Physical activity and exercise in primary open-angle glaucoma: a scoping review

Introduction: Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness worldwide. Although intraocular pressure (IOP) reduction remains the cornerstone of management, increasing attention has focused on physical activity (PA) and structured exercise as potential adjunct strategies. Exercise induces systemic physiological adaptations, including changes in systemic vascular health, autonomic regulation, and perfusion dynamics, which may influence glaucoma pathophysiology and ocular health beyond IOP-dependent pathways. Methods: This scoping review was conducted in accordance with PRISMA-ScR guidelines. MEDLINE, Embase, and SPORTDiscus were systematically searched from database inception to 13 June 2024. Eligible studies investigated associations or effects of PA or exercise on POAG-related outcomes, including ophthalmological parameters, systemic vascular markers, and patient-reported outcomes. All study designs were considered. Data were extracted and synthesized narratively across predefined clinical domains: incidence, progression, disease severity, and quality of life. Results: Eighteen studies met the inclusion criteria (14 observational, 4 randomized controlled trials). Aerobic exercise interventions were consistently associated with short-term reductions in IOP and increases in ocular perfusion pressure. Observational evidence suggested that higher habitual PA was associated with lower glaucoma prevalence, reduced incidence, and slower disease progression. However, findings across studies were heterogeneous, and no study directly evaluated disease severity or vision-related quality of life. Methodological limitations included inconsistent outcome definitions, inadequate patient characterization, reliance on self-reported PA, and short follow-up durations. Conclusion: Current evidence suggests that higher levels of PA are associated with more favorable POAG-related outcomes, potentially mediated through both IOP-dependent and systemic vascular mechanisms affecting ocular perfusion. However, causal inference remains limited. Future research should prioritize adequately powered, long-term randomized trials incorporating objective PA assessment and comprehensive ophthalmological and patient-reported outcomes to clarify the role of exercise in glaucoma prevention and management.