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Glaucoma

• Signs and Symptoms
• What Causes It?
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Prognosis/Possible Complications
• Supporting Research

Glaucoma is a slowly progressing disease that causes damage to the eye's optic nerve and can result in blindness. Open-angle glaucoma, the most common form of the disease, affects about three million Americans. It is the leading cause of blindness for African-Americans. Because there are usually no symptoms at first, half of the people with this disease don't know they have it. With early treatment, serious vision loss and blindness can usually be prevented.

Signs and Symptoms

While symptoms do not initially occur, as the disease progresses, you can lose peripheral (side) vision and then forward vision. Some signs can only be found during an eye exam, such as increased pressure inside the eye and optic nerve abnormalities.

What Causes It?

A clear fluid flows in and out of the space at the front of the eye, nourishing nearby tissues. Glaucoma causes the fluid to pass through too slowly or to stop draining altogether. As the fluid builds up, the pressure inside the eye increases, causing damage to the optic nerve and vision loss.

Who's Most At Risk?

People with the following conditions or characteristics are at risk for glaucoma:

• Over 60 years of age
• Family history
• African-American descent
• Diabetes
• Myopia (near-sightedness)
• Taking certain drugs, such as antihistamines or blood pressure medications
• Food sensitivities
• Stress
• Sedentary lifestyle
• Hypothyroidism

What to Expect at Your Provider's Office

It is important to have your eyes examined on a regular basis to check for glaucoma. If you are experiencing symptoms, you should see your eye care provider immediately.

To detect glaucoma, your eye care professional will perform the following tests:

• Visual acuity -- use of an eye chart measures how well you see at various distances
• Visual field -- measures your peripheral vision
• Pupil dilation -- drops are placed into the eye to dilate (widen) the pupil. This gives your eye care professional a better view of the optic nerve to check for signs of damage
• Tonometry -- determines the fluid pressure inside the eye. One type uses a purple light while, another type uses a puff of air

Treatment Options

Prevention

While glaucoma is not preventable, early detection and treatment are the best defenses against serious visual damage. At-risk patients should avoid medicines that increase eye pressure.

Treatment Plan

The primary goal of treatment is to minimize loss of vision by reducing pressure in the eye.

Drug Therapies

Eye drops and pills are the most common early treatment for glaucoma. Some cause the eye to produce less fluid, while others lower pressure by helping fluid drain from the eye.

Surgical and Other Procedures

While glaucoma surgery may save remaining vision, it does not improve sight.

• Laser surgery -- makes 50 - 100 evenly spaced burns that stretch the drainage holes in the eye, allowing fluid to drain more efficiently
• Conventional surgery -- creates a new channel for fluid to drain from the eye

Complementary and Alternative Therapies

A comprehensive treatment plan for glaucoma may include a range of complementary and alternative therapies. However, glaucoma should only be treated by a qualified ophthalmologist. Use alternative medicine as support for a healthy body.

Nutrition and Supplements

Nutritional tips include the following:

• Eliminate all suspected food allergens, including dairy (milk, cheese, and eggs), wheat (gluten), soy, corn, preservatives and food additives. Your health care provider may want to test you for food allergies.
• Eat more antioxidant-rich foods (such as green, leafy vegetables and peppers) and fruits (such as blueberries, tomatoes, and cherries).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in such commercially baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise moderately, if tolerated, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil daily, to help decrease inflammation. Cold-water fish, such as salmon or halibut, are good sources.
• Vitamin C, 500 - 1,000 mg daily, as an antioxidant.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant support.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
• Lutein, 2 - 6 mg daily, for antioxidant support in eye health.
• Zeaxanthin, 1 - 10 mg daily, for antioxidant support in eye health.
• Melatonin, 2 - 5 mg at bedtime, for antioxidant support, and as needed for sleep.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Bilberry ( Vaccinium myrtillus ) standardized extract, 80 mg two to three times daily, for antioxidant and vision support.
• Ginkgo ( Ginkgo biloba ) standardized extract, 40 - 80 mg three times daily, for antioxidant and immune support.
• Green tea ( Camellia sinensis ) standardized extract, 250 - 500 mg daily, for antioxidant and immune effects. Use caffeine free products. You may also prepare teas from the leaf of this herb.
• Milk thistle ( Silybum marianum ) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.

Homeopathy

An experienced homeopath could prescribe a regimen for treating glaucoma that is designed especially for you. Acute dose is three to five pellets of 12X to 30 C every 1 - 4 hours until symptoms are relieved. Some of the most common acute remedies are listed below.

• Phosphorus for vertigo
• Physostigma for muscle spasms and neurological problems
• Spigelia for sharp pains

Prognosis/Possible Complications

If glaucoma is not treated early, some vision loss can occur. If you have glaucoma in one eye, your provider may recommend treating your other eye as well, since it is at risk for the same disease process.

Supporting Research

Bartlett H, Eperjesi F. An ideal ocular nutritional supplement? O phthalmic Physiol Opt . 2004;24(4):339-49.

Bast A, Haenen GR. Lipoic acid: a multifunctional antioxidant. Biofactors . 2003;17(1-4):207-13.

Behrman RE, ed. Nelson Textbook of Pediatrics . 15 ^th ed. Philadelphia, PA: W.B. Saunders; 1996.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr . 2006;25(2):79-99.

Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine . 20 ^th ed. Philadelphia, PA: W.B. Saunders; 1996.

Dambro MR. Griffith's 5-Minute Clinical Consult . 1999 ed. Baltimore, MD: Lippincott Williams & Wilkins, Inc.; 1999.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine . 14 ^th ed. New York, NY: McGraw-Hill; 1998.

Fontani G, Corradeschi F, Felici A, et al. Cognitive and physiological effects of Omega-3 polyunsaturated fatty acid supplementation in healthy subjects. Eur J Clin Invest. 2005;35(11):691-9.

Gaby AR. The role of coenzyme Q10 in clinical medicine: Part 1. Alt Med Rev . 1996; 1(1):11-17.

Goroll AH, ed. Primary Care Medicin e. 3 ^rd ed. Philadelphia, PA: Lippincott-Raven Publishers; 1995.

Gruenwald J, Brendler T, et al, eds. PDR for Herbal Medicines . Montvale, NJ: Medical Economics Company; 1998: 1030.

Ivers RQ, Cumming RG, Mitchell P. Visual impairment and falls in older adults: the Blue Mountains eye study. J Am Geriatrics Soc . 1998; 46(1).

Head KA. Natural therapies for ocular disorders, part two: cataracts and glaucoma. Altern Med Rev. 2001;6(2):141-66.

Kang JH, Pasquale LR, Willett W, et al. Antioxidant intake and primary open-angle glaucoma: a prospective study. Am J Epidemiol . 2003;158(4):337-46.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms . Albany, Calif: Hahnemann Clinic Publishing; 1993.

Pandi-Perumal SR, Srinivasan V, Maestroni GJ, et al., Melatonin. FEBS J. 2006;273(13):2813-38.

Rakel RE, ed. Co nn's Current Therapy . 50 ^th ed. Philadelphia, PA: W.B. Saunders; 1998.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin . 2001;17(1):239-47.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr . 2002;21(6):495-505.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J . 2005;46(5):585-96.

U.S. Preventive Services Task Force. Guidelines from Guide to Preventive Services . 2 ^nd ed. 1996.

Werbach M. Nutritional Influences on Illness . New Canaan, Conn: Keats Publishing; 1988: 202-203.

West AL, Oren GA, Moroi SE. Evidence for the use of nutritional supplements and herbal medicines in common eye diseases. Am J Ophthalmol . 2006;141(1):157-66.

• Review Date: 8/6/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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