength training are important for general 00:01:45.280 --> 00:01:47.560 health. And of course, for the athletes, this 00:01:47.560 --> 00:01:49.840 is bread and butter. So they want to get better. 00:01:49.900 --> 00:01:51.780 They want to get stronger. They want to get more 00:01:51.780 --> 00:01:55.120 powerful. But some conditions may develop. Yeah. 00:01:55.239 --> 00:01:58.060 So the question is whether it's from exercise. 00:01:58.260 --> 00:02:01.739 Is it the exercise is just speeding it up? What 00:02:01.739 --> 00:02:06.140 do we know about exercise and health? of the 00:02:06.140 --> 00:02:11.419 eye. Yes, yes. So we have to say just a few things 00:02:11.419 --> 00:02:15.099 before this question. So we have to know that 00:02:15.099 --> 00:02:18.659 inside each of our eyes there is a fluid that 00:02:18.659 --> 00:02:21.580 maintains the ace shape and the pressure created 00:02:21.580 --> 00:02:25.219 by this fluid is called intraocular pressure. 00:02:25.580 --> 00:02:29.379 However, when eye pressure becomes too high or 00:02:29.379 --> 00:02:33.120 when it changes too much over time, it can damage 00:02:33.120 --> 00:02:35.960 the optic nerve, which is the structure that 00:02:35.960 --> 00:02:39.479 sends visual information from the eye to the 00:02:39.479 --> 00:02:43.539 brain. So this damage is what happens in glaucoma. 00:02:43.539 --> 00:02:46.740 And glaucoma between ophthalmologists is called 00:02:46.740 --> 00:02:50.560 the silent... thief of sight because it causes 00:02:50.560 --> 00:02:54.099 no pain, no early warning signs and unfortunately 00:02:54.099 --> 00:02:57.919 no sound effect either. So we really have to 00:02:57.919 --> 00:03:01.139 look for it. And many people don't realize there 00:03:01.139 --> 00:03:04.300 is a problem until damage is advanced. That's 00:03:04.300 --> 00:03:07.360 why doctors care so much about intraocular pressure. 00:03:07.699 --> 00:03:11.659 And eye pressure normally is measured in ophthalmology 00:03:11.659 --> 00:03:15.259 clinic with a test that is called tonometry. 00:03:15.439 --> 00:03:19.990 That's quick, safe and... painless. But what 00:03:19.990 --> 00:03:25.150 many people don't know is that eye pressure changes 00:03:25.150 --> 00:03:29.490 during the day. It can be influenced by body 00:03:29.490 --> 00:03:33.659 position, breathing. stress, physical effort, 00:03:33.919 --> 00:03:37.960 and yet we usually measure it when a person is 00:03:37.960 --> 00:03:41.000 sitting calmly in a clinic. So I began to wonder 00:03:41.000 --> 00:03:44.699 what happens to eye pressure when people exercise 00:03:44.699 --> 00:03:50.180 intensely, as athletes do every day. And so we 00:03:50.180 --> 00:03:54.699 all know that physical activity is good for health. 00:03:54.819 --> 00:03:59.259 We all know exercise is good for the heart, the 00:03:59.259 --> 00:04:02.840 lungs. and the muscles but but the eyes they 00:04:02.840 --> 00:04:06.580 don't exactly exactly go to the gym so yet they 00:04:06.580 --> 00:04:10.319 clearly feel the workout but not all exercise 00:04:10.319 --> 00:04:13.319 is the same there are two different types so 00:04:13.319 --> 00:04:18.040 we focused on endurance exercise like running 00:04:18.040 --> 00:04:22.500 or cycling and strength and exercise like weight 00:04:22.500 --> 00:04:26.019 lifting previous study suggested that endurance 00:04:26.019 --> 00:04:31.379 exercise might slightly lower eye pressure while 00:04:31.379 --> 00:04:35.220 strength exercise could temporarily raise it. 00:04:35.560 --> 00:04:39.139 However, very few studies had directly compared 00:04:39.139 --> 00:04:43.379 different sports. This is why we decided to design 00:04:43.379 --> 00:04:48.800 a study that focused on real athletes in real 00:04:48.800 --> 00:04:51.800 training conditions. Let's maybe dive into your 00:04:51.800 --> 00:04:54.620 study because you specifically designed a study 00:04:54.620 --> 00:04:57.439 looking at eye pressure in two groups of athletes. 00:04:57.540 --> 00:05:01.980 So we studied 40 healthy young athletes, all 00:05:01.980 --> 00:05:07.079 between 18 and 35. years old they were divided 00:05:07.079 --> 00:05:11.379 into two groups so marathon runners and weight 00:05:11.379 --> 00:05:14.740 lifters all of them were in their first year 00:05:14.740 --> 00:05:17.920 of competitive training and none of them had 00:05:17.920 --> 00:05:22.180 eye disease glaucoma or other medical conditions 00:05:22.180 --> 00:05:26.279 so we measured their eye pressure at rest just 00:05:26.279 --> 00:05:29.879 before training and immediately after one hour 00:05:29.879 --> 00:05:34.060 training session and we used very precise instrument 00:05:34.639 --> 00:05:37.779 including the same method eye doctors use in 00:05:37.779 --> 00:05:40.899 hospitals. Our goal was really simple. So to 00:05:40.899 --> 00:05:45.199 understand how different types of sport affect 00:05:45.199 --> 00:05:48.000 eye pressure. In terms of training, they did 00:05:48.000 --> 00:05:51.180 their usual training? Yes. Or you prescribed 00:05:51.180 --> 00:05:54.000 the exercise session? No, no, no, no, no. Usually 00:05:54.000 --> 00:05:57.939 training, yes. All right. So did you measure 00:05:57.939 --> 00:06:01.639 it one time or was it a longer study? Actually, 00:06:01.639 --> 00:06:06.970 we took... fast one year to complete the study. 00:06:07.189 --> 00:06:11.589 Yes. In total, we included 40 male athletes and 00:06:11.589 --> 00:06:14.610 they were divided into two groups based on the 00:06:14.610 --> 00:06:18.129 type of sport they practiced. So 20 marathon 00:06:18.129 --> 00:06:22.550 runners representing endurance sports and 20 00:06:22.550 --> 00:06:25.870 weightlifters representing strength or resistance 00:06:25.870 --> 00:06:29.829 sport. To ensure accuracy, we used two instruments, 00:06:30.089 --> 00:06:33.750 Goldman Applanation Tonometry, that's the clinical 00:06:33.750 --> 00:06:38.009 gold standard, and rebound tonometry, which is 00:06:38.009 --> 00:06:41.470 faster and a little bit more comfortable. So 00:06:41.470 --> 00:06:44.149 these are the measurements you have done. You 00:06:44.149 --> 00:06:47.110 measured it many times over one year, you said? 00:06:47.389 --> 00:06:49.850 Yes. Wow, this is impressive. One year, it's 00:06:49.850 --> 00:06:53.050 a long study. Okay, what has it found? So what 00:06:53.050 --> 00:06:56.790 we discovered, so the results were very clear. 00:06:56.970 --> 00:07:03.029 So in marathon runners, we observed that actually 00:07:03.029 --> 00:07:07.930 eye pressure stayed stable or slightly decreased 00:07:07.930 --> 00:07:12.550 after training. So this suggests that aerobic 00:07:12.550 --> 00:07:18.310 exercise helps the eye regulate its pressure. 00:07:18.529 --> 00:07:23.269 Strength athletes, so in weightlifters, eye pressure 00:07:23.269 --> 00:07:27.649 increased after training. In about one out of 00:07:27.649 --> 00:07:31.850 three athletes, the increase was quite large. 00:07:32.430 --> 00:07:36.629 And we also found that the heavier the weight 00:07:36.629 --> 00:07:41.750 lifted, the higher the increase in eye pressure. 00:07:41.949 --> 00:07:45.610 And these were young, healthy people with no 00:07:45.610 --> 00:07:49.829 eye disease. And yet their eyes were experiencing 00:07:49.829 --> 00:07:55.069 significant pressure changes. So large. changes 00:07:55.069 --> 00:07:59.129 you said is it large enough for you as a specialist 00:07:59.129 --> 00:08:03.389 to worry naturally people with no eye disease 00:08:03.389 --> 00:08:08.990 have not to worry about, but people with glaucoma 00:08:08.990 --> 00:08:12.850 are really known or people with a family history 00:08:12.850 --> 00:08:16.730 of glaucoma have to worry about. Yes. So for 00:08:16.730 --> 00:08:18.829 normal activities of daily life, I don't know, 00:08:18.850 --> 00:08:23.230 if we pick up groceries, will we also pick up 00:08:23.230 --> 00:08:26.329 a child, something heavy. So you strain yourself 00:08:26.329 --> 00:08:29.589 a little bit, but it's a short activity. I don't 00:08:29.589 --> 00:08:32.470 know, a few seconds you carry to the car. groceries 00:08:32.470 --> 00:08:35.450 maybe three minutes five minutes will the eye 00:08:35.450 --> 00:08:38.470 pressure rise with this activity too pressure 00:08:38.470 --> 00:08:43.210 changes pressure changes during the day it depends 00:08:43.210 --> 00:08:46.549 also it for the pressure eye pressure follows 00:08:46.549 --> 00:08:50.669 the circadian rhythm so also without doing anything 00:08:50.669 --> 00:08:54.129 pressure eye pressure changes naturally these 00:08:54.129 --> 00:08:59.370 changes are absolutely not so large that no so 00:08:59.370 --> 00:09:04.480 how also for life weight we have not to consider 00:09:04.480 --> 00:09:08.720 that also when we drink too much caffeine too 00:09:08.720 --> 00:09:14.019 much coffee that could be a risk so but are really 00:09:14.019 --> 00:09:17.740 yes yes too much coffee also can impact high 00:09:17.740 --> 00:09:21.340 pressure yet it's not so good yes absolutely 00:09:21.340 --> 00:09:26.659 but we talk about like small changes are small 00:09:26.659 --> 00:09:30.259 changes that we have not to worry about but People 00:09:30.259 --> 00:09:34.940 with glaucoma have to. So that's especially recommendation 00:09:34.940 --> 00:09:40.679 for people that has already diagnosis or family 00:09:40.679 --> 00:09:44.519 history of glaucoma. That's the most high risk 00:09:44.519 --> 00:09:47.649 factor to develop glaucoma. Okay, you mentioned 00:09:47.649 --> 00:09:50.789 that caffeine is also influencing eye pressure. 00:09:50.929 --> 00:09:53.830 Could you explain? Yeah, so we have to think 00:09:53.830 --> 00:09:58.450 about that small things that we do every day 00:09:58.450 --> 00:10:02.110 can have a great impact in general on the body, 00:10:02.190 --> 00:10:05.309 but especially from a point of view of an ophthalmologist 00:10:05.309 --> 00:10:08.850 on our eyes. And we have to think about, so for 00:10:08.850 --> 00:10:13.110 example, also too much coffee. So I talk about... 00:10:13.289 --> 00:10:17.610 two or more than two or three coffee in people 00:10:17.610 --> 00:10:22.370 at risk can have a negative impact on eye pressure. 00:10:22.529 --> 00:10:24.730 So I'm not sure whether you know, but weightlifters 00:10:24.730 --> 00:10:29.509 drink pre -workouts, so energy drinks, coffee, 00:10:29.690 --> 00:10:32.370 whatever they can, maybe an hour before the training, 00:10:32.409 --> 00:10:35.970 so they feel really energetic and they can perform 00:10:35.970 --> 00:10:38.750 really well in heavy training. What would you 00:10:38.750 --> 00:10:41.450 say to that? It's a really good, good question 00:10:41.450 --> 00:10:45.100 because also... this is very very important so 00:10:45.100 --> 00:10:49.360 in people at risk they should be they should 00:10:49.360 --> 00:10:53.279 not drink so much energy drink no because we 00:10:53.279 --> 00:10:56.600 all know that this energy drink yes it's perfect 00:10:56.600 --> 00:10:59.700 for energy and everything but also for energy 00:10:59.700 --> 00:11:03.379 drink i will suggest in people at risk to not 00:11:03.379 --> 00:11:05.940 drink them because the weight lifting exercise 00:11:05.940 --> 00:11:09.340 raises eye pressure then on top of it the energy 00:11:09.340 --> 00:11:12.360 drink because the doses of caffeine in energy 00:11:12.360 --> 00:11:15.120 drinks are really really high so this is a double 00:11:15.120 --> 00:11:18.860 dose for the eye yes in different studies was 00:11:18.860 --> 00:11:25.659 observed that actually consuming 340 mg of caffeine 00:11:25.659 --> 00:11:29.899 showed statistically significant pressure increases. 00:11:30.379 --> 00:11:33.259 Yes. So we have to worry about that. All right. 00:11:33.299 --> 00:11:35.779 What else have you found in the study? So why 00:11:35.779 --> 00:11:39.720 these important changes between marathoners and 00:11:39.720 --> 00:11:43.620 weightlifters? The reason lies in how the body 00:11:43.620 --> 00:11:47.899 behaves during intense strength exercise. When 00:11:47.899 --> 00:11:52.059 lifting heavy weights, many people hold their... 00:11:52.080 --> 00:11:56.320 breathe, contract their muscles strongly, increase 00:11:56.320 --> 00:12:00.200 the pressure inside the chest and abdomen. And 00:12:00.200 --> 00:12:04.340 this pressure is transmitted to the eyes and 00:12:04.340 --> 00:12:08.220 can temporarily block the normal fluid drainage 00:12:08.220 --> 00:12:12.659 inside the eye. Running, on the other hand, encourages 00:12:12.659 --> 00:12:16.759 regular breathing, improves blood circulation, 00:12:17.399 --> 00:12:22.769 helps the eye maintaining balance. does not mean 00:12:22.769 --> 00:12:25.830 that weight lifting is dangerous. Absolutely 00:12:25.830 --> 00:12:29.590 not. But it tells us that the eye... respond 00:12:29.590 --> 00:12:33.570 differently to different types of effort. So 00:12:33.570 --> 00:12:36.690 eye, it's not outside of the body. If we hold 00:12:36.690 --> 00:12:39.909 breath, if we raise pressure in the upper body 00:12:39.909 --> 00:12:43.110 by Valsava maneuver, holding breath and bracing, 00:12:43.210 --> 00:12:47.250 the eye will experience the same. So the fluid 00:12:47.250 --> 00:12:51.190 will not drain as quickly or fluidly and it will 00:12:51.190 --> 00:12:54.110 stay there creating this pressure. Exactly. Now 00:12:54.110 --> 00:12:57.070 you measured after training. So how long after 00:12:57.070 --> 00:12:59.809 training the higher... pressure in the eye you 00:12:59.809 --> 00:13:03.029 think will be lingering or staying? So there 00:13:03.029 --> 00:13:06.950 are not so many studies about this point but 00:13:06.950 --> 00:13:12.610 until now as ophthalmologists we think that acute 00:13:12.610 --> 00:13:18.909 eye pressure increases can last over one to four 00:13:18.909 --> 00:13:24.429 hour period but new scientific evidence should 00:13:24.429 --> 00:13:29.710 be performed so i will say one to four hour period 00:13:29.710 --> 00:13:34.350 after training but we need more evidence about 00:13:34.350 --> 00:13:36.850 that okay another question a little bit tricky 00:13:36.850 --> 00:13:40.789 one so you said that eye pressure fluctuates 00:13:40.789 --> 00:13:43.190 during the day it follows the circadian rhythm 00:13:43.190 --> 00:13:48.149 so when it is the lowest the lowest in the evening 00:13:48.149 --> 00:13:52.850 in the evening normally after so 6 p .m normally 00:13:52.850 --> 00:13:56.529 it's the lower yes so if a person is worried 00:13:56.529 --> 00:14:00.230 has some signs of glaucoma and they are worried 00:14:00.230 --> 00:14:02.929 about eye pressure if they schedule the training 00:14:02.929 --> 00:14:06.309 at 6 p .m will it be the safest time for them 00:14:06.309 --> 00:14:09.450 to train it could be it could be absolutely i 00:14:09.450 --> 00:14:12.620 will suggest for For sure. We always talk about 00:14:12.620 --> 00:14:16.679 people at risk. So I don't want to disseminate 00:14:16.679 --> 00:14:21.860 panic. So really people at risk with only people 00:14:21.860 --> 00:14:25.480 with a really known glaucoma or as I said before, 00:14:25.679 --> 00:14:28.659 family history of glaucoma. I would suggest that 00:14:28.659 --> 00:14:33.120 could be a good option to ask for eye pressure 00:14:33.120 --> 00:14:36.779 measurement to an ophthalmologist. And maybe 00:14:36.779 --> 00:14:39.720 it could be, yes, it could be a possible solution. 00:14:39.980 --> 00:14:43.580 Yes. If a weightlifter is training hard and they're 00:14:43.580 --> 00:14:45.879 holding a breath and they're training, if they 00:14:45.879 --> 00:14:49.480 go for a run after the training session, will 00:14:49.480 --> 00:14:52.860 the run regulate their eye pressure? So from 00:14:52.860 --> 00:14:56.639 an ophthalmologist perspective, weightlifting, 00:14:56.779 --> 00:15:00.659 particularly associated with Valsava -like maneuvers, 00:15:00.799 --> 00:15:05.690 can... induce transient spikes in intraocular 00:15:05.690 --> 00:15:10.870 pressure and subsequent running does not necessarily 00:15:10.870 --> 00:15:14.970 eliminate this acute high pressure elevation, 00:15:15.509 --> 00:15:19.289 even if naturally it's beneficial for overall 00:15:19.289 --> 00:15:22.429 cardiovascular health. So while the combination 00:15:22.429 --> 00:15:27.350 of weights followed by running may be reasonable 00:15:27.350 --> 00:15:32.500 for in general, large and repeated high pressure 00:15:32.500 --> 00:15:36.399 spikes should be avoided in subjects at risk 00:15:36.399 --> 00:15:40.639 with glaucoma or with a strong history of glaucoma, 00:15:40.639 --> 00:15:44.700 as I said before. So in these individuals, minimizing 00:15:44.700 --> 00:15:49.440 excessive strain, avoiding breathing, holding 00:15:49.440 --> 00:15:53.059 and favoring controlled breathing and moderate 00:15:53.059 --> 00:15:57.559 loads is advisable, along naturally with regular 00:15:57.559 --> 00:16:00.980 ophthalmologic monitoring. So the safe way to 00:16:00.980 --> 00:16:04.690 know is to measure at the doctor's office. to 00:16:04.690 --> 00:16:08.149 know whether in general the eye pressure is high 00:16:08.149 --> 00:16:11.289 in a given person and check for glaucoma. If 00:16:11.289 --> 00:16:13.629 there are no signs and no family history, it's 00:16:13.629 --> 00:16:17.009 probably safe and no problem. And you can forget 00:16:17.009 --> 00:16:19.409 about today's conversation, not think about it 00:16:19.409 --> 00:16:22.870 for some time. But if there is a history of glaucoma 00:16:22.870 --> 00:16:25.850 and someone is training hard and doing weightlifting, 00:16:26.070 --> 00:16:28.950 would you say that it's worth checking periodically 00:16:28.950 --> 00:16:32.129 eye pressure at the doctor's office and keeping 00:16:32.129 --> 00:16:35.850 an eye on it? Yes. Exactly, exactly. So really 00:16:35.850 --> 00:16:39.590 the key point for athletes in general, strength 00:16:39.590 --> 00:16:42.629 training is healthy, but naturally awareness 00:16:42.629 --> 00:16:46.070 is important. Breathing correctly, that's also 00:16:46.070 --> 00:16:49.990 very, very important during exercise that may 00:16:49.990 --> 00:16:54.149 help reduce eye pressure spikes. So breathe even 00:16:54.149 --> 00:16:57.750 correctly. For coach and trainers, so eye health 00:16:57.750 --> 00:17:01.490 should be part of overall athlete care. So regular 00:17:01.490 --> 00:17:06.109 eye checkups are... essential and informal. your 00:17:06.109 --> 00:17:10.210 ophthalmologist, what type of exercise you practice. 00:17:10.509 --> 00:17:13.910 And as someone who works every day with patients 00:17:13.910 --> 00:17:17.089 affected by glaucoma, I strongly believe that 00:17:17.089 --> 00:17:21.009 prevention starts with understanding that eyes 00:17:21.009 --> 00:17:23.809 are not separate from the body. They respond 00:17:23.809 --> 00:17:28.170 to how we move, how we breathe and how we live. 00:17:28.329 --> 00:17:32.109 So sport teaches us a lot about human physiology, 00:17:32.509 --> 00:17:35.630 including how delicate and adaptable table our 00:17:35.630 --> 00:17:39.950 visual system is. And by understanding this connection, 00:17:40.309 --> 00:17:43.089 we can protect the vision while continuing to 00:17:43.089 --> 00:17:46.390 enjoy the benefits of physical activity. If there 00:17:46.390 --> 00:17:50.309 is one practical takeaway from today, it's this 00:17:50.309 --> 00:17:54.029 breathe while you lift and your eyes will thank 00:17:54.029 --> 00:17:57.619 you. All right. Usually I ask two short questions 00:17:57.619 --> 00:18:00.700 at the end of each interview. The first question 00:18:00.700 --> 00:18:03.579 is, what is your favorite exercise? My favorite 00:18:03.579 --> 00:18:08.099 exercise is running, actually. Yes, from a personal 00:18:08.099 --> 00:18:12.839 point of view, running is simple, helps me to 00:18:12.839 --> 00:18:16.960 maintain physical and mental balance. So yeah, 00:18:17.019 --> 00:18:19.980 actually is especially running. Great. And the 00:18:19.980 --> 00:18:23.200 last question is, if people want to see what 00:18:23.200 --> 00:18:26.079 you're up to, maybe... read your newest research, 00:18:26.279 --> 00:18:29.460 where should they go online? People can find 00:18:29.460 --> 00:18:32.599 my work and my contacts primarily through scientific 00:18:32.599 --> 00:18:36.660 publication and academic platforms. Feel free, 00:18:36.759 --> 00:18:40.359 everyone, to contact me. I am really always open 00:18:40.359 --> 00:18:43.759 to scientific collaboration, discussion, and 00:18:43.759 --> 00:18:47.039 if you have questions, I will be happy to answer 00:18:47.039 --> 00:18:49.279 them. Thank you, Feliciana, so much. It was a 00:18:49.279 --> 00:18:51.660 pleasure. Thanks to you. You're welcome. It was 00:18:51.660 --> 00:18:52.440 a pleasure for me.