2 replies to this topic

[warner]

Hi all.  Been busy last few years using hi-res OCT to determine link between strenuous activity (SA) and my normal tension glaucoma (NTG).  We recently finished putting together presentations, including a submission to ARVO 2024, plus 5-minute YouTube overview, and simple diagram that fits pieces together:

 

5-minute Overview

Links Site w/ Diagram

ARVO 2024 Abstract & 15-min Video

 

The last time I was here discussing glaucoma, emphasis was on NAD world, and I presented results showing NAM supplementation appeared to produce minor improvement in visual field results.  At that time, I had a complex model in mind of the factors potentially affecting glaucoma progression -- typical of where one is led when etiology remains unclear!  However, our research showed a very simple, quantitative relationship between,

 

Strenuous Activity --> Microhemorrhage (MH) Leak Volume --> Glaucoma Progression as RNFL Loss

 

which accounted for all RNFL loss during the study period.  In other words, whatever factors may have led to this damaged optic nerve head (ONH) state (such as high IOP earlier in life - now kept normal), the game now is mainly management of strenuous activity + further reduction of MH leak (Microleak) risk by other means, where latter, for example, is affected by reduced wound healing with age, as IGF-1 levels fall, as well as by use of blood thinners, etc. -- similar to factors affecting cerebral MH risk.  So, for this type or stage of glaucoma, the etiology appears to be pretty simple, and with RNFL loss having a quantitative relation to SA time and intensity.

 

Anyway, thought some of you might find that interesting from an aging point of view, and am also grateful for the insights I've gained from this forum over the years, so wanted to give something back.  If we generate some discussion here, I'll put a link to this topic on our Links Site to help others find it.  Thanks!

[warner]

Here's the intro we're now using on other discussion sites (w/ updated Links Site & Videos)...

 

A Cautionary Tale of Strenuous Activity & Glaucoma Progression

 

When Activity Trumps IOP - an unprecedented 5-year, weekly OCT study of NTG based on thousands of hi-res ONH and triplicate RNFL scans

 

See Links Site for details

 

10 Key Findings for study subject:

 

1. All progression, as RNFL loss, was attributable to strenuous activity, producing discontinuous and sector-specific losses

2. Strenuous activities (SA) included common home & yard projects, but with head-down posture & Valsalva being much riskier

3. Multi-day SA clusters (SACs) greatly increased RNFL loss

4. It took 8 weeks after a SAC for RNFL loss to complete

5. RNFL loss was proportional to total SA time x intensity, cubed (SAT cubed) [2 hr was 8x riskier than 1 hr]

6. Progression, as RNFL loss, was mainly managed by keeping weekly SAT below level at which predicted loss was considered tolerable

7. SA triggered ONH microhemorrhage (MH) vessel leaks (microleaks) of varying size, but often small, short-lived or hidden

8. Microleak volume, when reaching axons, led directly to RNFL loss

9. SA increased both microleak flow rate and duration, explaining why RNFL loss was proportional to SAT-cubed

10. Other factors affecting MH likely affect progression:  MH history, aging, hormones, thinners, VP&BP spikes, hi/low IOP, etc.

 

Conclusion:  RNFL loss (progression) in this subject was due to MH vessel leakage reaching axons, with MH triggered by strenuous activity

Edited by warner, 13 March 2024 - 02:19 PM.

[warner]

Major update to links site, addressing many of the questions we've gotten...

 

Strenuous Activity, Microleaks and Glaucoma Progression

https://watioplinks.tiiny.site  (with 1-min Intro video)

 

Reporting a case of unprecedented 3-year, weekly, hi-res OCT tracking of NTG with good IOP control, resulting in some surprising findings, including:

 

- progression, as measured by RNFL loss, was discontinuous, sector-specific, and attributable to strenuous activity (SA)

- activities included common home and yard projects, although head-down posture and Valsalva were many times riskier

- multi-day SA clusters (SACs) greatly increased RNFL loss

- took 8 weeks after each SAC for RNFL loss to complete

- RNFL loss was proportional to the cube of SA time and intensity (2x SAT, 8x loss)

- ONH microhemorrhages (microleaks), triggered by SA, likely accounted for RNFL loss

 

These findings suggest that, in some cases where IOP is well-controlled, strenuous activity may become the key modifiable risk factor for glaucoma progression.

 

I’d be happy to answer any questions you might have about the report.