Eye health should be part of overall athlete
care, so regular eye checkups are essential and
inform your ophthalmologist what type of exercise
you practice. And as someone who works every
day with patients affected by glaucoma, I strongly
believe that prevention starts with understanding.
Hi Feliciana, it's my pleasure to have you on
the Edidence Strong show. If you could briefly
introduce yourself. Hi Alex, thank you for the
kind invitation to talk about this interesting
topic. My name is Feliciana Minno. I am an ophthalmologist.
I work at Terracina Hospital in my daily clinical
practice. I mainly take care of patients with
retinal diseases and especially glaucoma. And
glaucoma is really a condition that can slowly,
slowly, slowly damage vision without pain, without
early symptoms. So that's why I love... this
aspect of ophthalmology and that's why especially
in glaucoma prevention and early detection are
really really really important and alongside
my clinical work i am also a researcher and one
question has guided my research so i thought
how does what we do with our bodies and especially
physical exercise affect our eyes that's perfect
so my audience is mostly strength sports athletes
and coaches. So we all know that physical activity
and strength training are important for general
health. And of course, for the athletes, this
is bread and butter. So they want to get better.
They want to get stronger. They want to get more
powerful. But some conditions may develop. Yeah.
So the question is whether it's from exercise.
Is it the exercise is just speeding it up? What
do we know about exercise and health? of the
eye. Yes, yes. So we have to say just a few things
before this question. So we have to know that
inside each of our eyes there is a fluid that
maintains the ace shape and the pressure created
by this fluid is called intraocular pressure.
However, when eye pressure becomes too high or
when it changes too much over time, it can damage
the optic nerve, which is the structure that
sends visual information from the eye to the
brain. So this damage is what happens in glaucoma.
And glaucoma between ophthalmologists is called
the silent... thief of sight because it causes
no pain, no early warning signs and unfortunately
no sound effect either. So we really have to
look for it. And many people don't realize there
is a problem until damage is advanced. That's
why doctors care so much about intraocular pressure.
And eye pressure normally is measured in ophthalmology
clinic with a test that is called tonometry.
That's quick, safe and... painless. But what
many people don't know is that eye pressure changes
during the day. It can be influenced by body
position, breathing. stress, physical effort,
and yet we usually measure it when a person is
sitting calmly in a clinic. So I began to wonder
what happens to eye pressure when people exercise
intensely, as athletes do every day. And so we
all know that physical activity is good for health.
We all know exercise is good for the heart, the
lungs. and the muscles but but the eyes they
don't exactly exactly go to the gym so yet they
clearly feel the workout but not all exercise
is the same there are two different types so
we focused on endurance exercise like running
or cycling and strength and exercise like weight
lifting previous study suggested that endurance
exercise might slightly lower eye pressure while
strength exercise could temporarily raise it.
However, very few studies had directly compared
different sports. This is why we decided to design
a study that focused on real athletes in real
training conditions. Let's maybe dive into your
study because you specifically designed a study
looking at eye pressure in two groups of athletes.
So we studied 40 healthy young athletes, all
between 18 and 35. years old they were divided
into two groups so marathon runners and weight
lifters all of them were in their first year
of competitive training and none of them had
eye disease glaucoma or other medical conditions
so we measured their eye pressure at rest just
before training and immediately after one hour
training session and we used very precise instrument
including the same method eye doctors use in
hospitals. Our goal was really simple. So to
understand how different types of sport affect
eye pressure. In terms of training, they did
their usual training? Yes. Or you prescribed
the exercise session? No, no, no, no, no. Usually
training, yes. All right. So did you measure
it one time or was it a longer study? Actually,
we took... fast one year to complete the study.
Yes. In total, we included 40 male athletes and
they were divided into two groups based on the
type of sport they practiced. So 20 marathon
runners representing endurance sports and 20
weightlifters representing strength or resistance
sport. To ensure accuracy, we used two instruments,
Goldman Applanation Tonometry, that's the clinical
gold standard, and rebound tonometry, which is
faster and a little bit more comfortable. So
these are the measurements you have done. You
measured it many times over one year, you said?
Yes. Wow, this is impressive. One year, it's
a long study. Okay, what has it found? So what
we discovered, so the results were very clear.
So in marathon runners, we observed that actually
eye pressure stayed stable or slightly decreased
after training. So this suggests that aerobic
exercise helps the eye regulate its pressure.
Strength athletes, so in weightlifters, eye pressure
increased after training. In about one out of
three athletes, the increase was quite large.
And we also found that the heavier the weight
lifted, the higher the increase in eye pressure.
And these were young, healthy people with no
eye disease. And yet their eyes were experiencing
significant pressure changes. So large. changes
you said is it large enough for you as a specialist
to worry naturally people with no eye disease
have not to worry about, but people with glaucoma
are really known or people with a family history
of glaucoma have to worry about. Yes. So for
normal activities of daily life, I don't know,
if we pick up groceries, will we also pick up
a child, something heavy. So you strain yourself
a little bit, but it's a short activity. I don't
know, a few seconds you carry to the car. groceries
maybe three minutes five minutes will the eye
pressure rise with this activity too pressure
changes pressure changes during the day it depends
also it for the pressure eye pressure follows
the circadian rhythm so also without doing anything
pressure eye pressure changes naturally these
changes are absolutely not so large that no so
how also for life weight we have not to consider
that also when we drink too much caffeine too
much coffee that could be a risk so but are really
yes yes too much coffee also can impact high
pressure yet it's not so good yes absolutely
but we talk about like small changes are small
changes that we have not to worry about but People
with glaucoma have to. So that's especially recommendation
for people that has already diagnosis or family
history of glaucoma. That's the most high risk
factor to develop glaucoma. Okay, you mentioned
that caffeine is also influencing eye pressure.
Could you explain? Yeah, so we have to think
about that small things that we do every day
can have a great impact in general on the body,
but especially from a point of view of an ophthalmologist
on our eyes. And we have to think about, so for
example, also too much coffee. So I talk about...
two or more than two or three coffee in people
at risk can have a negative impact on eye pressure.
So I'm not sure whether you know, but weightlifters
drink pre -workouts, so energy drinks, coffee,
whatever they can, maybe an hour before the training,
so they feel really energetic and they can perform
really well in heavy training. What would you
say to that? It's a really good, good question
because also... this is very very important so
in people at risk they should be they should
not drink so much energy drink no because we
all know that this energy drink yes it's perfect
for energy and everything but also for energy
drink i will suggest in people at risk to not
drink them because the weight lifting exercise
raises eye pressure then on top of it the energy
drink because the doses of caffeine in energy
drinks are really really high so this is a double
dose for the eye yes in different studies was
observed that actually consuming 340 mg of caffeine
showed statistically significant pressure increases.
Yes. So we have to worry about that. All right.
What else have you found in the study? So why
these important changes between marathoners and
weightlifters? The reason lies in how the body
behaves during intense strength exercise. When
lifting heavy weights, many people hold their...
breathe, contract their muscles strongly, increase
the pressure inside the chest and abdomen. And
this pressure is transmitted to the eyes and
can temporarily block the normal fluid drainage
inside the eye. Running, on the other hand, encourages
regular breathing, improves blood circulation,
helps the eye maintaining balance. does not mean
that weight lifting is dangerous. Absolutely
not. But it tells us that the eye... respond
differently to different types of effort. So
eye, it's not outside of the body. If we hold
breath, if we raise pressure in the upper body
by Valsava maneuver, holding breath and bracing,
the eye will experience the same. So the fluid
will not drain as quickly or fluidly and it will
stay there creating this pressure. Exactly. Now
you measured after training. So how long after
training the higher... pressure in the eye you
think will be lingering or staying? So there
are not so many studies about this point but
until now as ophthalmologists we think that acute
eye pressure increases can last over one to four
hour period but new scientific evidence should
be performed so i will say one to four hour period
after training but we need more evidence about
that okay another question a little bit tricky
one so you said that eye pressure fluctuates
during the day it follows the circadian rhythm
so when it is the lowest the lowest in the evening
in the evening normally after so 6 p .m normally
it's the lower yes so if a person is worried
has some signs of glaucoma and they are worried
about eye pressure if they schedule the training
at 6 p .m will it be the safest time for them
to train it could be it could be absolutely i
will suggest for For sure. We always talk about
people at risk. So I don't want to disseminate
panic. So really people at risk with only people
with a really known glaucoma or as I said before,
family history of glaucoma. I would suggest that
could be a good option to ask for eye pressure
measurement to an ophthalmologist. And maybe
it could be, yes, it could be a possible solution.
Yes. If a weightlifter is training hard and they're
holding a breath and they're training, if they
go for a run after the training session, will
the run regulate their eye pressure? So from
an ophthalmologist perspective, weightlifting,
particularly associated with Valsava -like maneuvers,
can... induce transient spikes in intraocular
pressure and subsequent running does not necessarily
eliminate this acute high pressure elevation,
even if naturally it's beneficial for overall
cardiovascular health. So while the combination
of weights followed by running may be reasonable
for in general, large and repeated high pressure
spikes should be avoided in subjects at risk
with glaucoma or with a strong history of glaucoma,
as I said before. So in these individuals, minimizing
excessive strain, avoiding breathing, holding
and favoring controlled breathing and moderate
loads is advisable, along naturally with regular
ophthalmologic monitoring. So the safe way to
know is to measure at the doctor's office. to
know whether in general the eye pressure is high
in a given person and check for glaucoma. If
there are no signs and no family history, it's
probably safe and no problem. And you can forget
about today's conversation, not think about it
for some time. But if there is a history of glaucoma
and someone is training hard and doing weightlifting,
would you say that it's worth checking periodically
eye pressure at the doctor's office and keeping
an eye on it? Yes. Exactly, exactly. So really
the key point for athletes in general, strength
training is healthy, but naturally awareness
is important. Breathing correctly, that's also
very, very important during exercise that may
help reduce eye pressure spikes. So breathe even
correctly. For coach and trainers, so eye health
should be part of overall athlete care. So regular
eye checkups are... essential and informal. your
ophthalmologist, what type of exercise you practice.
And as someone who works every day with patients
affected by glaucoma, I strongly believe that
prevention starts with understanding that eyes
are not separate from the body. They respond
to how we move, how we breathe and how we live.
So sport teaches us a lot about human physiology,
including how delicate and adaptable table our
visual system is. And by understanding this connection,
we can protect the vision while continuing to
enjoy the benefits of physical activity. If there
is one practical takeaway from today, it's this
breathe while you lift and your eyes will thank
you. All right. Usually I ask two short questions
at the end of each interview. The first question
is, what is your favorite exercise? My favorite
exercise is running, actually. Yes, from a personal
point of view, running is simple, helps me to
maintain physical and mental balance. So yeah,
actually is especially running. Great. And the
last question is, if people want to see what
you're up to, maybe... read your newest research,
where should they go online? People can find
my work and my contacts primarily through scientific
publication and academic platforms. Feel free,
everyone, to contact me. I am really always open
to scientific collaboration, discussion, and
if you have questions, I will be happy to answer
them. Thank you, Feliciana, so much. It was a
pleasure. Thanks to you. You're welcome. It was
a pleasure for me.