The Effect of Intradialytic Eye Exercise in Hemodialysis Patients

Patients receiving maintenance hemodialysis often live with deconditioning, reduced mobility, impaired balance, and substantial fall-related concern, all of which can undermine independence and daily functioning. Recent hemodialysis research has shown that poorer physical performance and greater fear of falling are strongly associated with fall risk, while recent reviews indicate that falls in this population are common and influenced by multiple interacting factors, including physical decline and reduced activity. Supervised intradialytic exercise is a logical delivery model because it can be integrated into the dialysis session, monitored directly by clinical staff, and implemented with acceptable safety and adherence in appropriately screened patients. In parallel, eye-focused training that targets oculomotor control, gaze stability, and visual-motor coordination has improved balance, gait, and fall-related confidence in other populations, including stroke survivors and older adults, suggesting a plausible mechanism for helping patients whose balance and mobility are compromised by inactivity, frailty, and treatment-related instability. However, evidence for this approach in hemodialysis remains limited, and it is not yet known whether such a program can be delivered reliably within the practical constraints of the dialysis unit without interfering with treatment. A pilot randomized trial is therefore warranted to determine feasibility, tolerability, and safety, to identify workflow barriers, and to estimate whether the intervention shows enough promise to justify a larger definitive efficacy trial.

Inclusion criteria

• Adults ≥18 years receiving maintenance in-center hemodialysis
• Clinically stable for brief seated intradialytic intervention
• Able to understand and follow eye-exercise instructions
• Able to provide informed consent
• Able to sit upright independently during dialysis
• Able to complete repeated outcome assessments
• Able to communicate discomfort or adverse symptoms
• Usual corrective lenses permitted if needed for visual clarity

Exclusion criteria

• Unstable cardiac conditions (e.g., unstable angina, recent myocardial infarction, decompensated heart failure, uncontrolled arrhythmia)
• Active infection or acute medical illness
• Hemodynamic instability
• Significant cognitive or communication impairment preventing instruction-following
• Severe uncorrected visual impairment or active ocular disease
• Recent major ophthalmologic surgery
• Severe musculoskeletal or neurologic limitations preventing participation or testing
• Any condition deemed unsafe for intradialytic exercise by the treating physician or nephrologist