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Thursday, September 5, 2013

Yoga After Cataract Surgery

by Baxter

A teacher wrote in to ask us about a student who will be having cataract surgery. The teacher said that the student's doctor told her she should avoid lifting for two weeks, and asked us: Are there any yoga poses that should be avoided? Inversions come to mind but does that mean downward dog as well? Because cataract surgery is one of the most common surgeries performed in the US each year, many of us will have students in this very situation, and some us will find ourselves there as well. So I decided to do a full post on the topic.

It is estimated that 50% of adults over the age of 80 have a cataract. Cataract is a clouding of the lens of the eye that lies just behind your pupil and iris, the front and center most parts of your eyeball. The lens allows light and images to pass through to the back of eye onto the retina, which is the part of the eye that sends that image info to the brain. The clearer the lens, the better the image. The lens also focuses the images onto the retina, not unlike the focus feature on a slide projector or movie projector.
What causes the clouding of the lens that we call a “cataract”? The lens is made up of mostly water and proteins. As we get older, some of the proteins begin to clump together. If the clumps get big enough, they begin to partially block the light trying to pass through the lens. As long as the clumps stay small, you may not even notice the changes, but if a clump gets big enough, your vision will start to get blurry or even color tinted, usually brownish.  Even though cataracts are sometimes referred to as “age-related” and I mentioned the percentage of elderly with them, you can sometimes develop cataracts in your 40s or 50s, and there are even rare forms of congenital cataracts that infants can be born with. You are at increased risk for developing one if you have prolonged exposure to sunlight, smoke cigarettes, drink alcohol, or have diabetes.

The good news is that treating cataracts with surgery is quite safe in general.  However, during the post-surgery period, there are risks of developing problems such as bleeding, infection, or changes in the pressure inside the eye, either up or down. And there is a very slight increase in the chance of the retina at the back of the eye coming away from inside surface of the eye, a condition known as retinal detachment. This last complication is considered a medical emergency as it can lead to sudden loss of vision. To learn more about cataracts in general, check out this National Institutes of Health-sponsored web page Facts About Cataracts.
 
On the NIH web page, I found the following recommendations for modified activity after cataract surgery, but without specific connection to the above risks:

“When you are home, try not to bend from the waist to pick up objects on the floor. Do not lift any heavy objects. You can walk, climb stairs, and do light household chores.”

I can only assume that these recommendations are made to reduce the risk of bleeding, pressure changes in the eye (which can be position- and exertion-influenced) and retinal detachment. So, how should you modify this student’s yoga practice during the two-week post-operative period, and maybe for a full eight weeks, the typical time for the surgery to completely heal up?

Inversions should certainly be avoided. This includes standing forward bends like Uttanasana and Prasarita Padottanasana, and even Downward-Facing Dog. You can still include modified poses like Half Dog pose at the wall.  If you apply the rule of not bending past 90 degrees from vertical, you will minimize the pressure increase to the head and subsequently to the eye.  As far as I know, there has not been a specific study to confirm eye pressure changes doing inverted yoga postures, but it seems likely that they would potentially cause it and are therefore best avoided. Also, as I think I have mentioned before regarding yoga and high blood pressure, you also need to limit the length of time you stay in a static or held pose, especially the standing poses, as the exertion required often leads to an overall increase in blood pressure, which could also influence pressures in the eyes.  Other rather obvious poses that could have a similar effect are those that require strong, sustained contraction of the abdominal muscles, which would also increase blood pressure in the eyes.  Poses like Boat pose (Navasana), deep held twists (even sitting versions), and arm balances like Crow pose (Bakasana) also fall into this category. 

In a time of healing—for cataract surgery or any other health recovery time—you want to keep the nervous system quieter, spending more time in the “rest and digest” part of the autonomic nervous system. So spend this two week healing period doing gentler practices, including lots of supported restoratives and guided meditations on health and healing. It would be great to hear back from the person who sent in the question on how things turn out for your student, and from any of our readers who have worked with this situation before.
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