Response to comment on: Effect of short-term meditation training in central serous chorioretinopathy.

Dear Editor,

We thank the authors for reading our published work on “Effect of short-term meditation training in central serous chorioretinopathy” and seeking certain clarifications pertaining to technique, timing, duration, and rapidity of effect of meditation and to some concerns on possible confounding effects.[12]

Sukshavyayama exercises consisted of simple muscle relaxing motions such as neck movements (forward, backward, left, right, clockwise, and anticlockwise rotations), shoulder and wrist rotation, and bending and rotation of knee and ankle, and shavasana included a session of guided meditation. The meditation protocol sequence followed regularly at the integrated health clinic [IHC] is indeed Sukshavyayama, Shavasana, and Pranayama. In the manuscript, the phrase “in order” seems to convey otherwise and we thank the authors for pointing out its inadvertent usage. Although the preferred time for meditation training is morning or evening, patients in this study were allotted to the 10.30 to 11.30 am time slot, owing to operational reasons and it being the earliest available slot at IHC during the study period. While it is true that the benefits of yoga are best realized when it is practiced as a way of life and consistently for a prolonged duration, scientifically the effects can be evaluated within 8 to 12 weeks after yoga-meditation practice.[3] Importantly, stress indicators may show an immediate response. For example, deep breathing will have an immediate effect on heart rate and stress. While long-term meditation may have a role in reducing the continuation of or arresting the sequelae of chronic CSC, short-term meditation may impede the course of CSC that presents following a period of stress and anxiety.

Categorization as acute or chronic was not considered prior to enrolment into the study and patients with features of chronic CSC and those with multifocal leaks were also excluded [methods section]. We presumed that the effect of confounding factors would be minimized by randomization. Being a pilot study, a small sample size was chosen but the balancing effect of randomization may have been affected by the high dropout rate in the meditation group [highlighted as a limitation in the discussion section]. Spontaneous resolution is observed in a majority of patients with first episode of CSC and the time frame for this resolution varies between 3 and 6 months. In our study, it can be seen that patients in the control group too were showing signs of clinically significant but statistically insignificant [P 0.08] resolution [results section, para 4, sentence 1], during the study duration of 4 months. It would have been ideal for us to first follow-up all patients and then recruit only those cases that failed to resolve or respond to treatment. However, this approach would have been impractical for us as it would have severely extended the window period available for patient recruitment and restricted the enrolment. Having said this, our long-term objective with further extensions of this study would be to address the effect of incentivized [to reduce dropout rates] meditation in this category of patients and its possible role in lowering the risk of recurrence and in enhancing stabilization in those with chronic CSC.

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Conflicts of interest

There are no conflicts of interest.