The ‘365 breathing technique’ reduced IOP by 2mm Hg after six weeks of practice, showing that it can help in preventing long-term glaucoma progression. Photo: Patrick Malleret/Unsplash.

Spending five minutes taking slow, deep breaths three times per day—a technique called ‘365 breathing’—is recommended by therapists to help deal with stress, as controlled slow breathing techniques have been shown to shift towards parasympathetic dominance, increase respiratory sinus arrhythmia and augment heart rate variability. As previous studies showing that mindfulness-based stress reduction helps reduce intraocular pressure (IOP), researchers recently evaluated the effect of the 365 breathing technique on IOP autonomic functions and stress biomarkers in patients with primary open angle glaucoma (POAG) and found that it caused a significant reduction in IOP (2mm Hg) in the intervention group after six weeks of practice.

A total of 40 subjects in intervention group followed 365 breathing for three times a day at a breathing rate of six cycles per minute for five minutes, in addition to their pharmacological glaucoma treatment. It was explained to subjects that breathing should be smooth, slow, deep and via nasal route, with five seconds devoted to each inhalation and exhalation. “Each day patients were asked to practice first session as soon as they wake up; second session four hours after the first session or just before lunch and the third session at the end of their workday or before starting their evening,” the researchers wrote in their paper.

Another 40 subjects in the control group continued only with their pharmacological glaucoma treatment. IOP, serum cortisol, heart rate variability and heart rate response to deep breathing test were recorded at pre-intervention and six weeks post-intervention.

The 365 breathing technique caused a significant reduction in IOP (2mm Hg) and significantly increased the parasympathetic activity in intervention group after six weeks of practice. Previous studies reported a 1.5mm Hg to 6.1mm Hg of IOP reduction after a short course (three to six weeks duration) of meditation/mindfulness-based stress reduction in patients with glaucoma/ocular hypertension.

The 365 breathing technique also reduced serum cortisol (stress biomarker) and improved autonomic dysfunction in glaucoma patients.

“Stress is not only a result but also a possible risk factor/cause of glaucoma,” the authors explained. “Acute and chronic stress have been shown to increase IOP. Studies have demonstrated that stress can cause a decline in parasympathetic activity, NO-cGMP dysfunction, endothelial and vascular dysfunction, glial cell activation and downregulation of neurotropins, all of which have been speculated to play a role in complex pathophysiology of glaucoma,” the authors explained.

Cortisol is known to increase in response to stress and alter trabecular meshwork morphology resulting in reduced aqueous humor outflow, thereby elevating IOP, the authors noted.

It is proposed that the increase in melatonin and nitric oxide could have led to decrease in IOP. An additional decrease in cortisol, as noted in this study, also contributes to decrease in IOP. The decreased sympathetic activity and increased parasympathetic activity can decrease in aqueous production and increase in aqueous outflow leading to decreased IOP, the authors explained.

“In our study, the IOP reduction after six weeks of practicing 365 breathing was 11% and though this is a small reduction, it can help in preventing long-term glaucoma progression. So, the 365 breathing technique cannot be used as a standalone modality to reduce IOP, but can be used as an adjuvant therapy along with glaucoma medications,” the authors explained.

Harvey DH, Roberts CJ, Mahmoud, AM, Nuñez, FM, Ma Y, Fleming, GP. Biomechanical and vascular metrics between eyes of patients with asymmetric glaucoma and symmetric glaucoma. Journal of Glaucoma. January 9, 2024. [Epub ahead of print].