The effects of traditional Muslim prayer positions on intraocular pressure in subjects with and without glaucoma

Purpose: To compare the magnitude and duration of intraocular pressure (IOP) increase during the two principal Islamic prayer positions, Rukū (standing while bowing forward at a 90-degree angle), and Sujud (kneeling with the forehead touching the ground) in healthy subjects and patients with primary open-angle glaucoma (POAG). Methods: Prospective, observational case series. Ninety-five eyes of 47 patients (27 with POAG and 68 without POAG) were included. Eligible candidates underwent IOP measurements in the sitting position and in two prayer positions using the Goldmann applanation tonometer and the Icare-Pro tonometer. IOP was measured at set intervals until it returned to baseline. Results: Mean IOP increased from a sitting baseline value of 16.1 ± 2.9 mmHg (8.6-26) to 19.3 ± 4.2 mmHg (10.2-32.3) following 30 s of Rukū (p ≤ 0.0001) and from 16.1 ± 0.4 mmHg to 22.2 ± 3.1 mmHg (14.9-37) following Sujud (p ≤ 0.0001). IOP increased similarly in the POAG and non-POAG groups in both positions. Twenty-six eyes (27%) failed to normalize within 2mmHg of baseline, but all returned to baseline after another five minutes. Conclusions: Performing traditional Muslim prayer positions increases IOP significantly. The increase did not resolve immediately in approximately a quarter of individuals. These findings may have a considerable impact on Muslim patients with glaucoma.