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Eye Disease: The Atrial Fibrillation Link to Glaucoma
This article was first published May 26, 2017 ♥ Last updated: August 26, 2020
Atrial Fibrillation patients are at high risk for developing Glaucoma. You may have Glaucoma right now and not know it because Glaucoma is often asymptomatic. Patients often have no eye complaints and have a normal range of intraocular pressure (IOP).
Glaucoma is a group of diseases that damage the eye’s optic nerve and can result in vision loss and blindness.
Like Atrial Fibrillation, Glaucoma is a progressive disease. It usually happens when fluid builds up in the front part of your eye. That extra fluid increases the pressure in your eye, damaging the optic nerve. Glaucoma is a leading cause of blindness for people over 60 years old.
Glaucoma: damage to the optic nerve
However, with early detection and treatment, you can often protect your eyes against serious vision loss. (See VIDEO below.)
Atrial Fibrillation Linked with Glaucoma
Research shows a connection between cardiac arrhythmias and Glaucoma. Glaucoma may be related to “ischemia” (when your heart muscle doesn’t get enough oxygen) and has been linked with Atrial Fibrillation
A 2017 research study at Medical University of Warsaw (Zaleska-Zmijewska) looked at the rate of Glaucoma in patients with Atrial Fibrillation.
Though it was a relatively small sample size of 117 patients (79 with A-Fib and a control group of 38 with sinus rhythm), participants were matched for age and sex. Ophthalmic examinations were conducted between October 2014 and December 2015.
Study findings: Normal-tension glaucoma was diagnosed almost 3 times more often in patients with A-Fib than in the control group. Just like an A-Fib diagnosis, normal-tension glaucoma is highly dependent on age. The older the patient, the greater the risk of glaucoma.
A-Fib increases risk of Glaucoma: Independent of other known cardiovascular risk factors, this research study and others have found that A-Fib increases the risk of developing normal-tension glaucoma.
Among A-Fib patients, glaucoma is found especially among those who are female, 60+ years old, take the medication Warfarin and have high blood pressure.
What Patients Need to Know
What Glaucoma looks like during eye exam.
While there are no known ways of preventing glaucoma, blindness or significant vision loss from glaucoma can be prevented if the disease is recognized in the early stages.
Know your risk: As a patient with Atrial Fibrillation, you’re at increased risk of glaucoma. If Glaucoma runs in your family, you are also at increased risk.
More frequent eye exams: When at higher risk of Glaucoma, the American Academy of Ophthalmology recommends having regular eye examinations. If you’re 55 to 64 years old, that would be every one to three years; if you’re older than 65, then every one to two years. Ask your doctor to recommend the right screening schedule for you.
Most ophthalmologists will include a glaucoma test as part of your regular eye care. Make sure to have your eyes examined through dilated pupils.
With early detection and treatment, you can often protect your eyes against serious vision loss.
VIDEO: Glaucoma Animation: The causes of glaucoma, a group of diseases that damage the eye’s optic nerve. National Eye Institute, NIH. (40 sec.)
YouTube video playback: Click center arrow icon to watch.
Holiday Season Warning: How Drinking Too Little Can Trigger Your A-Fib!
With the holiday season approaching, we want to remind Atrial Fibrillation patients that cold weather, dry air and drinking too little water can lead to dehydration which can trigger an Atrial Fibrillation episode.
Many people don’t realize how quickly and deeply dehydration can set in, especially since the early warning signs are subtle.
The Good News, The Bad News
The good news is that usually dehydration on its own won’t cause an Atrial Fibrillation episode. The bad news, when combined with other well-known triggers, it will.
For example: You risk dehydration when traveling by air (low humidity) during the hectic holidays (tired and stressed), drinking too much coffee (diuretic effect), and vacationing in the desert (dry climate).
Hydration Affects the Rhythm of Your Heart
Your body contains significant amounts of water. A change in fluid levels in your body can affect a number of bodily functions, including heart function. When you have atrial fibrillation, drinking enough water is important.
When you’re dehydrated, your body’s electrolytes (electrolytes in general, and sodium and potassium in particular) are crucial for heart health. Electrolyte levels plummet when you’re dehydrated. This can lead to abnormal heart rhythm.
Dehydration Risk Factors Beyond Sweating and Heat
Your risk of dehydration isn’t just from sweating during exercise or from the extreme heat of summer. Other risks include high altitudes, the arid desert, exhaustion and increased stress, missing meals or a change in eating patterns, and vomiting or diarrhea.
Do you travel by plane often? Flying dehydrates you because the humidity level on a plane is usually less than 10%. How about your choice of beverages? Alcohol and caffeinated drinks also dry you out.
Cold weather can also dehydrate you. When it’s cold, the body works to maintain its core temperature, and works less to keep ideal fluid balance. And since you don’t feel thirsty when it’s cold, you often don’t think about drinking extra water.
A-Fib Patients: Preventing Dehydration
Under normal conditions, 64 to 80 ounces of water per day is considered enough. On a plane, a good rule of thumb is 6 to 12 ounces of water (or club soda) for every hour in the air.
Drink at least 64-80 oz of water a day or more when…
Be aware of the not-so-obvious signs of dehydration: dry mouth, constipation, feeling tired and sleepy, low urine output, dry skin and dizziness or lightheadedness. Furthermore, your body may misinterpret the need for water as the need for food making you feel hungry, when what you really need is more water.
Drink more water when…the weather is too hot or too cold, when traveling by plane, when you’ve skipped meals, when exhausted or you’re sick. For each coffee or alcohol beverage, have a glass or two of water.
Check your hydration level. Each body has individual needs for water intake. If you’re drinking enough, look at the color of your urine when you go to the washroom. If your urine is clear or light yellow, you are well hydrated. If it’s darker, you need to drink more water.
Stay Aware—Stay Hydrated
Dehydration is never a healthy state, but the mineral imbalance that results can be especially troublesome for A-Fib patients. Sometimes it’s the lack of a dietary staple that causes the heart to misfire, and in many cases, that substance is water.
More Research on Coffee (& Caffeine)! Could it Actually Help Prevent A-Fib?
Yes—another study about coffee and Atrial Fibrillation.
A retrospective study from Australia included 228,465 subjects. Researchers found that drinking coffee lowered atrial fibrillation occurrence. Regular coffee drinkers had a 6% average reduction in A-Fib. While heavy coffee drinkers had a 16% reduction. How do they explain this? Caffeine blocks the effects of adenosine, a compound that can facilitate A-Fib.
Conclusion: In this one study, researchers found that coffee doesn’t increase abnormal heart rhythms—but helps prevent them.
Added 10/14/22:
In an analysis of six observational studies, caffeine was “unlikely to cause or contribute to atrial fibrillation. In fact, habitual caffeine consumption might modestly reduce the risk of arial fibrillation…for every cup of coffee per day there was a 3% decrease of atrial fibrillation or other arrhythmias.” (Cheng, 2014) (Thanks to David Holzman for calling our attention to this research.)
Coffee and the Bottom Line for A-Fib Patients
Needless to say, the caffeine in coffee is a stimulant. And we don’t all react to stimulants the same way.
Remember, A-Fib is not a “one-size fits all” disease. Contrary to this research, coffee or caffeine may trigger or worsen your A-Fib. So, you may want to start (or continue) avoiding caffeinated beverages until your A-Fib is cured.
For some, drinking coffee regularly (including me) may have no ill effects. This research suggests coffee and caffeine may actually help prevent A-Fib.
Coffee May Protect Against Cognitive Decline
Coffee increases the neurotransmitters serotonin and acetylcholine and stimulates the brain. The polyphenols in coffee may prevent tissue damage by free radicals. Trigonelline, a substance found in high concentration in cofee beans, may activate antioxidants that protect blood vessels in the brain.
How Much Caffeine is There in the Food and Beverages you Consume?
Caffeine is not a nutrient but a drug that is a mild stimulant of the central nervous system. Like any drug, the effects of caffeine on the body are not wholly good or bad. For an extensive list of how much caffeine there is in the food and beverages you consume, go to Caffeine Effects, Half-Life, Overdose, Withdrawal
• Naidoo, Uma. Eat for your brain. Bottom Line Health, May 2021, p. 10
PVCs Aren’t Always Benign, and He Didn’t Want to Live with Them
Do NOT listen when doctors say PVCs are harmless, writes John Thorton from Sioux Falls, SD. Besides A-Fib and A-Flutter, his PVCs were destroying his life and driving him crazy.
Premature Ventricular Contractions (PVCs) are premature beats that occur in the ventricles, i.e., the heart’s lower chambers. (Premature beats that occur in the atria, the heart’s upper chambers, are called premature atrial contractions, or PACs.) In his A-Fib story, John writes:
“The local MDs (about a half dozen different ones), cardiologists, EPs, and other local specialists, all told me stuff like: “Everyone has PVCs” and “PVCs are benign,” and “It is just anxiety,” and “You just need to learn to live with it”.
Which was completely WRONG.
Being his Own Patient Advocate
In his A-Fib story, PVC-Free After Successful Ablation at Mayo Clinic, John advises: Be assertive, even aggressive.
“I had to set up my own appointment at Mayo Clinic to get evaluated there. It was a lot of work, by me alone, to get in to see the doctors at Mayo, but it was worth it.
I honestly believe that had I not gone to Mayo, I would have suffered some major heart event, or possibly death.”
PVCs Aren’t Always Benign
Especially for people with A-Fib, PVCs should be taken seriously. Often they precede or predict who will develop A-Fib. They can increase chances of a fatal heart attack or sudden death. The good news: sites in the heart that produce PVCs can be mapped and ablated just like A-Fib signals.
To learn more about PVCs, see my article: FAQs Coping with A-Fib: PVCs & PACs
Don’t be Afraid to Fire Your Doctor!
Kudos to John for being his own best patient advocate, for taking the bull by the horns and dealing with his PVCs. In spite of what he heard from everyone else, he persevered and went to probably the best center in the US for treating PVCs—the Mayo Clinic. Now John’s A-Fib free and only has occasional PVCs.
Like John, don’t be afraid to fire your doctor! To learn how to interview doctors, see our page: Finding the Right Doctor for You and Your A-Fib.
Your Life-Threatening Risk of A-Fib with Untreated Sleep Apnea
At least 43% of patients with Atrial Fibrillation suffer from Obstructive Sleep Apnea (OSA) as well. In his A-Fib story, Kevin Sullivan, age 46, wrote about his discovering his Sleep Apnea on his own and the effect on his A-Fib. He wrote:
“My A-Fib seemed to start at night while I was sleeping. One night when I woke up, my heart was racing and I felt sweaty. I started reading about things which contribute to A-Fib and learned that high thyroid levels and sleep apnea contribute to the condition. My brother had sleep apnea, so that made me think I might as well.
When I asked my doctor about it, he told me that it was unlikely because I was not overweight and I did not feel tired during the day.
I went to a sleep lab anyway, and it turned out that I did have sleep apnea. My A-Fib was being triggered by apnea episodes during the night. I got an CPAP machine to address the sleep apnea and hoped that was the end of my A-Fib….“
To read the rest of Kevin Sullivan’s A-Fib story, go to: A-Fib Patient Story: Overcoming Silent A-Fib—Ablation by Dr. Patrawala.
Sleep Apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
Risk of A-Fib with Untreated Sleep Apnea
It is now established that there’s a connection between Sleep Apnea and A-Fib.
If you have untreated Sleep Apnea, you are at greater risk of having a more severe form of A-Fib or of not benefiting from an A-Fib treatment. To learn more about sleep studies, see my article: Sleep Apnea: Home Testing with WatchPAT Device and the Philips Respironics
More EPs are Sending Patients for Sleep Studies
So many A-Fib patients also suffer from sleep apnea that many Electrophysiologists (EPs) routinely send their patients for a sleep apnea study. Some A-Fib centers have their own sleep study program. (The patient just walks down the hall to an A-Fib sleep study area.)
For some lucky patients, normal sinus rhythm (NSR) can be restored just by controlling their sleep apnea and getting a good night’s sleep.
Take Action: Sleep Apnea Can be Lethal
Sleep apnea isn’t a minor health problem, and it’s a condition you can do something about. If your bed partner tells you that you have pauses in breathing or shallow breaths while you sleep, or that you snore, do something about it! (Not everyone with sleep apnea snores, but snoring may indicate sleep apnea.)
Talk with your doctors about testing for sleep apnea. You may need an in-lab or home sleep test).
FAQ: Updated Answer About A-Fib and Marijuana Use
During the past few years compelling evidence has developed that marijuana has significant effects on the cardiovascular system. Recently, we’ve updated our answer to this question regarding marijuana use by A-Fib patients:
There isn’t much clinical research on this subject. But due to the increased use of medical marijuana in California and other states, we should soon be getting more data on marijuana’s effects on A-Fib.
Feedback from A-Fib Patients About Marijuana
THC and CBD: From speaking to actual marijuana users, the THC component, such as is found in the marijuana plant Stavia, is what makes you feel “high.”
The CBD component, such as is found in the marijuana plant Endica, works better to reduce pain and anxiety and induce sleep.
Best Marijuana Product for A-Fib Patients? Probably the edible forms of marijuana using primarily the CBD component seem to be something that A-Fib patients might want to investigate. Read my full answer->
Personal Experiences: You may want to read the personal experiences of A-Fib patients Jim, John, William, Jonathan and Scott who share how marijuana use has improved or provoked their A-Fib episodes. Read more->
My 7 Ways of Coping With the Psychological Distress of Atrial Fibrillation
The psychological and emotional effects of Atrial Fibrillation can be debilitating. Recent research indicates that “psychological distress” worsens the severity of A-Fib symptoms.
Anxiety by itself can produce physical symptoms such as gastrointestinal distress, sleep issues, shortness of breath, exhaustion, muscle aches, shaking and trembling, sweaty palms, difficulty swallowing, a racing heart like in A-Fib, getting colds frequently because of a depressed immune system.
(Don’t expect much help from your cardio doctors. When it comes to the psychological and emotional aspects of A-Fib, most doctors aren’t trained or often have little effective experience in dealing with it.)
Don’t be ashamed to admit how A-Fib makes you feel (especially if you’re a guy). Your psyche is just as important as your physical heart. Just acknowledging you have some of these symptoms is a step in the right direction.
Read my article Coping With the Fear and Anxiety of Atrial Fibrillation for seven ways to fight your fears and ambush your anxiety!
Atrial Fibrillation may be in your heart—
But it doesn’t have to be in your head.
The Threat to Patients with “Silent A-Fib” How to Reach Them?
‘Silent A-Fib’ is a serious public health problem. Anywhere from 30%-50% of those with A-Fib aren’t aware they suffer from A-Fib and that their heart health is deteriorating.
In his A-Fib story, Kevin Sullivan, age 46, wrote about his diagnosis of Silent A-Fib.
“I was healthy, played basketball three times per week, and lifted weights. I started to notice on some days playing basketball, I was having some strange sensations in my chest. And sometimes, difficultly catching my breath. But the next day I would feel fine. I assumed this was just what it felt like to get old.”
He writes, that at the time, he happened to see a cardiologist about medication for high cholesterol:
“I went to see a cardiologist. They looked at my heart with ultrasound and asked if I could feel “that.” I asked them what they were talking about, and they told me that I was having atrial fibrillation. That was the first time I had ever heard of the phrase.”
‘Silent A-Fib’ vs. ‘Symptomatic A-Fib’
Silent (asymptomatic) A-Fib can have similar long-term effects as A-Fib with symptoms. Silent A-Fib may progress and get worse just like symptomatic A-Fib. Increased fibrosis may develop, the atrium may become stretched and dilated, the frequency and duration of the unnoticed A-Fib attacks may increase over time (electrical remodeling).
Is “Silent A-Fib” Really Silent? Some people question whether “silent” A-Fib is really silent (from a clinical aspect). Even with Silent A-Fib, one loses 15%-30% of normal blood flow to the brain and other organs which certainly has an effect. (For Kevin Sullivan, he experienced occasional pain in his chest and shortness of breath while playing basketball.)
Those with Silent A-Fib may get used to their symptoms, or they write off the tiredness, dizziness or mental slowness like Kevin Sullivan did. Nonetheless, almost everyone in Silent A-Fib is affected and changed by their A-Fib to some extent.
‘Silent A-Fib’ More Dangerous: Increased Risk of A-Fib Stroke
When left untreated, A Fib patients have a 5X higher chance of stroke, and a greater risk of heart failure. Often, an A-Fib patient is hospitalized or dies from an A-Fib-related stroke without anyone ever knowing the patient had A-Fib.
And if the patient with A-Fib survives, they have about a 50% higher risk of remaining disabled or handicapped (compared to stoke patients without A Fib).
Tactics to Find Undiagnosed ‘Silent A-Fib’
Today, during a routine physical exam, general practitioners (GPs) will listen to your heart with a stethoscope and would notice if your heart beat was irregular. After a certain age, your exam may also include an ECG (EKG), and the tracing would show if you are in Atrial Fibrillation, even if your not aware of it. Cardiologists routinely perform an ECG and catch Silent A-Fib (like Kevin Sullivan’s cardiologist did).
But, to be detected, A-Fib must be present at the time of the ECG, and we know that A-Fib is often intermittent. If intermittent A-Fib is suspected, your EP has an array of A-Fib wearable event monitoring devices (like the band-aid-size ‘Zio patch’ monitor).
What if A-Fib isn’t even on the patient’s radar? What’s the remedy? More frequent and regular screenings! But how? First, by healthcare personnel teaching ‘at-risk age groups’ how to use pulse-taking palpation (which can be readily taught). See also the VIDEO: “Know Your Pulse” Awareness Campaign.)
Second, through community-sponsored health screening events when patients who are interacting with their healthcare provider for another reason, such as an annual flu vaccination.
Think of the lives and permanent disabilities that would be saved by inexpensive screening and easily administered monitoring for Silent A-Fib.
The Future of Screening for Silent A-Fib: Heart-monitoring apps and devices are growing in popularity. Two FDA-approved devices are the iPhone app called Cardio Rhythm, and the AliveCor Kardia device that connects to a app-equipped smartphone.
What Patients Need to Know
If you have A-Fib, discuss it with your family and friends. Answer their questions. Because A-Fib runs in families, urge your immediate family members to discuss A-Fib with their doctors.
Encourage your friends over 60 years old to do the same. Support community-sponsored health screening events.
Eye Disease: The Atrial Fibrillation Link to Glaucoma
Glaucoma is a disease that damages your eye’s optic nerve and is a leading cause of blindness for people over 60 years old. While anyone can get glaucoma, those at higher risk include African Americans over age 40, everyone over age 60 especially Mexican Americans, and people with a family history of the disease. Blindness can often be prevented with early treatment.
Link with Atrial Fibrillation: Glaucoma may be related to ischemia (when your heart muscle doesn’t get enough oxygen) and has been linked with Atrial Fibrillation. Among A-Fib patients, glaucoma is found especially among those who are female, 60+ years old, take the medication Warfarin and have high blood pressure.
Risk May Be Dormant
Patients may be at risk of glaucoma for years but not develop any signs. Then something changes abruptly, such as developing atrial fibrillation, and the glaucoma-related damage begins to occur.
What Patients Need to Know
When you have Atrial Fibrillation, you should be tested for glaucoma regularly (most ophthalmologists will include a glaucoma test as part of your regular eye care).
if you fall into one of the high-risk groups for the disease, make sure to have your eyes examined through dilated pupils every one to two years by an eye care professional. 
See the dentist too: Besides regular visits with your eye doctor, A-Fib patients should see their dentist regularly, too! See my article about the link between A-Fib, inflammation and gum disease: Brush & Floss! Is Oral Hygiene Linked to A-Fib?
How Drinking Too Little Can Trigger Your A-Fib
Drinking too little alcohol? Coffee? Juice? No, we’re talking about just plain ol’ water. Drinking too little water leads to dehydration which can trigger an Atrial Fibrillation episode, and raises the risk for blood clots (it makes the blood thicker and more viscous).
Hydration Affects the Function of Your Heart
Your body contains significant amounts of water. A change in fluid levels in your body can affect a number of bodily functions, including heart function. When you have atrial fibrillation, drinking enough water is important.
When you’re dehydrated, your body’s electrolytes (electrolytes in general, and sodium and potassium in particular) are crucial for heart health. Electrolyte levels plummet when you’re dehydrated. This can lead to abnormal heart rhythm.
Dehydration Risk Factors
Your risk of dehydration isn’t just from sweating during exercise or from the extreme heat of summer. Other risks include high altitudes, the desert, exhaustion and increased stress, missing meals or a change in eating patterns and vomiting or diarrhea.
Do you travel by plane often? Flying dehydrates you because the humidity level on a plane is usually less than 10%. Alcohol and caffeinated drinks also dry you out.
Cold weather can also dehydrate you. When it’s cold, the body works to maintain its core temperature, and works less to keep ideal fluid balance. And since you don’t feel thirsty when it’s cold, you often don’t think about drinking extra water.
The Good News, The Bad News
The good news is that usually dehydration on its own won’t cause an A-Fib episode. The bad news, when combined with other well known triggers, it will.
For example, you risk dehydration when traveling by air (low humidity) during the hectic holidays (tired and stressed), drinking too much coffee (diuretic effect), and vacationing in the desert (dry climate).
Preventing Dehydration
Under normal conditions, 64 to 80 ounces of water per day is considered enough. On a plane, a good rule of thumb is 6 to 12 ounces of water (or club soda) for every hour in the air.
Be aware of the not-so-obvious signs of dehydration: dry mouth, constipation, feeling tired and sleepy, low urine output, dry skin and dizziness or lightheadedness. Furthermore, your body may misinterpret the need for water as the need for food making you feel hungry, when what you really need is more water.
Drink more water when… the weather is too hot or too cold, when traveling by plane, when you’ve skipped meals, when exhausted or you’re sick. For each coffee or alcohol beverage, have a glass or two of water.
Check your hydration level. Each body has individual needs for water intake. If you’re drinking enough, look at the color of your urine when you go to the washroom. If your urine is clear or light yellow, you are well hydrated. If it’s darker, you need to drink more water.
Be Aware—Stay Hydrated
Sometimes it’s the lack of a dietary staple that causes the heart to misfire, and in many cases, that substance is water.
As fatigue or muscle ache turns into thirst, you’re already pretty far down that path to dehydration. Many people don’t realize how quickly and deeply dehydration can set in, especially since the early warning signs are subtle.
Dehydration is never a healthy state, but the mineral imbalance that results can be especially troublesome for A-Fib patients.
