Intraocular Pressure Responses to Four Different Isometric Exercises in Men and Women.

SIGNIFICANCE: The performance of resistance exercise has evidenced to induce abrupt intraocular pressure (IOP) changes, which has been linked to the onset and progression of glaucoma. We found that four different isometric resistance exercises lead to an instantaneous and progressive IOP elevation, with these changes being independent of the type of exercise. PURPOSE: The impact of physical exercise on IOP has demonstrated to be dependent on exercise type and intesity, as well as individuals' characteristics. In this study, we aimed to explore the influence of the load, exercise type, and participant's sex on the IOP behavior during a 2-minute isometric effort. METHODS: Twenty-eight physically active collegiate students performed 2 minutes of isometric exercise in the military press, biceps curl, leg extension, and calf raise exercises against two different loads (high load and low load). Intraocular pressure was measured by rebound tonometry before, during (semicontinuos assessment [24 measurements]), and after 10 seconds of recovery in each of the eight (four exercises × two loads) conditions. RESULTS: We found a statistically significant effect of load (P < .001, np = 0.906), with greater IOP values when performing the isometric exercises against heavier loads. There was a positive IOP rise during the execution of isometric exercise in the high-load condition, returning to baseline levels after 10 seconds of passive recovery. The exercise type and participant's sex did not reveal statistically significant differences (P = .33 and P = .56, respectively). CONCLUSIONS: Our data evidenced an instanteneous and progressive IOP rise during the execution of isometric exercise leading to muscular failure, regardless of the exercise type and participant's sex. After exercise, IOP rapidly retuned to baseline levels (within 10 seconds). The inclusion of glaucoma patients in future studies is guarranteed.

Acute intraocular pressure changes during isometric exercise and recovery: The influence of exercise type and intensity, and participant´s sex.

We assessed the intraocular pressure (IOP) behaviour during a 1-minute period of isometric physical effort and the immediate 1-minute of recovery in the mid-thigh clean pull and squat exercises at three different intensities. Twenty physically active individuals performed the isometric mid-thigh clean pull and squat exercises at three intensities (0% [low-intensity], 25% [medium-intensity] and 50% [high-intensity] of the maximum isometric force). IOP was semi-continuously measured by rebound tonometry. There was a statistically significant effect of exercise intensity on IOP (p < 0.001, ƞp² = 0.416), observing that IOP increments were positively associated with exercise intensity. The mid-thigh clean pull and squat exercises did not demonstrate differences (p = 0.510), and also, no differences were observed between men and women (p = 0.683). The IOP changes during the isometric physical effort showed a positive linear behaviour in all conditions (r = 0.70 to 0.96). IOP returned to baseline levels after 8 seconds of recovery.  Our data showed a progressive and instantaneous IOP increment during isometric exercise, which was positively associated with exercise intensity. IOP changes were independent on the type of exercise and participant´s sex. After exercise, IOP rapidly (≈ 8 seconds) returned to baseline levels.

Effect of wearing different types of face masks during dynamic and isometric resistance training on intraocular pressure.

CLINICAL RELEVANCE: The use of face masks has demonstrated to be an effective strategy to prevent transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Wearing face masks, mainly Filtering Face Piece 2 (FFP2) masks, during exercise practice has demonstrated to affect several physiological measures. BACKGROUND: This study was aimed at assessing the intraocular pressure (IOP) behaviour during the execution of the dynamic and isometric biceps-curl exercise with a surgical and FFP2 face mask. METHODS: Twenty two physically active young adults performed sets of 10 repetitions against the 10-RM (repetition maximum) load and 1-minute isometric effort against a load 15% lower than the 10-RM load with the FFP2 and surgical mask and without any mask. A total of six exercise sets (3 experimental conditions [FFP2, surgical and control] × 2 exercise modalities) were performed. A rebound tonometer was used to measure IOP before, during (10 measurements), and after (30-seconds of passive recovery) each training set. RESULTS: At rest, there were not statistically significant IOP differences (p = 0.222). During dynamic exercise, there was a progressive IOP rise (p < 0.001), and a higher IOP response with the FFP2 than without the mask (corrected p-value = 0.003). For the isometric exercise, there was a greater IOP response as a function of accumulated effort (p < 0.001), which was dependent of the face mask used (FFP2> surgical>control; corrected p-values< 0.01). CONCLUSIONS: The FFP2 masks cause a heightened IOP response during the execution of dynamic and isometric biceps-curl exercise, suggesting that, when possible, glaucoma patients should limit the use of FFP2 masks during resistance training.

Dynamics of the accommodative response and facility with dual-focus soft contact lenses for myopia control.

OBJECTIVE: To assess the impact of using dual-focus soft contact lenses for myopia control on the dynamics of the accommodative response and facility. METHODS: 24 young adult myopes were fitted with dual-focus soft contact lenses for myopia control (MiSight®) and single-vision soft contact lenses (Proclear®). The WAM-5500 open-field autorefractor was used to measure the dynamics of the accommodative response (magnitude and variability) in binocular conditions, with accommodative data being gathered from the dominant eye, at three viewing distances (500 cm, 40 cm, and 20 cm) during 90 s. Also, the binocular accommodative facility was assessed with the WAM-5500 autorefractor. All participants performed the same experimental protocol with the dual-focus (MiSight) and single-vision (Proclear) soft contact lenses, with both experimental sessions being carried in two different days and following a counterbalanced order. RESULTS: This study showed greater lags of accommodation with the MiSight than the Proclear lenses at near distances (40 cm: 1.27 ± 0.77 vs. 0.68 ± 0.37 D, corrected p-value = 0.002, Cohen-d = 0.90; and 20 cm: 1.47 ± 0.84 vs. 1.01 ± 0.52 D, corrected p-value = 0.007, Cohen-d = 0.75), whereas a higher variability of accommodation was observed with the dual-focus than the single-vision lenses at 500 cm (0.53 ± 0.11 vs. 0.23 ± 0.10 D), 40 cm (0.82 ± 0.31 vs. 0.68 ± 0.37 D), and 20 cm (1.50 ± 0.56 vs. 1.15 ± 0.39 D) (corrected p-value < 0.001 in all cases, and Cohen-ds = 0.67-2.33). Also, a worse quantitative (27.75 ± 8.79 vs. 34.29 ± 10.08 cycles per minute, p = 0.029, Cohen-d = 0.48) and qualitative (23.68 ± 7.12 vs. 28.43 ± 7.97 score, p = 0.039, Cohen-d = 0.45) performance was observed with the MiSight when compared to the Proclear lenses. CONCLUSIONS: The use of dual-focus soft contact lenses for myopia control alters the dynamics of accommodative response and facility in the short-term. Although this optical design has demonstrated its effectiveness for myopia control, eye care specialists should be aware of the acute effects of these lenses on accommodation performance.

Examining the Validity of a New Method for the Objective Assessment of Binocular Accommodative Facility (2Q-AF Test): A Comparison with ± 2.00 DS Lens Flippers.

PURPOSE: Recent technological advances have permitted to objectively record the accommodative response while shifting between two different levels of accommodation. This study is aimed at examining the concurrent validity of a new objective method for the qualitative and quantitative assessment of binocular accommodative facility, which is named 2Q-AF test, in comparison to the ±2.00 DS lens flippers. METHODS: Fifty-six individuals took part in this study (36 healthy young adults [24.4 ± 3.2 years] and 20 children [12.2 ± 0.4 years]). Participants randomly performed the 2Q-AF and the ±2.00 DS lens flipper tests. For the 2Q-AF test, a binocular open-field autorefractor was used to record the magnitude of accommodative response during a 60-sec period, while participants repeatedly changed fixation from a 5 m to a 40 cm chart when clarity of vision was achieved at each level. Due to the advantages of the proposed method, we have determined the number of cycles and the 2Q-AF score, with the latter also considering the accuracy of changes in accommodation. A standard procedure was followed for the ±2.00 DS flipper test. RESULTS: Our data exhibited a moderate association between the number of cycles with the ±2.00 DS lens flippers and the number of cycles in the 2Q-AF test in the group of young adults (p = .005, r = 0.46 [0.15-0.68]) and children (p = .007, r = 0.58 [0.19-0.81]), whereas a stronger relationship was observed when considering the number of cycles with the ±2.00 DS lens flippers and the 2Q-AF score (young adults: p < .001, r = 0.83 [0.69-0.91]; and children: p < .001, r = 0.78 [0.52-0.91]). CONCLUSIONS: The current findings show that the 2Q-AF test is a valid method for accommodative facility assessment, as suggested by its good levels of reliability and validity. This method allows to examine the accommodative facility in qualitative terms and solve most of the limitations associated with the ±2.00 DS lens flipper test.

Short-term effects of caffeine intake on binocular accommodative facility: a quantitative and qualitative analysis.

CLINICAL RELEVANCE: Caffeine intake has been demonstrated to influence several physiological measures, including some related to eye physiology. The ability to focus at different distances is of paramount importance in real-world situations, and thus, the possible impact of caffeine intake on accommodative facility may have important clinical implications. BACKGROUND: This placebo-controlled, double-blind, balanced crossover study aimed to assess the acute effects of caffeine ingestion on the frequency and precision of the binocular accommodative facility. METHODS: Twenty university students (21.9 ± 3.4 years) ingested a capsule of caffeine (4 mg/kg) or placebo (300 mg of corn-starch) on two different days and counterbalanced order. The binocular accommodative facility was objectively assessed, using the WAM-5500 binocular open-field autorefractometer, after 60 min of capsule ingestion (caffeine/placebo). Perceived levels of activation was also assessed in each experimental condition. RESULTS: The ingestion of a single administration of caffeine (~ 4 mg/kg) causes an increase in the number of cycles performed per minute (p = 0.023, Cohen's d = 0.55), whereas no effects were observed for the mean magnitude of accommodative change between the far and near targets (p = 0.794), and the percentage of incorrect cycles of accommodation and dis-accommodation (p = 0.271 and 0.396, respectively). Participants reported a perceived level of activation of 6.8 ± 1.5 and 7.6 ± 1.8 in the placebo and caffeine conditions, respectively (p = 0.059). CONCLUSION: Caffeine intake improves quantitative, but not qualitative, measures of accommodative facility. These results corroborate the impact of caffeine on visual function and suggest that this ergogenic effect of caffeine may be used to enhance visual performance in applied situations.

The intraocular pressure response to lower-body and upper-body isometric exercises is affected by the breathing pattern.

We assessed the mediating role of the breathing pattern adopted during isometric exercise on the intraocular pressure (IOP) response in the back squat and biceps curl exercises. Twenty physically active young adults performed sets of 1-minute isometric effort against a load corresponding to 80% of the maximum load while adopting three different breathing patterns: (i) Constant breathing: 10 cycles consisting of 3 s of inhalation and 3 s of exhalation, (ii) 10-sec Valsalva: 3 cycles consisting of 10 s holding the breath and 10 s of normal breathing, and (iii) 25-sec Valsalva: 2 cycles consisting of 25 s of the Valsalva maneuver and 5 s of normal breathing. A rebound tonometer was used to semi-continuously assesses IOP during the six sets of 1-minute isometric effort (2 exercises × 3 breathing patterns). We found a progressive IOP rise during isometric effort (P < 0.001, ηp2 = 0.83), with these increases being greater when the breath was held longer (P < 0.001, ηp2 = 0.58; 25-sec Valsalva > 10-sec Valsalva = constant breathing). There was a trend towards higher IOP values for the back squat in comparison to the biceps curl, although these differences did not reach statistical significance for any breathing pattern (corrected P-value ≥ 0.146, d ≤ 0.69). These findings reveal that glaucoma patients or those at risk should avoid activities in which the breath is held, especially when combined with physical exercise modalities that also promote an increment in IOP values (e.g. isometric contractions).

Validation of an Objective Method for the Qualitative and Quantitative Assessment of Binocular Accommodative Facility.

Purpose: Assessing binocular accommodative facility (BAF) enables the evaluation of the interaction between the accommodative and vergence systems, which is relevant for the diagnosis of accommodative and binocular disorders. However, the tests used to assess BAF present methodological caveats (e.g., lack of objective control, vergence demands, and image size alterations), limiting its external validity. This study aimed to (i) develop a new objective method to quantitatively and qualitatively evaluate the BAF in free-viewing conditions, and explore its validity by the comparison with the Hart Chart test, and (ii) assess the inter-session reliability of the proposed method.Methods: 33 healthy young adults took part in this study. We used a binocular open-field autorefractor to continuously assess the magnitude of accommodative response during a 60-sec period, while participants repeatedly changed fixation from a far to a near chart when clarity of vision was achieved at each level. Accommodative response data were used to characterize the BAF measurement in quantitative (number of cycles) and qualitative terms (percentage of times that correctly accommodating or dis-accommodating in each level of accommodation as well as the magnitude of the accommodative change).Results: Our data revealed that the new proposed method accurately counted the number of cycles per minute when compared with the Hart Chart test (p = .23, ES = 0.02; mean difference = 0.18 ± 0.85). The inter-session reliability of the proposed method was demonstrated to be excellent (Pearson r and intraclass correlation coefficient: 0.95 to 0.98) for the parameters obtained with the BAF test.Conclusions: The present outcomes evidence that the proposed objective method allows to accurately assess the frequency and precision of BAF by the combination of the classical Hart Chart test and a binocular open-field autorefractometer. Our findings may be of relevance for the diagnosis and treatment of accommodative and binocular disorders.

Investigating the Immediate and Cumulative Effects of Isometric Squat Exercise for Different Weight Loads on Intraocular Pressure: A Pilot Study.

BACKGROUND: The execution of resistance exercise against heavy loads promotes an acute intraocular pressure (IOP) rise, which has detrimental effects on ocular health. However, the effect of load on the IOP behavior during exercise remains unknown due to technical limitations. HYPOTHESES: IOP monitoring during isometric squat exercise permits assessment of IOP behavior during physical effort. Second, greater loads will induce a higher IOP rise. STUDY DESIGN: Randomized cross-sectional study. LEVEL OF EVIDENCE: Level 2. METHODS: Twenty-six young adults (13 women, 13 men) performed an isometric squat exercise against 3 loads relative to their maximum capacity (low, medium, and high). IOP was measured before, during (1 measurement every 6 seconds), and after exercise (10 seconds of recovery). RESULTS: There was a progressive IOP rise during exercise, which was dependent on the load applied (Bayes factor10 >100). Higher IOP values were found in the high load condition in comparison with the medium (mean IOP difference = 1.5 mm Hg) and low (mean IOP difference = 3.1 mm Hg) conditions, as well as when the medium load was compared with the low load condition (mean IOP difference = 1.6 mm Hg). Men reached higher IOP values in comparison with women during the last measurements in the high load condition. Ten seconds of recovery were enough to obtain IOP values similar to baseline levels. CONCLUSION: Isometric squat exercise induces an immediate and cumulative IOP elevation, which is positively associated with the load applied. These IOP increments return to baseline values after 10 seconds of recovery, and men demonstrate a more accentuated IOP rise in comparison with women when high levels of effort are accumulated. CLINICAL RELEVANCE: These findings may help in better management of different ocular conditions and highlight the importance of an individualized exercise prescription in clinical populations.