Monday, June 24, 2019

Acute Angle Closure Glaucoma and Asana Practice

Kopf (Head), Oskar Schlemmer, 1919
by Kathleen Owen, E-RYT200

In early April, I went for my annual eye appointment. I expected nothing unusual. The optometrist said after he looked into my eyes with some very fancy eye scopes: You have Acute Angle closure and need to be seen by an ophthalmologist ASAP. What! Me! Something emergency? No way. But the appointment was made; I was off to the ophthalmologist.

What is Acute Angle Closure (AAC) Glaucoma? How is it corrected? How would it affect my asana practice? AAC is an eye condition that makes the pressure inside your eye go up quickly and happens when fluid in your eye cannot drain. The condition is caused by a sudden increase in pressure inside the eye, called intraocular pressure (IOP).

By way of a system of canals, aqueous fluids drain out of your eyes. These canals are part of a meshwork of tissues between your iris and your cornea. When the iris and cornea move closer to each other, the angle between them becomes closed and there is no drainage route for the eye fluids. Without an outlet, these fluids build up and the IOP goes up, often sending someone to the Emergency Room with intense pain. If the IOP stays very high, even for a short period of time, it can put pressure on the optic nerve and cause permanent blindness. Unlike other forms of glaucoma, Acute Angle Closure needs immediate attention by an ophthalmologist.

Some of the symptoms can include blurry vision, severe eye pain, seeing halos, red eye, and nausea. When in crisis mode, AAC can cause very intense eye or headache pain. The main treatment options are laser iridotomy or lens replacement surgery, both performed by an ophthalmologist. The pros and cons of each procedure depend upon the age and general health of the patient. Acute Angle Closure Glaucoma is found mostly in older women and those of Asian or Native American descent.

I was concerned about how to adapt my yoga practice to make it more accessible to this new condition. As I read about the condition, the glaring truth from all expert yoga and medical sources was: stay away from inversions! Why? Because inversions add more pressure in the eye which we don't want if diagnosed with AAC. Ok, got it! But what about my practice?

It has been six weeks and both eyes have been corrected from AAC glaucoma. I chose to have the natural lens removed; exactly the same procedure one would have for cataract surgery. Although I showed no signs of cloudy lens, at 68 years old I chose this option to relieve the anterior eye pressures.

The surgeries were done within two weeks, one eye each week. The recovery is minimal; eye drops for about six weeks. But what about my yoga practice? When can I resume it fully? Including inversions? I was told I could resume yoga practice about a week after the second eye surgery. To be on the safe side, I wanted to be safe and waited an additional week before resuming my full practice and kept my inventions to gentle forward folds and lazy Down Dogs holding each for only a few seconds.

During the time I waited for my surgery and during the recovery from it, I created a practice that worked to keep me in “my asana practice” during this ordeal. Before beginning this practice, I referenced many modern yoga texts on asanas and found these gentle poses kept me strong, flexible, and away from any inversions until the AAC condition was healed. Talk with your ophthalmologist to get his/her affirmation before beginning this practice as your condition may have more restrictions than mine.

The primary restrictions for ACC are: No Headstands. No Handstands. No Shoulder Stands. No Plow Poses. No Karnapidasana (Ear Pressure Pose). No Down Dogs. No forward folds. No Legs Up the Wall. The key to this practice is very simple: Keep the Head Above Heart At All Times.

This is the asana practice I created and used until my AAC condition was corrected. I followed it in order from number 1-10, spending up to 8 breaths in each pose.

1. Corpse pose: on mat, 3 minutes, relaxing the body, following the breath.

2. Pelvic Tilts: lay on the back with both knees bent and raised to ceiling, feet on mat. With an inhalation gently press the tailbone into the mat, tilting the pelvis up; with an exhalation press the lower back into the mat; moving the pelvis the opposite direction. Part of pelvis always remains on mat.

3. Knee to Chest: one foot on mat, pull other knee into chest. Repeat other side.

4. Knees Side to Side: feet on floor, gently move bent knees side to side with arms at sides.

5. Knees Rest: with feet on floor take both knees to right, arms out like cross, hold. Repeat knees to other side.

6. Arm Hugs: lay on the back with both knees bent and raised to ceiling, feet on mat. Hug arms across torso, elbows pointing up. Repeat other arm on top.

7. Cross Openings: lie on one side with knees bent, arms extended in front of torso at shoulder height, palms together. Lift top arm to open to the other side. Repeat other side.

8. Down Dog at the Wall: stand facing the wall, place palms on wall at height of head. Keep the spine elongated, knees straight, gently push on palms, step away from wall to where you feel a stretch in the spine from crown of the head to the tailbone.

9. Table Top at the Wall: stand facing the wall, place palms on wall slightly below shoulder height. Pressing the wall with the palms, gently step back as you walk the palms down the wall until the torso is almost parallel to the floor (don't let head go below heart). Keep the spine elongated, knees straight, gaze is at the floor. Stretch the spine from crown of the head to the tailbone.

10. Corpse pose. Relaxed belly breathing. Meditation 5-10minutes.

Three weeks after surgery, I am fully recovered and practicing my asana routines including my favorite inversions. I am also back to teaching chair yoga. I have learned that asana adaptation is the key to enjoying my life.

Kathleen Owen is a E-RYT 200 who has been teaching accessible yoga since 2017 in Decatur, Illinois. She completed her 200 hour Yoga Alliance training at Yoga with Connie Pease in Latham, Illinois. She continues her yoga with on-line training and recently with workshops by Max Strom and Gabriel Halpern. She teaches many mat and chair accessible yoga classes in Decatur and Macon County Illinois.

This post was edited by Patrice Priya Wagner, co-editor of Accessible Yoga blog and member of the Board of Directors.

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