Dual effect of the Valsalva maneuver on autonomic nervous system activity, intraocular pressure, Schlemm’s canal, and iridocorneal angle morphology

Sun, Li; Chen, Wei; Chen, Zhiqi; Xiang, Yan; Guo, Jingmin; Hu, Tian; Xu, Qiongfang; Zhang, Hong; Wang, Junming

doi:10.1186/s12886-019-1275-y

Cited by 12 publications

(7 citation statements)

References 35 publications

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“…Some investigations have reported a dual effect of the VM on IOP. 18,32 We showed that in some subjects, the SFCT decreased or remained unchanged, while the CVI decreased in some individuals. The large variability in manual measurements of choroidal thickness might explain these discrepancies.…”

Section: Discussionmentioning

confidence: 79%

Choroidal vascularity index changes during the Valsalva manoeuvre in healthy volunteers

Sevik

Çam

Aykut

et al. 2021

Ophthalmic Physiologic Optic

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To evaluate the effects of the Valsalva manoeuvre (VM) on the choroidal vascularity index (CVI) in healthy volunteers.Methods: This prospective, cross-sectional study included 60 eyes of 30 healthy volunteers. Enhanced depth imaging-optical coherence tomography scans of both eyes involving the fovea were taken, and a 1500 μm subfoveal choroidal area was selected for image binarization with open-access Fiji software. The binarized image was segmented into the stromal area (SA) and luminal area (LA), and CVI was calculated as the ratio (%) of LA to the total choroidal area (TCA). CVI, subfoveal choroidal thickness (SFCT), IOP, systolic and diastolic blood pressure were evaluated at rest and during the VM.Results: During the VM, a mean ± standard deviation increase in LA (0.02 ± 0.05 mm 2 , p < 0.001) and CVI (1.72 ± 2.83%, p < 0.001) was observed, whereas SA (−0.02 ± 0.05 mm 2 , p < 0.001) decreased. There was no significant change in TCA (0.00 ± 0.03 mm 2 , p = 0.55) or SFCT (1.05 ± 10.92 μm, p = 0.46). There was a moderate positive correlation between the spherical equivalent refractive error (SE) and SFCT both at rest and during VM (r 58 = 0.49, p < 0.0005 and r 58 = 0.49, p < 0.0005, respectively). However, there was no significant correlation between SE and CVI either at rest or during VM (p = 0.11 and 0.06, respectively). In a multiple linear regression analysis, CVI was only associated with SFCT; however, SFCT was also associated with SE, both at rest and during VM (p < 0.001). Conclusion: Valsalva manoeuvre increases CVI by choroidal vascular dilation as demonstrated by an increase in LA and a decrease in SA. Researchers should be careful about unintentional VM during examinations. K E Y W O R D S choroidal vascularity index, enhanced depth imaging optical coherence tomography, subfoveal choroidal thickness, Valsalva manoeuvre How to cite this article: Sevik MO, Çam F, Aykut A, Dericioğlu V, Şahin Ö. Choroidal vascularity index changes during the Valsalva manoeuvre in healthy volunteers.

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Section: Discussionmentioning

confidence: 79%

Choroidal vascularity index changes during the Valsalva manoeuvre in healthy volunteers

Sevik

Çam

Aykut

et al. 2021

Ophthalmic Physiologic Optic

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“…However, other mechanisms have been proposed to explain how the VM increases IOP. One relates to changes in eye muscle activity (45), and another theory involves the autonomic nervous system (58). Although IOP was shown to increase independent of the VM in numerous studies in the present review, it cannot be excluded that the VM was unintentionally performed.…”

Section: Discussionmentioning

confidence: 99%

“…Performing a Valsalva maneuver (VM) compared with unrestricted breathing was shown to significantly elevate blood pressure during RE (39). Furthermore, IOP was increased during a VM alone (58) and accentuated when RE was performed with a VM (65). When lifting heavy loads (>80% maximal voluntary contraction—MVC) and usually as a repetition maximum (RM) is approached, a breath-hold or VM is reflexively performed (18).…”

Section: Introductionmentioning

confidence: 99%

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Acute Effects of Resistance Exercise on Intraocular Pressure in Healthy Adults: A Systematic Review

Hackett,

Li,

Wang

et al. 2023

Journal of Strength and Conditioning Research

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Hackett, DA, Li, J, Wang, B, Way, KL, Cross, T, and Tran, DL. Acute effects of resistance exercise on intraocular pressure in healthy adults: A systematic review. J Strength Cond Res XX(X): 000–000, 2023—Intraocular pressure (IOP) tends to fluctuate during a resistance exercise (RE). This systematic review examines the acute effects of RE on IOP in healthy adults and factors that influence changes in IOP. Five electronic databases were searched using terms related to RE and IOP. A strict inclusion criterion was applied, which included being 55 years or younger with no medical conditions and RE intensity needing to be quantifiable (e.g., based on a maximal effort). Thirty-four studies met the inclusion criteria for this review. Isometric and isotonic contractions produced similar changes in IOP during RE up to 28.7 mm Hg. Exercises that involved larger muscle mass, such as squats and leg press, were found to produce changes in IOP during exercise ranging from 3.1 to 28.7 mm Hg. Smaller changes in IOP during RE were found for exercises engaging less muscle mass (e.g., handgrip and bicep curls). Intraocular pressure was found to increase during RE when lifting heavier loads and with longer exercise durations (e.g., greater repetitions). The Valsalva maneuver (VM) and breath-hold during RE accentuated the change in IOP, with more extreme changes observed with the VM. However, most studies showed that postexercise IOP returned to baseline after approximately 1 minute of recovery. An acute increase in IOP is observed during RE in healthy adults with fluctuations of varying magnitude. Factors that independently increase IOP during RE include exercises involving larger muscle mass, heavy loads, greater set duration, and when the VM or breath-hold is performed.

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“…43 It has also been suggested that the extraocular muscles play a role in the increase in IOP that is known to occur during lid squeesing. 44 Others Open access have suggested a role for the autonomic nervous system. 42 Sun et al have shown that the expansion and collapse of Schlemms canal during the Valsalva manoeuvre may arise from autonomic nervous system activity as well as the changes in blood flow.…”

Section: Blood Pressure Changesmentioning

confidence: 99%

Intraocular pressure fluctuation during resistance exercise

et al. 2021

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ObjectiveTo evaluate the effect of weightlifting (leg press) on intraocular pressure (IOP).DesignProspective cohort study.SubjectsA total of 24 participants met the inclusion criteria and completed the study procedures. Participants had an average age of 22.7±2.7 years and included nine women. The mean baseline IOP was 13.9 mm Hg (SD=2.4) with an average body mass index of 24.5 (SD= 3.1).MethodsThe maximum load for a single lift was found for each participant. Participants then performed three leg press regimens: one repetition using 95% of maximal load (1RM), six repetitions using 75% of maximal load (6RM) and isometric push against a weight much heavier than maximal load (ISO).Main outcome measureIOP was measured pre-exercise, during and immediately following the exercise using an iCare TA01i rebound tonometer. Blood pressure and HR were being monitored continuously during the lift. Optical coherence tomography images were obtained pre and postexercise session.ResultsThe average maximum weight lifted by our participants was 331.9 Kg (SD=97.3). Transient increased IOP was observed across the 1RM, 6RM and ISO exercises with an average increase in 26.4 mm Hg (23.7 mm Hg to 28.7 mm Hg) to reach an average max IOP of 40.7 mm Hg (27.8 mm Hg to 54.2 mm Hg), with an absolute maximum of 70 mm Hg in one participant.ConclusionsThere is a transient and dramatic fluctuation in IOP with resistance training. This coupled with regular exposure to resistance training is potentially a significant risk factor for glaucoma. It should be noted that this study has been carried out in a healthy young population, and, thus, the external validity of these results in glaucoma participants requires further investigation.

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Dual effect of the Valsalva maneuver on autonomic nervous system activity, intraocular pressure, Schlemm’s canal, and iridocorneal angle morphology

Cited by 12 publications

References 35 publications

Choroidal vascularity index changes during the Valsalva manoeuvre in healthy volunteers

Choroidal vascularity index changes during the Valsalva manoeuvre in healthy volunteers

Acute Effects of Resistance Exercise on Intraocular Pressure in Healthy Adults: A Systematic Review

Intraocular pressure fluctuation during resistance exercise

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