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Editors Selection IGR 24-1
Miscellaneous: Is Muslim prayer position affecting IOP?
Comment by Miki Atsuya on:
It has been increasingly recognized that intraocular pressure (IOP) is dynamic rather than static in nature.1 This dynamic nature manifests over both short and long-term periods,1 influencing the progression of glaucoma.2 Studies have shown that some activities such as headstand yoga posture3 and robotic surgeries4,5 are also associated with a significant increase in IOP. However, there remains a need to explore and identify additional daily activities that exert an influence on IOP.
In this study, the authors explored the magnitude and duration of IOP elevation during two Islamic prayer positions, Rukūand Sujud, in 95 eyes of 47 subjects (27 eyes with primary open-angle glaucoma [POAG] and 68 eyes without POAG). Results indicated an average 20% increase in IOP after 30 seconds of the Rukū position and a 37.1% increase following 30 seconds of the Sujud position. IOP returned to baseline within five minutes in 72.7% of participants and within ten minutes in all participants. The authors found no significant differences between glaucoma patients and healthy controls, and no baseline factors were associated with the observed increases. Given the obligation for Muslims to pray five times daily, the rise in IOP following Muslim prayers may have significant implications for the 1.9 billion Islamic population, particularly those with glaucoma.
However, the study has notable limitations. The primary constraint lies in the small number of participants, especially glaucoma patients, potentially influencing the lack of significant correlations with baseline factors. Additionally, the IOP measurement protocol, which involves measuring IOP after 30 seconds of Rukūand Sujud five times in participants maintaining the same position, may introduce variability in posture duration. Recommending a multi-time point approach (e.g., 30, 60, 90, and 120 seconds) with fewer measurements at each time point could enhance the quantitative assessment of the positions' effects and determine acceptable limits for glaucoma patients. Furthermore, the study lacks essential information about glaucoma status, such as type, quantitative parameters (e.g., visual field mean deviation, OCT retinal sublayer thickness), visual acuity, and axial length, critical for establishing the validity and clinical relevance of IOP increases after Muslim prayer positions.
Despite these limitations, the authors are commendable for pioneering research on religious prayer as a potential risk factor for IOP elevation. The authors are encouraged to conduct further research that addresses the current study's limitations, providing clarity on the phenomenon's relevance in clinical practice.
References
- Aptel F, Weinreb RN, Chiquet C, Mansouri K. 24-H Monitoring Devices and Nyctohemeral Rhythms of Intraocular Pressure. Prog Retin Eye Res. 2016;55:108-148.
- Zeimer RC, Wilensky JT, Gieser DK, Viana MAG. Association between Intraocular Pressure Peaks and Progression of Visual Field Loss. Ophthalmology. 1991;98(1):64-69.
- Prata TS, De Moraes CG, Kanadani FN, Ritch R, Paranhos A. Posture-induced intraocular pressure changes: Considerations regarding body position in glaucoma patients. Surv Ophthalmol. 2010;55(5):445-453.
- Awad H, Walker CM, Shaikh M, Dimitrova GT, Abaza R, O'Hara J: Anesthetic considerations for robotic prostatectomy: A review of the literature. J Clin Anesth 2012; 24:494-504.
- Shirono Y, Takizawa I, Kasahara T, et al. Intraoperative intraocular pressure changes during robot-assisted radical prostatectomy: associations with perioperative and clinicopathological factors. BMC Urol 2020;20:26.
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