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Author Topic: Glaucoma and brass playing  (Read 3857 times)
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zemry

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« on: Oct 30, 2006, 08:43PM »

The principal trombonist in our community announced his "retirement" tonight. He has had glaucoma for several years now and it has become progressively worse.

He asked his doctors whether the pressure from playing trombone would further injure his eyes and their answers were rather non-committal.

However, he was speaking to an ex-girlfriend of his who is Russian. According to her, Russian doctors said that the pressure from playing a brass instrument could further damage his eyes.

Does anyone know of any evidence to support or debunk this theory?

Would he be better off not playing trombone?

Would switching to bass trombone (less pressure) not be as harmful?
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There won't come a time when you won't have to practice anymore.........J.J. Johnson

Richard Zemry Johnson, Jr.
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« Reply #1 on: Oct 31, 2006, 09:16PM »

How advanced is the disease? What treatments has he had? We have this disease in our family and my father went blind with it. I will probably get it one of these days? When you get a disease like this, you don't just roll over and play dead. You do what you want to do as long as you can. If you go blind, you keep playing the bone anyway.
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zemry

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« Reply #2 on: Nov 01, 2006, 02:21PM »

I don't know how advanced it is.
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There won't come a time when you won't have to practice anymore.........J.J. Johnson

Richard Zemry Johnson, Jr.
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« Reply #3 on: Nov 01, 2006, 02:45PM »

There are so many treatments and surgeries for that disease that my counsel would be to continue life as usual.
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josh roseman

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« Reply #4 on: Nov 01, 2006, 03:10PM »

Quote from: "zemry"
The principal trombonist in our community announced his "retirement" tonight. He has had glaucoma for several years now and it has become progressively worse....
 he was speaking to an ex-girlfriend of his who is Russian. According to her, Russian doctors said that the pressure from playing a brass instrument could further damage his eyes.

Does anyone know of any evidence to support or debunk this theory?

Hey, Zem
I don't know the answer to this specific question about pressure-  but it's a tricky disease for sure.    There are additional issues relating to side effects from medication-  that stuff can severely affect your metabolism- and of course your ability to read music and follow a conductor.  Then there are lifestyle issues that crop up- when it's hard to transport oneself as your peripheral vision erodes, brings up tough choices in terms of week-to-week priorities.   My heart goes out to the guy.  

My mom has glaucoma and she's continually wrestling with medication issues and so on.. so I try to learn as much as I can.  May be a question for a doctor in the end- but if anyone has further infos on the eyeball-pressure-and-playing issue, would be interested to hear.
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zemry

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« Reply #5 on: Nov 01, 2006, 04:40PM »

I've done some research......may be some truth to it.

http://www.local802afm.org/publication_entry.cfm?xEntry=74098871

MUSICIANS AND GLAUCOMA

It has recently been shown that musicians who play high-resistance wind instruments are significantly more prone to develop glaucoma. This is because blowing into high-resistance wind instruments produces a Valsalva maneuver. To experience a Valsalva maneuver, inhale deeply, put your thumb in your mouth, and try to blow out against your thumb while holding your nose closed and without letting any air out of your mouth. This results in transiently increased blood pressure, increased pressure in the chest cavity, increased cerebrospinal fluid (the fluid bathing the brain) pressure, and increased intraocular pressure. Retinal hemorrhages have been reported to occur with a Valsalva maneuver.

Prolonged high expiratory air resistance, such as is experienced by professional brass musicians, may be a risk factor for the development of glaucomatous optic nerve damage. A study by Dr. Theodore Krupin, in Chicago, demonstrated that professional brass musicians can generate significant increases in eye pressure while playing high-resistance and amplitude notes. The greatest increase in eye pressure (+49.1 percent) was observed in trumpet players. Smaller increases occurred in persons playing the alto saxophone, French horn and oboe. The IOP returns to normal after the musician stops blowing into the instrument. These players may be subject to "transient" (in terms of hours) periods of increased eye pressure during instrument playing.

No one knows just how common glaucoma is in high-resistance wind instrument players because it has not yet been studied. Musicians who have more than one risk factor for glaucoma are probably more susceptible. For example, a nearsighted African American professional trumpet player with a family history of glaucoma would have an incredibly high chance of developing glaucoma. The glaucoma study we plan to conduct hopefully will provide important data on this question.

THE GLAUCOMA STUDY

In an effort to determine how common glaucoma is among professional musicians, and to identify musicians who have glaucoma so that they can be treated before they develop significant visual damage, a study has been initiated by Dr. Kerline Marcelin, under the direction of Dr. Robert Ritch and with the assistance of Local 802 member Dean Pratt, a trumpet player. The first part of the study consists of having one's eye pressure measured while playing an instrument. Measurements will be taken before, during and after playing a series of high-pitched notes at high volumes. Measuring IOP is a simple routine test, merely requiring an anesthetic drop to be placed in the eye.

The second part of the study involves scheduling a complete, complimentary eye examination to look for any evidence of glaucoma. This will consist of measuring visual acuity, a slit-lamp examination, and a visual field examination, all routine tests. The examinations will be performed free of charge at the offices of Glaucoma Associates of New York at the New York Eye and Ear Infirmary, 310 East 14th Street, Third Floor, South Building, under the direction of Dr. Robert Ritch.

Dr. Ritch is Professor and Chief of Glaucoma Service at the New York Eye and Ear Infirmary. To participate in this study, contact Kerline Marcelin, MD, at (212) 475-9297 or kerl@rcn.com, or contact Dean Pratt at bgband@earthlink.net.


Another article: http://www.medicalnewstoday.com/healthnews.php?newsid=51707

If you are a regular weightlifter perhaps you should bear in mind that you could be increasing your chances of developing glaucoma, a condition that can make you blind, say Brazilian researchers.

The scientists found that weightlifting is associated with a temporary increase in intraocular pressure (pressure inside the eye). Introcular pressure is raised further if the person holds his/her breath during reps. This increase in pressure inside the eye raises the risk of developing glaucoma.
Reps = repetitions of an exercise. The total repetitions done in one go is called a Set. A person may do '3 sets of 7 reps of a bench press exercise')

You can read about this study in the journal Archives of Ophthalmology.

When air is forced against a closed windpipe (Valsalva manoeuvre) pressure inside the eyeball tends to go up. Valsalva manoeuvre commonly occurs when a person coughs, vomits, plays a brass wind instrument (trumpet) and does heavy weightlifting.
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Richard Zemry Johnson, Jr.
zemry

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« Reply #6 on: Nov 01, 2006, 04:50PM »

ITA Journal article:

http://www.trombone.net/journal/2001/fall/wolff01.asp
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There won't come a time when you won't have to practice anymore.........J.J. Johnson

Richard Zemry Johnson, Jr.
josh roseman

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« Reply #7 on: Nov 01, 2006, 06:32PM »

Quote
a nearsighted African American professional trumpet player with a family history of glaucoma would have an incredibly high chance of developing glaucoma. The glaucoma study we plan to conduct hopefully will provide important data on this question.

Cheery news...!  
I'll be practicing pedals if you need me  :)
thanks for the infos, Zem
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Orestes
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« Reply #8 on: Nov 01, 2006, 07:55PM »

Quote from: "zemry"


I think Dr. Wolff makes very good points. I doubt that playing a trumpet or a trombone would CAUSE glaucoma in an otherwise healthy individual. (Note that the increase in pressure is not sustained.) I think that the studies sighted lacked statistical strength. I would have to study the articles themselves, however.  I can sympathize with Zem's friend who is trying to do everything he can to preserve his eyesight, though, apparently he has tried many treatments. I also think that you can make a compelling case for yearly screening for glaucoma for EVERYONE over age 40 and younger for diabetics, family history etc., especially those as noted who are at risk. Most glaucoma cases can be controlled. There should be NO reason to curtail your trombone playing as long as your IOP remains controlled even if you have glaucoma. I have a yearly screening for IOP.

Zem's article sited Dean Pratt a New York trumpet player who HAS glaucoma. He continues to play, incidentally. Hence his avid interest. I rather think that he would be more than happy to correspond with anyone here who might have questions or concerns. (His email is noted in the article above.) And, by the way He and his brother Mike front a big band in NY and have made a really excellent CD called "16 guys and a Chick Singer Swinging" with Roberta Gambarini that just rocks!
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Galen McQuarrie

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« Reply #9 on: Nov 03, 2006, 08:20AM »

I have congenital glaucoma and have experienced pressure control problems attendant to occular surgery for other eye problems. This is a matter of great interest to me as well.

Dr. Krupin, cited above, is a partner of my primary ophthalmologist and has examined me numerous times. We have never discussed brass playing and its effects on glaucoma but I will call hime for some more information on this.

The other study referred to above was, if I recall correctly, was based on a sample of 36 Turkish symphony symphony orchestra players. I showed a temporary increase in IOP (intra-ocular pressure) immediately after playing oboe, trumpet and french horn. These were the "high resistance" brass instruments" This study indicated that more study was needed and did not differentiate larger bore horns such as the trombone, euphonium, or tuba.

The real question, unanswered to date, is whether playing a brass instrument can worsen an existing glaucoma condition, i.e., cause permanent damage to the optic nerve. I don't think the medical community has definitive answers to this question and it deserves research. Anyone who has, or is prone to have glaucoma, should get their pressure checked regularly. For the average adult, a pressure under 20 is fine and 20-25 deserves watching. Ophthalmologists will also do visual field screening to measure any loss of field of view - indicative of optic nerve damage, along with slit-lamp and other exams. There is no cure for glaucoma and optic nerve damage, once it has occurred, can not be reversed. Notwithstanding, there are many drugs available that can control IOP in many cases and doctors know have several laser surgery techniques available to them, if needed.

Obviously, I'm not an MD. If you think you have, or are told you have this problem, see an opthalmologist (MD).
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« Reply #10 on: Jan 31, 2007, 09:49AM »

Just to update this a bit . . .

Yesterday afternoon, I spoke briefly with Dr. Theodore Krupin, co-author of one of the studies cited above, and partner of my ophthalmologist. I mentioned that I played trombone and asked about his research. He told me that the eye pressure increase that comes with brass playing is transient and pressure generally comes back down shortly after ceasing to play. With the trombone, that increase is relatively minimal when compared to trumpets, oboes and french horns. Moreover, a cause/effect relationship between playing and glaucoma has not been established and there is no direct evidence that the transient increase that occurs while playing is, per se, damaging. His advice: if you have glaucoma or have risk factors, check with your eye specialist regularly and faithfully take your meds if prescribed. He said he would dig up some of his articles and share them with me.

He did say: "... now trumpet . . . that's BAD". I think he meant it differently but his sentiment is felt by many low brass players.

 
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