Glaucoma

Glaucoma actually represents many different diseases, affecting all age groups from newborns to the elderly. It can be very painful or can progress without any symptoms. Glaucoma is a major cause of irreversible blindness. Glaucoma is often associated with high pressure in the eyes, however a high percentage of people with glaucoma have normal or even low pressure. Ultimately, the final cause of vision loss in each type of glaucoma is an inability to get the needed nutrients to the cells of the retina and optic nerve, as well as to remove metabolic wastes and any other toxins that may be present in these tissues of the central nervous system.

Medical and surgical control of intraocular pressure is sometimes necessary and should be utilized when less invasive means of management are insufficient by themselves. Drugs and surgery appear to suppress glaucoma damage only for a limited time for each individual. Drugs and surgery do not correct or eliminate the causes of disease, which are often individual and multifactorial. Learning more about your biochemical individuality and how to be a good steward of your body are necessary in order to achieve your optimum potential for health and longevity.

As many as 15 million Americans may have glaucoma, of which 1.6 million already suffer some loss of vision, and over a quarter million are blinded by it in at least one eye. The cost is over $2.5 billion each year, mostly for medical and surgical care, including over 7 million office visits. With the aging of our population, these figures are rapidly increasing, despite the fact that 50% of glaucoma continues to go undiagnosed. Even in diagnosed cases, 70% of the vision loss occurs prior to diagnosis, despite the fact that 47% have been examined by an ophthalmologist or optometrist within one year prior to diagnosis. Loss of optic nerve fibers occurs well before any change can be detected in visual fields. With increased use of general practitioners as gate-keepers in managed care, this situation may worsen, since 78.4% of primary care practitioners falsely believe intraocular pressure (IOP) is the only diagnostic indicator of glaucoma. In truth, most people with elevated IOP, an estimated 7 million Americans, have ocular hypertension, 80% of whom never develop detectable signs of glaucoma, though they do lose 25 to 40% of the 1,200,000 nerve cells in the optic nerve. At the same time, 60% of those with glaucoma have normal or even low pressure in the eye. Glaucoma can occur at pressures as low as 12, while the optic nerve can sustain pressures as high as 24 without damage. The common category of low tension glaucoma, which can be associated with hypertension, diabetes, migraines, cold extremities, and heart disease, is thought to be caused by vasoconstriction, and 30% of cases appear to show optic nerve damage from systemic causes including anemia, heart disease, and hypertension. Glaucoma is actually a constellation of collagen-vascular diseases (i.e. connective tissue and blood vessel conditions related to processes like rheumatoid arthritis and atherosclerosis) which cause similar types of peripheral vision loss. The Cardiovascular Health Center at Harvard concludes that non-pharmacological approaches to cardiovascular diseases should be the first method of treatment by physicians. About 90% of glaucoma cases are of the insidious primary open-angle type involving constricted blood flow and nutrition to the optic nerve with either normal (15 to 21 mm Hg) or elevated pressure (over 21 mm Hg). About 10% consist of low pressure (less than 15 mm Hg) glaucoma, which also involves decreased ocular blood flow. More rare types of glaucoma include the typically painful but periodic acute angle-closure type as well as pigmentary, inflammatory and congenital glaucomas. Together, the glaucomas represent the second greatest cause of blindness in America, with 70,000 affected to the point of blindness. What these conditions have in common is not elevated intraocular pressure (IOP), but morphological changes in the collagen structure of the lamina cribrosa (the part of the sclera or white connective tissue layer of the eye through which the optic nerve passes), the papillary blood vessels (which provide nutrition to the papilla, or optic nerve head, where it passes through the lamina cribrosa), and the trabecular meshwork (the filter through which the eye fluid, or aqueous humor, passes to reach Schlemm’s canal, the drainage channel which removes fluid from the eye and delivers it back into the blood vessels). Even in glaucoma cases where pressure does become elevated, causing further risk of damaging the optic nerve fibers (axons), these connective tissue changes precede the changes in IOP. In most cases of glaucoma, vision loss occurs with these microstructural changes even without an increase in IOP. Glaucoma may be an extension of myopia (nearsightedness, involving stretching of the sclera), which occurs when the elastic limit of the sclera is exceeded by the intraocular pressure, thus causing expansion at the optic nerve (a change in shape called “cupping”) with resulting loss of vascular flow and neuronal function. Both glaucoma and myopia are associated with other collagen disorders, including Ehlers-Danlos syndrome, Marfan’s syndrome, and osteogenesis imperfecta.

One study of the systemic health of glaucoma patients found that 30% had low tension glaucoma, 42% had high tension glaucoma and 28% had identifiable systemic causes including anemia, carotid obstruction, syphilis, and intracranial tumor.

Large diurnal fluctuations in IOP during the day or over consecutive days, such as those associated with food sensitivities and allergies, are associated with an increased risk of glaucoma progression over and above more traditional risk factors such as age, race, and sex.

Asrani S, Zeimer R, Wilensky J, et al. Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma. J Glaucoma. 2000;9:134-42.

Diurnal pressures of normal subjects vary by only 3.7 mm Hg, while medically treated glaucoma patients still show 7.6 mm Hg variation compared to untreated patients with 11 mm Hg variation.

Drance SM. Diurnal variation of intraocular pressure in treated glaucoma: significance in patients with chronic simple glaucoma. Arch Ophth. 1963;70:302-11. Drance SM. The significance of diurnal tension variation in normal and glaucomatous eyes. Arch Ophth. 1960;64:494-501.

The Advanced Glaucoma Intervention Study found that patients whose pressure was 18 mm Hg or lower at every visit over 6 years had almost no progressive visual field loss.

The AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol 2000;130(4):429-40.

In a more recent study, medical patients with a low daily IOP variance as well as low minimum and maximum IOP had the lowest probability of developing a new visual field defect over a 5-year period. Subjects treated with Travatan (PGF 2 derivative) had the lowest average IOP and the lowest variance as compared with the other treatment groups.

Nordmann JP, LePen C, Berdeaux G. Estimating the long-term visual field consequences of average daily intraocular pressure and variance. Clin Drug Invest 23(7):431-438. 2003.

Regulating intra-cellular communication via prostaglandins has demonstrated superior diurnal IOP control over all other glaucoma medications. Coleus forskohlii also regulates intra-cellular communication via c-AMP which mediates most of the effects of prostaglandin PGE 2 (see chart).

PG Endogenous Physiologic Signaling

Receptor Eicosanoid Actions Pathway

Ligand

DP PGD 2 PGD 2 Increased Ca++ via PLC stimulation

EP 1 PGE 2 PGE 2 Increased Ca++ via PLC stimulation

EP 2 PGE 2 PGE 2 Increased cAMP via AC stimulation

EP 3 PGE 2 PGE 2 Decreased cAMP via AC inhibition

EP 4 PGE 2 PGE 2 Increased cAMP via AC stimulation

FP PGF 2 PGF 2 Increased Ca++ via PLC stimulation

IP PGI 2 PGI 2 Increased Ca++ via PLC stimulation

TP TxA 2 TxA 2 Increased Ca++ via PLC stimulation

Eicosanoid Precursors Analogs

Local Physiologic Actions

PGD 3 Omega-3: EPA, DHA –

Lower IOP without

and plant precursors inflammatory effects

(rabbit)

PGE 2 Arachidonic acid latanoprost (Xalatan), Stimulates hyperalgesic

(high in modern diet) travoprost (Travatan), response (sensitize to pain)

bimatoprost (Lumigan) Lowers IOP

and unoprostone Promotes inflammation

isopropyl (Rescula)

PGE 3 Omega-3: EPA, DHA – Lower IOP without

and plant precursors inflammatory effects

(rabbit)

PGF 2 – Forskolin Lower IOP

(Coleus forskohlii) Inhibits inflammation

Most anti-inflammatory drug therapies try to block pro-inflammatory physiological pathways. Prednisone, which can cause glaucoma, is used in high doses to block the liberation of arachidonic acid, the precursor of the pro-inflammatory prostaglandins. This can often be more safely achieved with supplementation of the safer steroids DHEA (or 7-Keto) or its precursor pregnenolone, as well as immune-modulating plant-analog phytosterols. Drugs that inhibit prostaglandin synthesis by blocking enzymes that convert arachidonic acid to prostaglandins include aspirin, NSAIDs, and acetaminophen. In contrast, EPA provides a substrate for the anti-aggregatory, anti-inflammatory, and vasodilating prostaglandin -3 series. Other effective alternatives for relief of pain and inflammation include a highly absorbable water-soluble quercetin (Pain Guard forte’).

Studies on omega-3 fatty acid metabolism show:

1.

PGE3 and PGD3 lowered intraocular pressure without causing ocular inflammation in rabbit

2.

some surveys demonstrated that in Greenland Eskimos whose marine diet is enriched with omega-3 substrate eicosapentaenoic acid, have a lower incidence of open-angle glaucoma as compared to Caucasians, whose diet is rich in arachidonic acid.

The anterior uvea synthesizes PGE3 and PGD3 in human, monkey, and rabbit and may play a role in lowering intraocular pressure.

Cyclooxygenase and lipoxygenase pathways in anterior uvea and conjunctiva.

Kulkarni PS, Srinivasan BD. Kentucky Lions Eye Research Institute School of Medicine, University of Louisville 40202. Prog Clin Biol Res 1989;312:39-52.

Lewith, G., Kenyon, J., Lewis, P. Complementary Medicine: An Integrated Approach 1996, pp. 108-9. New York: Oxford University Press.

Plant sources such as flaxseed, hemp seed, chia seed, and walnut provide the precursor Omega-3 fatty acid: Alpha-linolenic acid that the human body converts, though inefficiently, to the longer chain EPA and DHA fatty acids needed for anti-inflammatory prostaglandin formation, neuro-visual development, and performance (e.g. DHA for visual acuity) and other cellular needs. Soy and rapeseed (Canola from Canadian Oil Company) also contain ALA but are not recommended as sources by Remission Foundation. DHA is the #1 fatty acid in the central nervous system. Fish oils contain the Omega-3 fatty acids in their physiologically active EPA and DHA forms for health benefits as immediate PG3 prostaglandin precursors, saving the time and energy of the inefficient enzymatic steps necessary to process Alpha-linolenic acid into the biologically active forms. In many health situations, these enzyme pathways limit the quantity of eicosanoids the body can produce too much less than the levels requisite for optimal health and performance. Nutrients required for the anti-inflammatory EFA pathways to function include:

• essential fatty acids (omega-3 and omega-6, in balance)
• zinc
• magnesium
• pyroxidine (vitamin B6) or its active form P5P
• niacin (vitamin B3)
• ascorbic acid (vitamin C)
• Enzymes: delta-6-desaturase, delta-5-desaturase, elongase, cyclo-oxygenase and oxygenase convert alpha-linolenic acid into the beneficial, anti-inflammatory PGE3 series prostaglandins (see chart).

Omega-3 Pathway:

Substrate + Enzyme + Cofactors = Product

Omega-3: delta-6 desaturase B6, Mg, Zn Stearidonic Acid

Alpha-linolenic Acid

(LNA)

Stearidonic Acid elongase – Eicosatetraenoic Acid

Eicosatetraenoic Acid delta-5-desaturase B3, C, Zn Eicosapentaenoic Acid

(EPA)

Eicosapentaenoic Acid cyclo-oxygenase blocked by COX PGE-3

(EPA) (COX) inhibiting drugs

Eicosapentaenoic Acid Lipoxygenase pathway promoted less inflammatory

(EPA) by COX inhibiting Leukotrienes

drugs

Omega-6 Pathway:

Substrate + Enzyme + Cofactors = Product

Linoleic Acid (LA) delta-6-desaturase B6, Mg, Zn Gamma Linolenic Acid

(GLA)

Gamma Linolenic Acid elongase – Dihomogamma Linolenic

(GLA) Acid (DGLA)

Dihomogamma Linolenic delta-5-desaturase B3, C, Zn preferred pathway to

Acid (DGLA) (prefers Omega-3 anti-inflammatory

oils) Series 1 Prostaglandins:

PGE1, or with Omega-3

deficiency: Arachidonic

Acid (AA)

Arachidonic Acid (AA) cyclo-oxygenase blocked by inflammatory Series 2

(COX) COX inhibiting Prostaglandins

drugs

Several investigators have demonstrated that PGE 2 and PGF 2 alpha in low doses, lower intraocular pressure in all species studied, including humans, but while PGF 2 promotes inflammation that could aggravate glaucoma, PGE 2 has anti-inflammatory effects.

PGF 2 derivatives are used to medically lower IOP by affecting the FP receptor. These include latanoprost (Xalatan), travoprost (Travatan), bimatoprost (Lumigan) and unoprostone isopropyl (Rescula). Forskolin (Colforsin) works on the complementary IOP-lowering but anti-inflammatory PGE 2 pathway via the cAMP-mediated EP 2, EP 3 and EP 4 receptors.

A rational beginning approach to glaucoma prevention therapy is to monitor IOP regularly at several times of day using the home eye pressure monitor while following a rotation diet to identify and eliminate food triggers of IOP elevation spikes and supplementing with oral Forskolin, Omega-3 fatty acids: EPA & DHA plus other IOP regulating (e.g. Melatonin at night for morning pressure spikes) and neuroprotective supplements, especially L-Carnosine, as indicated clinically and/or by resonance matching using energetic biofeedback. Drinking microwater and rebounding are also central to a balanced anti-glaucoma lifestyle. The target IOP is a daily maximum of 15 to 18 with a diurnal variability of up to 3 mm Hg.

In the same embryonic tissue layer as the connective tissue is the circulatory system. Circulation, both lymphatic and vascular, seems to be a real key to understanding and preventing glaucoma. When looking at circulatory patterns among glaucoma patients, two types of problems emerge. In one group, there is vasoconstriction, causing symptoms like cold hands. In the second distinct group, the problems relate to blood clotting, resulting in symtoms like electrocardiogram (ECG) abnormalities. The risk factors that affect glaucoma are generally those associated with vascular problems, including hypertension, hypotension, migraine, increased blood viscosity, carotid artery stenosis, heart disease, and even a familial tendency, which is true of vascular disease in general. Vascular abnormalities have been confirmed in every type of glaucoma via Doppler ultrasound. Optic disc hemorrhages are commonly seen several years before glaucoma is diagnosed, and they undoubtedly occur but go undetected in many additional cases. Dilated and tortuous retinal blood vessels are also frequently seen in the retina, and these have been linked to coronary artery disease.

Loss of optic nerve fibers is directly related to decreased pumping ability of the heart. Severe loss of visual fields is seen in 42% of glaucoma patients, but 70% of those with atrial fibrillation have severe losses. Atrial fibrillation is also twice as likely among glaucoma patients as compared to normals. Decreased blood flow to the eyes causes structural changes over time that result in increased IOP. Glaucoma patients have narrowed retinal blood vessels compared to normals. Thermography, such as used in the new field of Ophthermology, shows that 89% of glaucoma patients have cerebral vascular disease! Computed tomography (CT) has shown that 90.3% of low tension glaucoma patients have calcification of the carotid artery near the opening of the optic canal, as compared to only 20.8% of individuals the same age, but without glaucoma. Magnetic resonance imaging (MRI) shows deep white matter lesions in the brain in low tension glaucoma patients, another effect of reduced cranial blood flow. Low tension glaucoma is also associated with peripheral and central vasoconstriction (e.g. migraine) and spontaneous blood clots. Blood clot formation is more common in glaucoma patients compared to those with ocular hypertension, and low tension glaucoma patients show higher blood viscosity than those with high tension glaucoma. Blood flow measurements taken in the fingers of low tension glaucoma patients shows rates significantly below normal. 44% of low tension glaucoma patients suffer classic migraine symptoms and in elderly sufferers of low-pressure glaucoma, this figure can be as high as 86%. Silent heart attacks (myocardial ischemia) are found in 3% of ‘normal’ adults, but one study found 30.8% in low tension glaucoma patients in a 24 hour period, which was double the rate found in both normal subjects and chronic open-angle glaucoma. Stenosis of the carotid artery can be an underlying cause of symptoms diagnosable as glaucoma, and restoring carotid blood flow can temporarily increase and then normalize IOP. Increased blood viscosity (hematocrit above 50) is often found in glaucoma patients. This can impair blood flow when combined with elevated IOP.

Drugs and Surgery

Medical and surgical treatments are actually aimed at lowering IOP rather than improving the underlying collagen metabolism. Among individuals with ocular hypertension (elevated IOP), only those who also show cupping appear to be at risk for visual field loss. Reversal of cupping changes is sometimes seen with filtering “bleb” surgery but has not been shown with medical treatments. According to an extensive review of the medical literature, a 30% reduction in IOP is needed to reverse cupping, and this is why the IOP reduction from most medications is not clinically significant in changing the rate of progression of vision loss in glaucoma. Beta-blocker eye drops can reduce IOP somewhat (6 mm Hg, preventing further loss of peripheral vision for 3 to 6 years), but do not improve blood flow to the eyes. Medical treatment even fails to control IOP in most cases (53%) of glaucoma within just 4 years. Laser surgery fails to control IOP in 23% the first year and 70% after just 10 years. Over 50% have to take drugs treatments in addition after just 2 years. Glaucoma itself increases the risk of cataracts by 2.9 times, but when surgery is added, this jumps to 14.3 times increased risk.

Side effects of glaucoma drugs are a real problem, causing up to 62% to fail to follow the recommended treatment. Beta-blocker drops commonly cause side effects including: low blood pressure, confusion, depression, dizziness, headache, impotence, hair loss, skin and nail changes, diarrhea, nausea, asthma, breathing difficulty, and increased LDL cholesterol. On average, glaucoma patients ‘forget’ to take their medication on 112 days each year. Patient surveys show that 30% experience side effects like changes in heart rhythm, congestive heart failure, and difficulty breathing. Hundreds actually die each year from respiratory problems caused by glaucoma drugs. One study also shows that 80% of glaucoma patients on beta-blocker drugs experience depression, compared to only 26% of patients with serious eye problems who do not take these drugs. Beta-blocker eye drops used for glaucoma have other serious implications for body chemistry. Timoptic, for example, reduces ‘good’ HDL cholesterol, while increasing ‘bad’ LDL cholesterol, enough to increase the risk of heart attack by 17%. Since heart attacks cause about half of all deaths in this country, this increased risk represents a major problem. When beta blockers fail to control IOP, treatment with other drugs with even worse side effects may be considered, such as carbonic anhydrase inhibitors (e.g. acetazolamide), which, although they can increase blood flow to the retina, cause kidney problems, fatigue, lethargy, anorexia, weight loss, depression, dementia, loss of libido, and occasionally aplastic anemia. Drug treatment decisions are often based on visual field tests which accurately show the progression of the disease only 43% of the time.

Many types of medical therapy can actually cause glaucoma. Corticosteroids in the form of eye drops, creams, pills, inhalers and injections are a common trigger, since these drugs polymerize molecules in the drainage system of the eye, while inhibiting the formation and repair of collagen and glycosaminoglycans necessary for maintaining normal structure and function of both the eye’s lamina cribrosa and the trabecular meshwork. Steroidal eye drops, for example, increase glaucoma risk seven-fold. There is no safe level of corticosteroid use and even stopping or changing medication once IOP elevation occurs does not always solve the problem, since up to a third of these cases of induced glaucoma are irreversible with standard medical/surgical treatment leaving permanent damage to the optic nerve. Even creams for eczema and inhalers (with over 8 million annual prescriptions in America alone) can cause increased IOP. Corticosteroids increase oxidative stress which impairs the phagocytic (debris clearing) ability of cells in the eye’s drainage system.

Many over-the-counter drugs can trigger acute attacks of glaucoma in susceptible individuals. Optic nerve atrophy can be caused by drugs that chelate metal ions like zinc (e.g. diodohydroxyquin, iodochlorhydroxyquin, and ethambutol), and zinc supplementation has been recommended preventively for all patients on such medications. Optic nerve toxicity is also known to occur with aspirin, ibuprofen, tranquilizers, antidepressants (e.g. lithium, MAO inhibitors), antibiotics (e.g. chloramphenicol, isoniazide, ethambutol), and medications for diabetes. Visual defects caused by this kind of toxicity are usually attributed to other causes, such as glaucoma. Even the preservatives used in many eye drops, including most glaucoma medications, may trigger chronic inflammation of the eye that can worsen glaucoma. Benzalkonium chloride used to preserve Timoptic, Betoptic, Optipranolol, and Ocupress anti-glaucoma drops increases dry eye symptoms by 250%. Merck manufactures an unpreserved beta blocker eye drop called OcuDose. While unpreserved ‘artificial tear’ eye drops used for temporary eye lubrication reduce the permeability of the corneal surface of the eye by 44%, those preserved with benzalkonium chloride actually increase this leakiness by 8%, disrupting the epithelial cell membrane that protects the integrity of the eye. The concentrations used, from .4 to 1 part per thousand (equivalent to a 3X homeopathic potency) are toxic to the cornea and, through accumulation in body tissues over time, have even been documented cause such severe corneal toxicity as to require a corneal transplant. Preservatives such as benzalkonium chloride and thimerisol used in contact lens solutions can also accummulate to toxic levels within soft contact lenses themselves, thus exposing the cornea whenever wearing the lens. The chronic inflammation and allergy responses triggered by such toxic chemicals can result in the deposition of inflammatory proteins in the drainage system of the eye, thus increasing IOP and contributing to the risk for glaucoma. Inflammation in the eye area may also reduce the quality of blood and lymph drainage from the eye, which can also impair outflow of fluid from inside the eye. It also increases free radical activity, which is probably the ultimate cause of damage to nerve cells in glaucoma.

Glaucoma is not only associated with hypertension, but also with hypotension. Anti-hypertensive medications may compound this problem, often triggering low blood pressures during sleep. This may deprive the optic nerve head of needed oxygen, resulting in loss of visual fields. Cardiac events also double at diastolic pressures of 75 comparted to 85 mm Hg. At systolic pressures below 140 mm Hg, glaucoma patients show 4 times the rate of visual field deterioration. Most glaucoma patients who progressively lose vision have blood platelets that tend to clump together spontaneously.

Many drugs can also precipitate an angle-closure glaucoma attack. These include motion sickness patches and antihistamines.

Other Risk Factors

The most significant controllable risk factors according to one report are untreated hypertension and cigarette smoking. Other major risk factors include free radical damage associated with aging, reduced health, hypotension, lack of exercise, poor nutrition, diabetes and other vascular diseases, as well as allergies and digestive problems. Other toxins that damage the optic nerve may be contributing factors in the loss of vision among glaucoma sufferers. These include tobacco, aspartame, methyl alcohol, factors present in blood transfusion tea, coffee, and alcohol.

Coffee may increase cholesterol, resulting in reduced circulation to eye tissues, unless it is passed through a paper filter before consumption. While caffeine does not increase IOP, it does promote vasospasms which can contribute to glaucomatous vision loss. It can also destabilize blood sugar, which is detrimental to nerve cell health. Coffee also impairs B12 absorption and destroys beneficial bacterial flora.

While some studies have found little relationship between smoking and glaucoma, one study showed a 2.9 times increased risk! Smoking constricts the internal lumen diameter of blood vessels and blocks the ability of vessels to redilate. After smoking a cigarette, vasoconstriction causes IOP to increase by more than 5 mm Hg in 37% of glaucoma patients and 11% of normals. Tobacco by itself can cause vision loss (tobacco amblyopia) as can alcohol (alcohol amblyopia), and can also contribute to nutritional deficiencies related to vision loss, by interfering with gastric production of hydrochloric acid and therefore preventing effective digestion and assimilation of many nutrients including vitamin B12. In some cases, supplemental vitamin B12 has reversed vision loss even despite continued smoking. Nicotine reduces retinal blood flow by 9.6 to 16.4% in diabetics who are at high risk for glaucoma as well as diabetic retinopathy. It is recommended that anyone who uses alcohol or tobacco should supplement at least 1500 to 3000 micrograms of vitamin B12, glutathione precursors such as cysteine and 600 I.U. of vitamin E to counteract the toxic effects of cyanide in the optic nerve as well as 1000 micrograms of folic acid. Folic acid has also been shown to improve visual acuity in smokers with optic neuropathy, with an average increase of 5 lines of visual acuity over a 2 month period! Supplementation of 300 milligrams of vitamin B1 weekly for 3 months by intramuscular injection (together with 1,000 micrograms of B12) has also been recommended for tobacco amblyopia.

Nicotine, LDL cholesterol and free radicals block acetylcholine receptors, increasing the tendency toward vasospasm. By lowering harmful LDL cholesterol levels (e.g. with GTF chromium, garlic, vitamin C, onions, almonds, olive oil, fish oil, grape seed oil, and avocado) and taking antioxidants (including vitamin E and coenzyme Q10), vasomotor relaxation to acetylcholine has been improved, with measurable increases in coronary artery diameter. This may also improve the ability of blood vessels to dilate in response to seratonin and aggregating platelets. , Cigarette smoking is one of the major risk factors for glaucoma, along with hypertension (especially systolic), obesity and the amount of pigmentation in the iris. Blacks, having the greatest amount of pigmentation, have four times the risk of glaucoma and 8 times the risk of blindness from glaucoma compared to whites.

Familial patterns are often strong, as well, in all races, with relatives of a glaucoma victim 20 times more likely to get glaucoma themselves. This can be from hard-wired genetic patterns as well as from miasmatic inheritance which can eventually be removed through homeopathy. Environmental factors are also very important, and have been found to play a strong role in exfoliation of the lens which can cause ocular hypertension and triples the risk of glaucoma. Such environmental effects are probably mediated via free radical pathology.

Obesity affects one out of three adults, the average weight having increased by 8 pounds between 1980 and 1991 to an average of 25 (female) to 30 pounds (male) overweight. Obesity increases blood pressure and secretion of adrenal hormones. In Japan, with the highest longevity in the world, overweight is not the norm, and IOP actually tends to decrease with age, the opposite of what is seen in America. In America, 8% of people over age 40 have increased IOP, and the rate of glaucoma climbs from 0.25% at age 20 to 1% at age 40 to 7% at age 70.

Lack of oxygen to the tissues in the eye can trigger neovascularization, which in turn can cause glaucoma. Antiangioneogenesis factors present in shark and bovine cartilage may be beneficial in controlling or modulating this type of response. Oxygen therapies may also be helpful, along with antioxidants and modalities to increase ocular blood flow, such as ginkgo.

Release of histamine and other pro-inflammatory substances seems to be a significant factor especially in low-tension glaucoma. 30% of low-tension glaucoma patients have immune-related problems, compared to only 8% of those with ocular hypertension.

Laser treatments seem to be even less successful in glaucoma than are drugs. Laser may be most effective when used before any drug therapy is started, but most who have laser first still need drug treatment within 2 years. Surgery on the other hand is capable of increasing blood flow to the eye by 29%, but only in those who have not already started drug treatments. Surgery appears to have more potential benefits than conventional drug therapy in at least temporarily slowing the damage caused by glaucoma 3 to 6 times more effectively than laser or drugs, although not universally, nor without significant risks. Surgery is not effective at slowing the progression of glaucoma in the majority of cases represented by low pressure glaucoma. Also, 15% of glaucoma surgery patients report a reduced quality of life following surgery, and 40% find no perceptible improvement. Surgery also needs to be repeated in many cases. Surgery of any kind is by definition controlled damage to the body, and such an invasive approach should be reserved whenever time permits until non-invasive methods have been exhausted. This follows the physician’s oath “Primum non nocere,” to above all do no harm.

The actual damage to nerve cells in the optic nerve, resulting in loss of vision, appears to be associated with hemorrhages of the blood vessels in the optic nerve head and related loss of cellular nutrition combined with free radical activity. Similar damage to the cells of the optic nerve is now known to occur during migraine headaches, when blood vessels constrict the flow of oxygen and other nutrients to the cells. The risk of developing measurable damage to the optic nerve goes up with increased IOP levels, from 15% at 24 mm Hg to 90% at 30 mm Hg, and nearly 100% at 33 mm Hg. Patients with healthy optic nerves and no peripheral vision loss can sustain pressures of 30 for up to 20 years without losing sight. Unfortunately, approximately 50% of the nerve cells in the optic nerve are lost before glaucomatous changes in the visual fields can be detected in an eye examination. This loss of nerve cells happens 2 to 6 years before changes show up on peripheral vision tests. Intervention in the presence of ocular hypertension and other risk factors has been shown to reduce the loss of peripheral vision and optic nerve health. Prevention, and especially non-toxic preventive approaches to therapy are critically important for anyone at risk, as well as those already showing damage. At best, conventional medical and surgical interventions attempt to check the advance of this progressive degenerative condition, but in many cases, blindness still is the final result. The following complimentary modalities should not be overlooked by the doctor and patient seeking the best long term outcome.

Water & Biological Terrain

In most cases, glaucoma is a chronic degenerative condition, resulting from Phase 1 conditions in the brain, eye and optic nerve area. This is also the terrain for viral conditions, and an association is seen with 28% of patients who have herpes eye infections experiencing secondary glaucoma. Phase 1 terrain is excessively oxidized, resulting in oxidation of circulating LDL cholesterol which deposits and hardens on the inner lining of the blood vessels, impairing their ability to dilate normally, thus restricting circulation. The retina of the eye has the highest oxygen demand of any tissue in the body, with local hypoxia or ischemia in the nerve fibers of the retina and optic nerve leading to further free radical activity. Lipid peroxidation can be especially destructive in the optic nerve area with its myelinated nerve fibers containing a high concentration of fatty acids which can produce a chain reaction of reactive oxygen species. It is also known that lipid peroxidation occurs in the degeneration of cells in the anterior chamber angle that drains the fluid from the eye.

Phase 1 terrain is also characterized by excessive alkalinity in the veinous blood. This is primarily due to a blocked and inefficient cellular energy metabolism, resulting in lack of acid metabolic wastes such as carbonic acid. Steroid eye drops, for example, induce a Phase 1 terrain in the eye. It has been shown that they alkalize the aqueous humor in proportion to the rise in IOP, while at the same time depleting antioxidant defences. Vitamin C levels fall by 50 to 80% throughout the eye. Thus circulation, oxygenation and cellular respiration in addition to antioxidant protection (especially the fat-soluble antioxidants) are critical components to provide the physiological system if it is to mount a successful remission from this Phase 1 terrain.

Drinking a lot of fluids all at once can temporarily raise IOP by as much as 30%. This does not mean glaucoma patients should drink less water. Drinking 8 ounces per hour, or better yet, about 4 ounces of good water every half hour on the other hand, increases lymph flow and detoxification. Hypertension and ocular hypertension are linked, and both may be significantly related to chronic dehydration. Chronic dehydration, resulting in increased blood viscosity, can be caused by diuretics, or simply the Standard American Diet (SAD) which includes more soda than water. Increased IOP has also been associated with constipation, which is closely linked to fluid metabolism. After about 3 days of regular consumption of water, the kidneys are able to readapt and increase the efficiency of their filtration of the blood as well. The best water is that which is filtered to remove unwanted chemicals, such as heavy metals, chlorine, fluoride and pesticide residues, and then ionized. Bio-electronics of Vincent (BEV) quality filtration can be achieved by a multi-stage filter system incorporating reverse osmosis with other water purification technologies. Ionization by electrolysis imparts a negative charge which provides the most effective biocompatible anti-oxidant known. It also restructures the water, reducing the average molecular cluster size from about 16 to about 8 water molecules according to NMR studies, resulting in a 10-fold increase in penetration into the lymphatic system and even the intracellular spaces. This water, a better solvent than tap water, increases nutrient absorption and utilization, while also enhancing elimination of metabolic wastes and other toxins from tissue stores. The alkaline-reduced water that is used for drinking and cooking accelerates the body’s healing process which initially involves the re-establishment of efficient mitochondrial aerobic metabolism followed by the shift from Phase 1 to Phase 2 terrain. This water releases oxygen specifically to those tissues which are eliminating toxins, including the toxins which are released in unblocking mitochondrial electron transport chain enzymes.

(see also: Feldman RM, Steinmann WC, Spaeth GL, et al: Effects of altered daily fluid intake on intraocular pressure in glaucoma patients. Glaucoma 1987;9:118-121.)

Osmotic agents like vitamin C, glycerine, and salt decrease IOP by pulling fluid from the eyes. They also increase biological energy (measured in microwatts) in the blood, shifting terrain away from Phase 1 which is the low energy zone where glaucoma is most prevalent.

High body temperature, characteristic of Phase 2 terrain (e.g. associated with bacterial infection, healing crisis and spontaneous remission), is related to a temporary increase in IOP. This can, however, if not suppressed by anti-biotics or antipyretics like aspirin, lead to resolution of the internal causes of the problem, followed by remission from the disease. If there is damage to the myelin sheath of the optic nerve fibers, as in MS, increased body temperature from exercise or a hot bath can temporarily worsen visual fields.

Complementary medicine is used by many glaucoma patients. (Rhee DJ, Spaeth GL, Terebuh A, Myers JS, Augsburger JJ, Shatz L, Ritner JA, Katz LJ. Prevalence of the use of complementary & alternative medicine (CAM) for glaucoma. Ophthalmology 2002;109:438-443.)

Nutrition in Glaucoma

The first step in developing a good balanced foundation for your nutritional program is to begin with a broad spectrum multi-vitamin and mineral supplement. A multiple to be used by someone with glaucoma should have both vitamin A and beta carotene according to some doctors. Rapid and sustained pressure reductions of 5 to 7 mm Hg have been achieved in studies using improved diet with supplementation of nutrients including vitamins A, B1, B2, B3, B5, and calcium, which is better than results achieved with current medical therapy. , Malnutrition and malabsorption syndromes should also be ruled out or treated, as they may contribute to optic nerve damage and susceptibility. Glaucoma in a malnourished population was brought under control within one week with the antioxidants 180,000 I.U./day of vitamin A, 200 I.U./day of vitamin E and 3,000 mg/day of vitamin C.

Vitamin A and carotenoids

Vitamin A deficiency has been observed in the glaucoma population. Blood levels of carotenoids (pro-vitamin A) are lower in people with glaucoma than in normals. Vitamin A is necessary to prevent hydration and swelling of the collagen in the drainage angle of the eye, which can block outflow. Loss of xanthophyll carotenoids in the papillo-macular area is the first detectable indication of loss of optic nerve fibers in glaucoma. Some practitioners recommend 25,000 IU/day of natural source beta carotene or a combination of vitamin A and beta carotene (pro-vitamin A) along with 400 IU/day of either dry or mixed tocopherol vitamin E. Beta carotene dosages up to 30 mg/day have been suggested as safe by the Alliance for Aging Research. Others recommend up to 40,000 IU/day of beta carotene.

Vitamin B Complex

The entire B complex, with specific emphasis on vitamins B1, B3, B5 B6, B12, folate, inositol and choline (or lecithin, as a source of choline) may be particularly helpful in glaucoma. A 50 mg B complex taken 3 times a day with meals is a good base, and in some cases B vitamin injections (preferably unpreserved) may be needed.

B1:

Thiamine (Vitamin B1) deficiency causes optic nerve disease and is depleted by stress. Optic atrophy linked to thiamine deficiency can be reversed in 10 days with large supplemental doses. Thiamine may be poorly absorbed and metabolized, or otherwise demanded at increased levels in glaucoma patients, as they usually have reduced blood levels despite normal dietary intake. This has been associated with lack of digestive enzymes resulting in malabsorption. A dosage of 25 to 50 mg a day has been recommended, except for smokers who should take 300 mg/day until vision improves.

B3:

Vitamin B3 cleans out the capillaries, reversing the effects of arteriosclerosis that contribute to glaucoma. B3 also dilates the capillaries, further improving blood flow to and from the eye and optic nerve. B3 raises ATP levels in depleted cells, raising their resistance to stressors like glutamate, which is associated with glaucoma.

B5:

Vitamin B5 (100 mg taken 3 times a day) helps to strengthen the adrenal glands.

B6:

Vitamin B6 decreases IOP by its diuretic effect. A dosage of 25 to 50 mg/day is recommended.

B12:

B12 may be preventive in low-tension glaucoma. Vitamin B12 deficiency, pernicious anemia, can by itself cause damage to the optic nerve. Over one million American seniors have pernicious anemia. The first sign of deficiency in over half of Vitamin B12 deprived animals is damage to the myelin sheath of the papillomacular bundle. In humans, too, B12 deficiency is linked to demyelinating processes like multiple sclerosis. Fortunately, resulting vision loss has been shown to be mostly reversible with B12 supplementation. B12 actually supports the regeneration of the myelin sheath. In humans, neurolgical damage including vision loss and optic atrophy are often seen before anemia is detected. Visual disorders associated with alcohol and tobacco clear up with Vitamin B12. Borderline B12 status may contribute to the susceptibility of the optic nerve to damage from other metabolic stress factors, and optic nerve damage from early B12 deficiency can precede any measurable changes in the blood. Pallor of the optic nerve head, considered a sign of glaucoma, is also a classic result of pernicious anemia. This is frequently accompanied by hypochlorhydria, leading to poor assimilation of many minerals and other glaucoma-preventive nutrients, and IOP may be either normal or increased. Over half of seniors lack adequate hydrochloric acid secretion to absorb B12 efficiently. B12 deficiency can cause nervous system-related symptoms including memory loss, confusion, dementia, depression and psychosis, all seen more frequently in the elderly. B12 deficiency is also accompanied frequently by photophobia and dependency on sunwear, as is deficiency of other B vitamins, as well as vitamin A and zinc. One 5 year study showed that 1500 mcg/day of vitamin B12 stopped the progression of visual field loss in glaucoma, and a significant percentage of patients actually had some vision restored. Since there was no change in eye pressure with B12 supplementation, different levels of B12, which can be stored in the body for years, may explain why some people can sustain higher pressures without damage to the optic nerve. Numerous studies confirm the beneficial effects of B12 supplementation on optic nerve disease. Supplementation may be especially beneficial when initiated within 6 months of the onset of visual symptoms. Coffee and aspirin are factors that impair vitamin B12 absorption. Zinc, which is necessary for production of hydrochloric acid, and digestive enzymes are recommended for some individuals to aid B12 absorption. A suggested dosage of 1500 to 2500 mcg/day of vitamin B12 has been proposed, as contrasted with the average adult intake of 5 mcg/day. Intramuscular injections may also be necessary initially for smokers and those with hypochlorhydria. Unpreserved injections are far preferable if they can be obtained. The hydroxycobalamin form has been shown to be effective when cyanocobalamin was not. The preferred form for reversing neurological conditions is Methylcobalamin.

Folate:

Folate may be preventive in low-tension glaucoma. Folate is high in raw, fresh salad vegetables such as asparagus, spinach leaves, garbanzo beans, and bean sprouts, as well as fresh, ripe, raw fruits. This means that it is important to find sources for locally grown organic produce since folate is the least stable and most often deficient of all vitamins in this country. 400 mcg/ day has been recommended, with 1000 mcg/day suggested for smokers.

Choline:

Choline (1,000 to 2,000 mg/day) cleans out the capillaries along with Vitamin B3, reversing the effects of arteriosclerosis that contribute to glaucoma. Others have recommended at least 100 mg/day.

Inositol:

Inositol is important in reducing the stress that can trigger increased IOP.

Vitamin C:

Vitamin C reduces intraocular pressure (IOP), according to research at the University of Rome. Daily intake of 35 grams in divided doses was used for patients weighing 150 pounds, with adjustments in this dosage proportional to body weight. Rapid and significant drops in pressure were obtained. A single dose of 500 mg/kg (about 35 grams for a 150 pound person) resulted significantly lowered IOP in 100% of patients, by an average of 16 mm Hg. Unfortunately, at such a high dosage, using the acid form of vitamin C causes diarrhea in may people, so neutral pH polyascorbate vitamin C is recommended by the author. Doses of up to 2 to 10 grams may be taken 4 times a day. Over 90% of patients given 100 to 150 mg/kg ascorbic acid 3 to 5 times a day achieved essentially normal IOP within 45 days, with GI symptoms only persisting for 3 to 4 days. Some of these patients had previously uncontrollable IOP even when taking maximum medical therapy. On the other end of the dosage spectrum, even low levels of vitamin C, such as 1200 mg/day have been shown to reduce IOP, when compared to a near RDA level of 75 mg/day, with a high level of statistical significance (p<.001). A study using .5 gm of ascorbic acid 4 times a day showed significant decreases in IOP after 6 days. Another study showed that .5 gm twice a day for 1 week significantly reduced IOP, which returned to the previous baseline level after 1 week off the vitamin C supplement. Even eye drops made of 10% ascorbic acid used 3 times a day for 3 days significantly lowered IOP of the treated eye compared to patients’ other untreated eye. Vitamin C is accepted as a treatment for glaucoma in European and Asian countries. One advantage of vitamin C over drugs therapies is that vitamin C not only lowers IOP through a combination of increased blood osmolarity, decreased aqueous production, and improved outflow, but it also provides antioxidant protection and enhances impaired collagen metabolism, which appears to be the primary cause of glaucoma. Vitamin C helps to regenerate type I collagen, laminin, and fibronectin in the trabecular meshwork. A month of topical steroid treatment lowers vitamin C levels by over 50% in the aqueous humor, over 60% in the vitreous humor and nearly 85% in the lens. Thousands of people get cataracts and/or glaucoma while on steroid therapies each year, yet few doctors recommend increased intakes of vitamin C for prevention. One author recommends at least 500 to 1000 mg/day of Vitamin C, and 2000 to 3000 mg/day for smokers.

see also: Feldman RM, Steinmann WC, Spaeth GL, et al: Oral ascorbic acid in the treatment of glaucoma. Glaucoma 1987;19(6):181-183.

Bioflavonoids:

Rutin, a bioflavonoid, supplemented at 60 mg/day in divided doses reduced IOP by at least 15% in 17 out of 26 eyes with uncomplicated primary glaucoma. These patients were also found to respond better to drug treatment following at least one month of rutin supplementation, as well. Some practitioners now recommend a dosage of 50 mg 3 times a day of Rutin. Mixed bioflavonoids should be taken at a dosage of 1,000 mg/day for all types of glaucoma. Bioflavonoids (which are also active components of herbs such as ginkgo and bilberry, in the herb section) have been shown to further reduce IOP in patients on miotic drops.

Quercetin inhibits histamine release. It also increases cyclic AMP, relaxing smooth muscle. It is also an effective oral chelation agent in removing excess iron that contributes to free radical pathology. Quercetin has been recommended at a dosage of 500 mg/day up to 3000 mg/day. Water-soluble quercetin, such as in Pain Guard Forte’, maximizes absorption.

Vitamin D:

Vitamin D may also be beneficial. The best source of this vitamin is moderate daily exposure to sunlight and the use of full spectrum lighting indoors. It is important to note that excess dietary calcium, vitamin A and vitamin D3(25,OH) from diets high in vitamin A & D fortified commercial dairy products may actually be a contributor to low tension glaucoma.

Vitamin E:

Vitamin E has been recommended in combination with ginkgo biloba or with vitamins A and C. Dosages of 400 IU/day have been recommended, with smokers requiring double that level. Others also suggest safe dosages of vitamin E up to 800 I.U./day. Esterified natural dry vitamin E (succinate), which I call ‘Ester E’ has been shown to be easier on the liver to absorb and process in research by Jeffrey Bland, Ph.D., President of Health-Comm. The only oil form of vitamin E that is undiluted by vegetable oil and therefore stable against oxidation is Unique E.

Nutritional-Cofactors

Coenzyme Q10:

CoQ10 can improve impaired heart function, improving the quality of circulation which is especially important in low-pressure glaucoma. Together with Vitamin E, CoQ10 has proven beneficial in glaucoma. CoQ10 raises ATP levels in depleted cells, reducing the risk of damage by glutamate. A daily dose of at least 30 mg/day of CoQ10, increased to 100 mg/day for low tension glaucoma, has been recommended.

Alpha Lipoic Acid:

150 mg daily of alpha-lipoic acid has been reported to improve visual function in patients with open-angle glaucoma in stages I and II.

Minerals

Calcium:

Calcium, when mishandled, can constrict blood vessels. Calcium supplementation often helps to improve calcium handling. Excess calcium, however, is linked to arterial-vascular disease.

Chromium & Vanadium:

Depleted chromium levels in body tissues are related to increases in IOP with visual stress. A combination of low dietary chromium, due to the loss of this trace mineral in food refining, together with the loss of this mineral when eating sugar and refined foods, or foods high in vanadium, results in increasing the risk of elevated IOP by 4.7 times. It is well documented that chromium stores in Americans are generally depleted with aging, due to our diet being high in sugar and refined carbohydrates. It is also well known that glaucoma incidence also increases dramatically with age. Since age itself is not a potential cause, being merely the passage of time, in the course of which causality may occur, we should be looking for more factors like chromium, heavy metals, and free radical effects at the optic nerve head to understand and prevent glaucoma. Vanadium should be avoided as it antagonizes chromium. Vanadium is more concentrated in low-fat dairy products, seaweed, mushrooms, vinegar, chocolate, carob, poultry, and large fish (tuna, swordfish, and shark), while more chromium is found in red meats, whole grains, molasses, fruits, vegetables, eggs (in the yolk) and dairy products made from whole milk.

Chromium improves lipid profiles. Recommended forms of chromium for supplementation are either chromium picolinate or chromium polynicotinate, and not ‘amino acid chelated’ chromium which can contain large unlabeled amounts of vanadium. A dosage of 200 to 600 mcg/day is recommended especially if taking topical or oral beta blockers to counteract their detrimental effects on lipid metabolism. 600 mcg/day increased HDL levels 16% to 38% in people on oral beta-blockers, resulting in 12 to 17% reduction in the risk of heart disease.

Copper:

Excess or unnecessary copper should be avoided, as in excess it promotes free radical pathology.

Germanium:

Germanium (100 to 200 mg/day) can help relieve discomfort associated with certain types of glaucoma, as it increases delivery of needed oxygen to the nerve cells.

Iron:

Excess or unnecessary iron should be avoided, as in excess it promotes free radical pathology.

Magnesium:

Magnesium may be beneficial in preventing mishandling of calcium which can lead to vasospasms in the optic nerve. This could be especially important in low tension glaucoma, where it is being suggested that calcium channel blockers might be used to produce this effect. Calcium channel blockers have been shown to increase peripheral vision in people with cold hands. Calcium channel blockers have been found to prevent the progression of optic nerve damage in 100% of glaucoma patients. The problem with calcium channel blocker drugs is their side effects. Magnesium is nature’s calcium channel blocker, increasing cyclic AMP levels through inhibition of calcium influx into the cell, resulting in relaxation of smooth muscle as well as prevention of platelet aggregation. Smooth muscles control the drainage of fluid from the eye. Cyclic AMP is also the primary intracellular regulator of aqueous humor production and IOP. Magnesium is 85% depleted in farmland soils as this macromineral is not present in the commercial NPK (nitrogen, phosphorus, and potassium) fertilizer preparations. As a result, 80% of adults are deficient in Magnesium. Magnesium deficiency is linked to high blood pressure, which in turn is associated with glaucoma. Even patients on oral beta-blockers can reduce blood pressure by taking 365 mg/day of Magnesium. 750 mg/day of Magnesium has been shown to improve retinal circulation in patients with hypertensive retinopathy and 243 mg/day improved both circulation and visual fields in glaucoma patients with vasospasm. Magnesium can reverse atrial fibrillation, which is linked to low tension glaucoma. Low Magnesium intake is also linked to deaths from a sudden heart attack, making repletion to optimal levels critical in the American population. Low Magnesium combined with high Calcium promotes coagulation of the blood as well as increases in adrenal hormones that increase IOP. Magnesium glycinate is the most absorbable form of magnesium and generally does not result in diarrhea as other less well-absorbed forms do in therapeutic dosages. It may take up to about 6 months to rebuild a deficient magnesium level, so it is important not to give up if there is no apparent immediate benefit. People with Raynaud’s disease (cold extremities), a condition linked to low-tension glaucoma, for example, do not respond as rapidly as healthy adults to Magnesium supplements. Stress, a condition that has been linked to glaucoma, increases the demand for Magnesium. The average American does not even consume the RDA level of Magnesium. A dosage of 250 to 400 mg/day at bedtime has been recommended at a 1:1 ratio with Calcium. It is often suggested to take Calcium at a different time of day to maximize absorption of both Calcium and Magnesium since they are both divalent cations and thus compete for the same absorption channels. Magnesium glycinate is the most absorbable form of Magnesium, eliminating the common side effect of diarrhea often experienced with high doses of Magnesium. As Magnesium levels are repleted over a period of about 6 months, watch for improvements in visual fields, visual acuity and circulation to the optic nerve. Watch also for muscular weakness as a possible indication that Magnesium levels have been built up higher than necessary. Greater Magnesium levels may be needed by those taking higher levels of Calcium and patients on diuretic medications.

Manganese:

Manganese supplementation at 20 mg/day has been suggested as part of a total nutritional program for glaucoma. Manganese picolinate is an excellent form to use.

Zinc:

Zinc supplementation with zinc picolinate or zinc monomethionine is often recommended, and a simple taste test using Zinc Sulfate solution can be used to monitor the degree of deficiency as well as the response to supplementation. A dosage of 15 to 25 mg/day of zinc has been recommended.

Food Sensitivities, Allergies, and Diet 

A study of 113 patients with chronic simple glaucoma showed immediate IOP increases of up to 20 mm Hg upon challenge (exposure) with food or other allergens. Another study of 3 individual cases of simple glaucoma, showed that elimination of food allergens markedly improved treatment outcomes compared to treatment with drugs and surgery or drugs alone. In one case, intraocular pressure could only be controlled once allergens were eliminated from the diet. In two other cases, despite adequate control of IOP with a combination of drugs and surgery, visual field loss continued to progress. Visual fields actually improved markedly upon beginning an allergen-free diet. This illustrates an important factor in glaucoma, that it is not simply a matter of pressure, but rather a complex interaction of biophysical and biochemical parameters that influence the cellular metabolism and function in the retinal ganglion cells and their axons in the optic nerve. Allergy responses are known to cause altered vascular permeability and vasospasm which could result in the congestion and edema found in glaucoma.

Sjogren first identified the relationship between allergy and IOP. As early as 1947, research showed that uncontrollable cases of glaucoma resolved on an allergy-free diet. Antihistamine treatment has proven effective in glaucoma patients with allergies after conventional treatment failed. Glaucoma in just one eye has even been found to be frequently due to sleeping with that eye against a feather pillow. In the trabecular meshwork, histamine increases the intracellular influx of calcium, increasing smooth muscle tension and potentially reducing circulation. Histamine has been shown to cause a reduction in the ability of the trabecular meshwork cells to keep the meshwork clear of debris, resulting in increased intraocular pressure. Antigen studies now also show a link to autoimmune processes.

Until individual testing of food reactions can be performed, many practitioners recommend as a minimum beginning with elimination of tobacco, sugar, coffee, and tea (including decaf; herb teas are allowed), alcohol, white flour, and other refined and processed foods, with reduction of commercially raised dairy products and red meats. Any beverages, preferably microwater (which can pass through the eye more readily), should be taken evenly throughout the day rather than drinking a lot at one time, which can raise IOP. Airborne allergens should be eliminated through the use of ozone, oxozone, or HEPA filtration units, although oxozone appears to be the most efficient method.

MSG may be a significant trigger of glaucoma, too. Glutamate has been found at elevated levels in the vitreous of glaucoma patients. Glutamate is known to be toxic to retinal ganglion cells and is known to cause circulatory disturbances such as vasospasms. Glutamate is an excitatory amino acid linked to neurological diseases such as Parkinson’s and Alzheimer’s. Acetyl-L-Carnitine, glutathione, vitamin B3, and CoQ10 are neuroprotective by preventing depletion of ATP since it is in low energy states (Phase 1) that nerve cells are damaged by glutamate.

It has been suggested to reduce commercial meats, dairy, salt, and nuts while including lots of vegetables along with cold-water fish, and eggs from free-ranging chickens. Moderate egg consumption may increase beneficial HDL without a significant increase of LDL. One study using a low-fat diet centered on rice and vegetables together with nutritional supplements achieved rapid (within 2 days) and sustained reduction in IOP of 5 to 7 mm Hg, which is better than results with current medical therapies. , This study was done at Duke University in 1949! Five servings of fresh organic produce (fruits and vegetables) per day is recommended. Green leafy vegetables, such as collards, kale, mustard greens and spinach are suggested as a source of xanthophyll carotenoids which help protect the optic nerve fibers, especially in the central vision area. Buckwheat is beneficial due to its high content of the bioflavonoid rutin.

Botanicals

Coleus forskohlii is an herb (related to mint) used traditionally in folk medicine in Northern India. It is the only known source of forskolin, a labdane diterpene compound that activates the enzyme adenylate cyclase, which elevates cAMP, which can then result in a reduction in intraocular pressure (IOP) when applied topically to the eye. Forskolin’s unique stimulation of the main catalytic subunit of adenylate cyclase has made it the subject of over 1,000 published scientific studies. Forskolin essentially acts as an amplifier for intracellular communication via the endocrine system. A double-blind study found that a 1% forskolin suspension produced a definite drop in intraocular pressure for 6 hours following use. Another controlled study showed that two instillations of 1% forskolin resulted in a 2.4 mm Hg drop in IOP in just 1 hour, with a 13% reduction in aqueous flow rate. Additional experiments showed that 1% forskolin lowered IOP in humans as well as in rabbits and monkeys, with a drop in outflow pressure of 34 to 70%. Coleus works like Magnesium, by relaxing smooth muscle, plus it has antihistamine properties, perhaps reducing allergic components of increased IOP as well. A dosage of 200 to 400 mg/day of the herb in capsule form has been recommended given the herb’s long record of safety. Coleus, for example, lowers blood pressure which often accompanies elevated IOP and is beneficial in asthma and congestive heart failure, conditions which contraindicate the use of beta blocker eye drops. Unlike beta-blockers, forskolin enhances ocular blood flow, while having no systemic side effects and not inducing miosis. Higher doses are required by those with darker eye color than for those with light-colored eyes. Synergistic effects can be achieved by combining coleus with omega 6 fatty acids.

How effective is forskohlii at lowering eye pressure? Here is the example of Dr. Kuakiniokalani Keeaumoku Kawananakoa-Prible, His Serene Highness, Hawaiian Prince, and European royalty (he grew up in Buckingham Palace). In his own words, Doctor Kuakini reported to me, “Eye pressure at Hawaiian Eye Clinic: 42 & 46. One month later, eye pressure at Hawaiian Eye Clinic: 30 & 31 without using any eye drops or chemical drugs. Used only herbal caps of Forskohlii.” The ophthalmologist at Hawaiian Eye, the #1 eye clinic in Hawaii, had prescribed eye drops which he had informed Dr. Kuakini he did not expect to work. He was amazed at the reduced eye pressures, thinking that the prescription had worked. When Dr. Kuakini informed him that he had not filled the prescription, since he was told they would not work anyway, but had instead taken an herbal remedy, the ophthalmologist was even more amazed and said that it was the first time he had ever actually seen a natural substance actually reduce a patient’s eye pressure.

Ginkgo biloba was found to actually produce mild improvements in a study on patients with glaucoma and other severe degenerative disorders of the circulation in the back of the eye. This was considered very significant given the very poor prognosis for the conditions treated. Treatment began with 160 mg/day for the first 4 weeks followed by maintenance on 120 mg/day.

Ginkgo biloba has several biological actions that help against glaucoma:

• improves central blood flow including the optic nerve and retina
• improves peripheral blood flow
• neuroprotection by inhibiting apoptosis

Chung HS, Harris A, Kristinsson JK, Ciulla TA, Kagemann C, Ritch R. Ginkgo biloba extract increases ocular blood flow velocity. J Ocul Pharmacol Ther 1999 Jun;15(3):233-240.

Ritch R. Potential role for Ginkgo biloba extract in the treatment of glaucoma. Med Hypotheses 2000;54: 221-35.

In a prospective, randomized, placebo-controlled, double-masked crossover trial at the Glaucoma Center, Clinica Oculistica Università di Brescia, and the Clinica Oculistica, Università di Catania, in Italy, GBE improves preexisting visual field damage in some patients with normal-tension glaucoma (NTG).

27 patients with bilateral visual field damage resulting from NTG received 40 mg GBE orally three times daily for four weeks, followed by a washout period of eight weeks, and then four weeks of placebo treatment (40 mg fructose). Other patients took the fructose first and the GBE last. Visual field tests were performed at baseline and the end of each phase of the study.

Significant improvements in visual fields indices were found after GBE treatment. Mean deviation (MD) at baseline was 11.40 +/- 3.27 dB versus 8.78 +/- 2.56 dB MD after GBE treatment; corrected pattern standard deviation (CPSD) at baseline was 10.93 +/- 2.12 dB versus 8.13 +/- 2.12 dB CPSD after GBE treatment. No significant changes were found in intraocular pressure (IOP), blood pressure, or heart rate after placebo or GBE treatment. The study concluded that ginkgo biloba extract administration improves preexisting visual field damage in some patients with NTG.

Quaranta L, Bettelli S, Uva MG, Semeraro F, Turano R, Gandolfo E. Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma. Ophthalmology 2003;110: 359-62.

Some doctors now recommend ginkgo together with vitamin E in glaucoma management. A dosage of 100 to 240 mg/day of ginkgo has been recommended.

Salvia miltiorrhiza is an herb used traditionally in oriental medicine. A study of patients with middle to late-stage glaucoma received a preparation made from the root of this herb for one month. Visual acuity improved in 43.8% of the eyes studied, while 49.7% showed increased visual fields (statistically significant at p<0.01 compared to untreated controls). Followups as long as 30 months continued to show either stable or improved visual fields.

Pilocarpine is a natural source drug long used to treat glaucoma, being derived from the herb Pilocarpus jaborandi. It has also been used in homeopathic doses for this purpose, which is a preferable form especially for people under the age of 40 due to the severe side effects of headaches that often accompany its use in young people.

Research has explored the possible use of the herb Cannabis sativa (hemp), either topically on the eye or systemically, to reduce IOP. With the potential to decrease eye pressure by 51%, it is the most effective agent known for IOP reduction. Smoking this herb, unfortunately, results in numerous side effects including tachycardia (speeding heart rate by 22 to 65%, the opposite of beta-blockers), low blood pressure, a false sense of euphoria, photophobia, blepharospasm, dry eyes, and loss of short term memory. Extracts of this herb were used widely in medicine until early in this century. Now, hemp oil is becoming available and is an excellent source of essential fatty acids to nourish the nerves of the eye. Tinctures and homeopathics, however, remain unavailable. The herb has been banned even for medical purposes since 1992.

Bilberry (Vaccinium myrtillus), taken at a dosage equivalent to 1/4 teaspoon of solid extract 3 times a day has been recommended for all types of glaucoma. This herb has been shown to improve visual function in a variety of conditions including myopia, night blindness, and diabetic retinopathy. The blue-red pigments (anthocyanosides) found in this and other berries have been shown to improve vitamin C utilization, improve capillary integrity, provide anti-oxidant protection and stabilize the collagen matrix by directly cross-linking with collagen and preventing the enzymatic breakdown of this backbone of the connective tissue.

Ginger (Zingiber officinalis) stimulates improve heart function and increased circulation. A dosage of 100 mg/day of ginger has been recommended.

Capsaicin cream (from cayenne pepper: Capsicum) increases circulation in the choroid of the eye, as does electrical stimulation of the trigeminal nerve. Capsicum capsules can also be taken internally, reducing cholesterol, providing antioxidant activity, relaxing smooth muscle for vasodilation and improved circulation, as well as stimulating digestive functions for better nutrient assimilation.

Garlic (Allium sativum), which improves circulation, blood pressure and cholesterol levels, while providing antioxidant properties, has been recommended at a dosage of 500 to 1000 mg/day.

Hawthorne berries have been suggested to improve heart rhythm and thus enhance circulation, while lowering hypertension and cholesterol where such cardiovascular problems are present together with glaucoma.

Spirulina has been reported to help restore vision lost due to glaucoma.

Vegetable source glycerin (1 to 2 g/kg body weight) mixed with an equal amount of water or juice can be used for first aid in acute angle-closure glaucoma attacks.

Several herbs may be combined or alternated as a warm eyewash or in eyedrop form (3 drops in each eye, instilled 3 times a day), including fennel, chamomile, and eyebright.

Glandulars

Epinephrine is a natural neuro-hormone, released by the adrenal glands, which is often used to treat glaucoma in conventional medicine. Adrenal glandulars, including the adrenal cortex and other nutritional supports for rebuilding the adrenal function, should be used whenever the adrenals are run down. Vitamin C and the B complex are particularly important for supporting the adrenals. Adrenal hormones seem to be the primary daytime regulators of IOP.

Melatonin, the hormone of darkness, secreted by the pineal gland, seems to be the primary night-time regulator of IOP. Many glaucoma patients also manifest sleep disturbances. Melatonin is significantly associated with longevity, cancer prevention, and restful sleep, as well. Its production can be blocked by turning a light turned on or left on during sleep or when waking during the night, as well as by electromagnetic and geopathic field exposure. Using a red filter over a flashlight or nightlight preserves the pineal's ability to sustain melatonin production. Melatonin may be taken as a supplement before bedtime, or alternatively, its production seems to be enhanced by stimulating the retina with violet light for up to 20 minutes before sleep. Melatonin reduces the rate of aqueous production from the daytime level of 3.1 microliters/minute to 1.5 microliters/minute during sleep. IOP, with a daily rhythm of changing pressure normally fluctuating about 5 to 7 mm of Hg (and more in many glaucoma patients), typically peaks just after waking. This is also when brain temperature and cerebral circulation peak, stimulated by light entering the eyes. Taken during the daytime, however, Melatonin has detrimental effects, promoting cancer in animal studies, and shows no effect on the rate of aqueous fluid production.

Thyroid glandulars or thyroid hormone replacement therapy can be helpful. Thyroid activity, along with zinc, is needed to metabolize beta carotene into vitamin A for the eyes. Both thyroid and adrenal regulation are needed to support the high energy metabolism of the cells in the retina, which have a higher metabolic rate than any other tissue in the body. When thyroxine is prescribed medically, the natural source (Armour thyroid) is preferable to synthetic (Synthroid), as electrodermal measures show better tolerance by the liver, which according to principles of oriental medicine is known to exert a strong influence on eye conditions.

Estrogen and prostaglandins (which carry the messages of hormones other than melatonin within the cell) may also play a role in regulating IOP.

Acetylcholine and serotonin relax the smooth muscle in blood vessels.

Amino Acids

Acetyl-L-Carnitine (ALC) raises ATP energy levels in neurons. It is neuroprotective against the excitatory amino acid glutamate, which is elevated in glaucoma.

L-Arginine relaxes the smooth muscle in blood vessels. It also supports regeneration of the myelin sheath along with adenosyl methionine and polyamines.

Glutathione is a tripeptide, which helps prevent oxidative damage to the trabecular meshwork. In animal research, trabecular outflow was only reduced with suppression of the glutathione antioxidant system. Oxidation of the methionine present in collagen in the trabecular meshwork of glaucomatous human eyes has been observed. N-acetyl cysteine, a glutathione precursor, is recommended at supplemental doses of 200 to 600 mg/day. Methyl-sulfonyl methane, a source of organic sulfur, may help to raise glutathione levels. Reduced glutathione is also available as a supplement. Glutathione increases ATP energy levels in nerve cells, protecting against damage by Glutamate.

L-Carnosine provides neuroprotection via antioxidant activity and independent defense against excitotoxins. L-Carnosine raises Glutathione levels.

Enzymes

Protein deposits in the drainage system of the eye can increase eye pressure by blocking the outflow of fluid from the eye. These proteins that typically accumulate with age may come from inflammatory processes such as allergy, toxicity, radiation, and infection, as well as from debris from ocular tissue such as melanin from the iris or exfoliation from the lens. It could also come from partially digested large food proteins such as dairy, wheat, eggs, and soy that often cause congestion in the lymphatic system as well. Proteolytic enzymes taken orally may be helpful in breaking down proteins deposited in the trabecular meshwork. This meshwork acts like a filter for the aqueous humor, the fluid which fills the front of the eye, as the fluid drains out from the eye into a drainage channel called Schlemm’s canal. The proteins leak from capillaries in the ciliary body, probably due to inflammation, so other anti-inflammatory therapies may be beneficial in prevention. In addition to proteolytic enzymes like bromelain, papain, trypsin, and chymotrypsin, this may include lipase, amylase, rutin, EPA, L-cysteine or N-acetyl-cysteine, zinc, catalase, and SOD. Antioxidant enzymes glutathione peroxidase (dependent on cysteine, selenium, and vitamin E) and SOD (dependent on zinc, copper, and manganese) have been shown to prevent demyelination of optic nerve fibers caused by the oxidant hydrogen peroxide. Dietary enzymes from raw foods may be beneficial, too. A study in Africa on genetically related tribesmen eating a traditional diet versus those in urban areas with a Western diet showed less high pressure (a significant risk factor in glaucoma). Traditional diets in general, with less processing and food additives, and containing some raw foods as well as some animal proteins, have been found to be beneficial for the prevention of degenerative diseases.

Reduced levels of the antioxidant enzymes superoxide dismutase (SOD) and catalase is a risk factor for loss of pigment from the structures inside the eye. This pigment can then clog the drainage channels of the eye leading to pigmentary glaucoma. Rebuilding the antioxidant enzyme levels requires amino acids as well as trace minerals to be available, including adequate copper, zinc, manganese, and selenium. While amino acids are important, excessive protein, especially when overcooked or microwaved, and thus more difficult to digest, may be a risk factor for pigmentary glaucoma, especially when dietary protein intake exceeds 3 times the RDA.

Essential Fatty Acids:

Essential fatty acids, precursors of anti-inflammatory prostaglandins, may be very beneficial in reducing chronic inflammatory processes involved in glaucoma. Eskimos who have a high intake of omega-3 fatty acids from fish have a very low incidence of open-angle glaucoma. Fish oil supplements have also been found beneficial in Raynaud’s syndrome, which is related to low tension glaucoma. The typical American diet is deficient in omega-3 fatty acids. Depleted levels of the omega-3 fatty acid eicosapentaenoic acid, or EPA, can be supplemented with dietary small cold-water fish (salmon, mackerel, sardines, herring, cod) and fish oil capsules. This common deficiency is a suspected risk factor for both pigmentary and low tension forms of glaucoma. Omega-3 oils thin the blood, improving circulation. They have also been shown to produce a significant lowering of IOP in rabbits. Even diabetics can take up to 2.5 grams of EPA without any side effects. Other sources of the beneficial omega 3 fatty acids include black currant oil, as well as flax or hemp seeds or their oils.

Omega-6 oils are also important. Diabetics have impaired omega-6 metabolism, contributing to the demyelination of nerves. Beneficial omega-6 oils are available as evening primrose oil and borage oil.

The deficiency of both omega-3 and omega-6 oils is linked to pigmentary glaucoma. In opposition to the beneficial fatty acids are long-chain and trans-fatty acids found in fried foods and hydrogenated oils such as margarine. These junk and processed foods should be avoided as they promote inflammatory processes and probably increase the risk of pigmentary glaucoma as well as many other diseases systemically. A suggested dosage of omega-3 fish oil, flax or hemp seed oil is at least 1000 mg/day.

Omega-6 fatty acids double cyclic AMP levels, and when combined with coleus or its extract, forskohlin, triple these levels (see herb section). A combined dosage of omega-3 and omega-6 oils is recommended at 500 to 3000 mg/day.

Homeopathy

Several practitioners have written about their success in treating glaucoma with homeopathic remedies. Remedies in italics are more frequently found useful. Descriptions in italics are key symptoms in confirming the selection of the remedy.

Aconite: at beginning of acute attack with much heat, redness and burning pain in eye, together with fever.Asafoetida: severe boring pain over the eye and around it.

Aurum metallicum: glaucoma with tendency toward blindness, upper half of objects invisible, with atherosclerosis and suicidal depression.

Belladonna: severe glaucoma pain with throbbing headache and flushed face; eyes injected, pupils dilated, fundus hyperemic with pain in and around eye; pains may come and go suddenly, worse in afternoon and evening; eyes hot and dry with light sensitivity; reddish halo around lights.

Bryonia: useful in early stages of acute glaucoma attacks; eyes feel full as if pressed out, often with sharp, shooting pains through the eye and head. The eyes feel sore to the touch and on moving them in any direction. Halo around lights, with heavy pain over eye, worse at night.

Cedron: severe shooting pains along the supraorbital nerve.

Colocynthus: severe, burning, aching, sticking or cutting pains in and around eye, relieved by firm pressure and by walking in a warm room; aggravated by rest at night and on stooping.

Gelsemium: very frequently useful clinically in glaucoma with heavy eyelids (ptosis), dim vision, one or both pupils fixed and dilated, pain and twitching of muscles, bruised pain behind eyes, with dizziness, drowsiness, dullness and trembling or muscle weakness or paralysis. Patient may not seem to care about his condition.

Nux vomica: marked morning aggravation; atrophy of optic nerve due to glaucoma.

Osmium: sudden, sharp severe pains in and around eye; dim, foggy vision; halo with colors around lights.

Phosphorus applies to inflamed nerves and hemorrhages that suddenly destroy nerve cells. The eyes fatigue easily. Green halos may be seen around lights and letters may appear red. Optic atrophy is also typical. The conjunctiva appears pearly white but there may be swelling of the eyelids.

Prunus spinosa: severe, crushing pain in the eye as if the eye were pressed asunder, or sharp pain shooting through the eye and same side of the head (similar to Spigelia); hazy aqueous and vitreous; fundus hyperemic.

Rhododendron: incipient glaucoma, with a lot of pain periodically in and around the eye, always worse just before a storm and better once the storm begins.

Spigelia: sharp, stabbing pains through the eye and head, worse with motion and worse at night.

Other individual remedies to consider include Arnica, Arsenicum, Atrop., Causticum, Chamomilla, Cocaine (not available in the states), Commocl., Conium, Croc., Croton tiglium, Eser., Hamamelis, Kali iodatum, Macrotin., Mag. carb., Mercurius, Op. (not available in the states), Pilocarpus, Rhus toxicodendron, and Sulfur. Homeopathic sarcodes (made from healthy organ tissues) including Epinephrine, Adrenal (Supraren ext.), Eye, Optic Nerve, Lamina Cribrosa, Ciliary Body, Schlemm’s Canal, Proteolytic Enzymes, Chromosome 1 and others, including vitamins, minerals, herbs and drugs listed above may be used as well.

The nosode Brucella abortus Bang can affect the eye and optic nerve areas, such as in MS and glaucoma. Other commonly used remedies for retrobulbar neuritis include Arsenicum album, Nux vomica, and Terebenthina, while less frequently prescribed homeopathics are Ferrum phosphoricum and Kali phosphoricum. In addition, the following remedies may be useful, as they are known to cause the condition in toxic doses: Amyl alcohol (methanol), Atoxyl, Cannabis indicus (hashish, not available in the U.S. as a homeopathic remedy), Carbon bisulphide, Dinitrobenzol, Iodoformium, Nitrobenzol, Plumbum (lead, Pb), Stramonium (jimson weed) and Tabacum (tobacco).

Optic atrophy is treated by Argentum nitricum, Arsenicum album, Nux vomica, especially if alcohol, tobacco or other drugs are used, Phosphorus, Plumbum metallicum, with small pupils and inflammation of the optic nerve (as in multiple sclerosis), Strychninum phosphoricum, Veratrum viride (American hellebore), Zincum phosphoricum.

Complex homeopathy, especially for lymphatic drainage and treatment of underlying energetic causes of glaucoma is also recommended by many practitioners. Excellent remedies include Lymphomyosot and Energessence for lymphatic drainage support and Stamina Plus (for stress), Food Tolerance (for food allergy) and AllerFree (for airborne allergies) to balance underlying causal factors.

Electrodiagnostic modalities like Electroacupuncture According to Voll (EAV), the Vegetative Reflex Test (VRT, formerly called the Vegatest Method) of Schimmel or other functional testing methods are often used to determine the optimum therapy, including homeopathy as well as nutrition, and even pharmaceuticals.

Color & Light

Ultraviolet protective eyewear is frequently recommended to reduce photo-oxidative stress in the eye. Even UV-absorbing contact lenses are now available. This may help reduce oxidative stress on ocular tissues and reduce the risk of exfoliation of lens proteins that can clog the trabecular meshwork. Exfoliation is seen more in people who spend more time outdoors and in sunnier environments. The same people show changes in the eyelids, and excessive sunlight is known to reduce the elasticity of connective tissues. It appears to be UV-B radiation (280-320 nanometers) that damages the lens cells that exfoliate, although antioxidants are known to protect against this damage.

Wearing green glasses may be helpful. Typically, cool colors such as blue-green, blue, indigo and violet are used directly in the eyes in glaucoma, since these stimulate the parasympathetic nervous system, contracting the pupil to increase drainage of the aqueous humor and reduce IOP. Syntonic phototherapy using color stimulation of the retina has been shown to increase visual fields in a number of studies in various populations. Both fluorescent and incandescent artificial lights are deficient in these cool colors, resulting in chronic stress, and contributing to glaucoma as well as 85% of all diseases. Full-spectrum lighting provides a more natural indoor light which reduces systemic and eye stress, while improving calcium metabolism. Full-spectrum light reduces hip fractures by 50%, while medical treatment for glaucoma has been shown to increase hip fractures by over 300%. This point is especially important not because medical treatment for hip fracture costs $25,000 per patient, but because one third of these patients will die within one year following a fractured hip.

For treating the whole body with light, Dinshah recommends yellow-green on the entire front of the body, followed by indigo on the eyes, and magenta on the heart and kidney areas.

Acupuncture

Acupuncture can help otherwise incurable eye diseases. Enkephalin, which is released in acupuncture, reduces IOP. Acupuncture may be able to slow progressive vision loss when drugs can’t. Acupuncture may also be able to help reverse optic atrophy. Acupuncture together with Vitamin B12 was able to control glaucoma in a dog.

Stress management and exercise

Socrates said, “just as we cannot treat the eye without the head, and we cannot treat the head without the body, so we cannot treat the body without the soul.”

Stress causes dilation of the pupil which can increase IOP. Stress has long been known as one of the triggers of acute angle-closure glaucoma attacks. As early as 1818, anxiety was linked to glaucoma attacks. Other risk factors which interact with stress include narrow drainage angles in the eyes and anatomically short eyes. Holding feelings of resentment, anger and frustration seem to contribute to such an eye structure, especially during the formative childhood years. Stress also causes an immediate rise in IOP in glaucoma patients, while chronic stress eventually leads to increased eye pressure for anyone. Above-average stress increases the risk of ocular hypertension by 2.8 times. One study found that 100% of glaucoma patients experienced frustrating life experiences at the time their glaucoma began. Associated emotions ranged from anxiety to anger to depression, and during periods when patients' sense of security was most threatened, IOP and glaucoma symptoms were found to increase. Anxiety not only affects blood pressure, which is associated with glaucoma but also increases the tendency of the blood to clot and triggers vasospasms in the retinal arteries. Many glaucoma patients show additional signs of stress including problems with sleep, digestion and loss of appetite. The glaucoma-prone individual tends to have a personality which includes anxiety, perfectionism, nervousness, and hypersensitivity. An association between low levels of alcohol use and reduced ocular hypertension may be due either to reduced chronicity of stress patterns or simply to the cardiovascular benefits which are at least partially due to the bioflavonoid content in red wines.

Stress reduction through biofeedback of the frontalis muscle can also be helpful in lowering IOP. The simple act of relaxing and smiling, however, if achievable, results in essentially the same changes. IOP is never elevated when one is happy and tranquil. Biofeedback to increase skin temperature as a measure of the quality of circulation and smooth muscle relaxation is helpful in migraine and Raynaud’s syndrome, both of which are related to glaucoma.

Whole-body aerobic exercise has been shown to reduce IOP significantly, by 4.6 mm Hg, in previously sedentary glaucoma patients, with the most sedentary patients experiencing the greatest benefit. Even a single session of exercise such as 6 deep knee bends reduces IOP, and benefits continue for 3 weeks if exercise is discontinued. The amount of IOP reduction is as great as (and additive to) that obtained by using beta blocker eye drops, with increased pressure reductions achieved by more intense exercise. In normal and low tension glaucoma, increased arterial partial pressure of carbon dioxide (pCO2), as produced by exercise, dilates blood vessels, increasing blood flow as well. An optimal activity program might include 45 minutes of essentially non-stop physical activity such as walking, swimming, cycling or rebounding every other day, while others have recommended 10 to 30 minutes daily. One study found that 40 minutes of brisk walking 4 times a week for 3 months significantly reduced IOP. Interestingly, the seasonal variation in IOP is typically highest in the winter and lowest in the summer. Perhaps this is due to increase physical activity in the summer. The daily variation of IOP is also usually highest on waking and has already decreased, even to normal levels, perhaps through lymph drainage due to physical activity, by the time it is measured in an eye doctor’s office. The best exercise program for circulation and lymph drainage for the entire body, including the eyes is rebounding, with 12 minutes a day giving equivalent exercise to 40 minutes of jogging, yet without straining joints in the knees or low back.

On the other hand, jarring exercise may contribute to increased release of pigment in a specific condition known as pigmentary glaucoma. Pigmentary glaucoma tends to affect highly nearsighted individuals with dark pigmentation.

Also, inverted postures, such as head-stands, can increase IOP dramatically, reaching levels above 30 mm Hg in normals and even higher in those with glaucoma. , In a few glaucoma suspects, pressure even increases simply by lying down.

When exercising, keep in mind that electrolytes such as zinc, potassium and magnesium are lost in sweating, so replacement of these minerals is important.

Vision training, involving activities which support enhanced efficiency and ease of eye movement have been shown in an unpublished study to reduce IOP. Looking to the side (lateral gaze) temporarily increases IOP by about 2 or 3 mm Hg. More frequent eye movements into lateral gaze may function to pump fluid out of the eye more efficiently, similar to the pumping of lymph through general body movements, resulting in a long-term decrease in IOP. Eye movement, in general, tends to increase with increased gross motor activity. Both glaucoma and myopia, which seem to closely related, seem to involve a lack of eye movement. In myopia, eye movement is greater when wearing contact lenses compared to glasses, but contacts should not be worn overnight, since this can affect eye pressure.

Daily massage of the eyes and orbit can help achieve a lower pressure in the eye by improving drainage of aqueous humor, lymph and venous blood. “Eye Points” is a recommended massage program that includes not only the bony orbit but also body acupressure points that trigger improved drainage in the eye area.

These relaxation techniques as well as “Palming should be used during frequent breaks in any visually centered task such as reading, computer work, or watching TV.

Eye Stretch is a recommended exercise to improve lymphatic and veinous drainage for the eye area while releasing tension in the extraocular muscle system.

Performance lenses or other plus lenses for close work have been shown to help reduce IOP by reducing the demand for contraction of the ciliary muscle which controls eye focusing.

Quitting smoking is critically important since by itself, nicotine can raise IOP. One herbal program has been proven 99% effective for quitting smoking within 7 days. Avoiding any other toxic drugs and food additives, as much as possible is also paramount, as many of these may have a similar effect. Detoxification is very important in the long run to remove the accumulated toxins in the body, but this should proceed gently so as not to trigger increased pressure during healing crises. Avoiding toxins in the diet, such as pesticides, is important, too. Peel commercially grown fruit, and wash vegetables before cooking. Steaming vegetables lightly also helps to remove volatile pesticides.

Weight loss and natural reduction of hypertension are helpful, too. Both of these factors, along with myopia, are associated with ocular hypertension. Pharmacological reduction of high blood pressure in the presence of ocular hypertension can actually increase glaucomatous damage to the optic nerve due to the creation of an increased pressure differential at the optic nerve head, increasing cupping and reducing capillary perfusion to the nerve fibers.

Even clothing can affect IOP and visual fields. Neckties can increase IOP by compressing the jugular veins, reducing veinous drainage from the head and eye area. In one study, 67% of businessmen in normal health wore neckties tight enough to reduce visual performance. None of us, especially someone with glaucoma or at risk of it, needs this kind of added stress, so loosen up those neckties just a notch, and now you’re dressed for success. Like a famous boxer used to say, “Float like a butterfly, sting like a bee, your hands can’t hit what your eyes don’t see.” And then there’s also the old adage, “use it or lose it.” This certainly applies to the use of our peripheral vision and related eye and body movement in maintaining our spatial vision, whether in glaucoma, or under any kind of stress conditions.

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The author was a 25-year-old interning eye doctor at the world’s largest outpatient vision clinic in New York City, and president of the American Optometric Student Association, representing over 4000 student doctors of optometry worldwide when he learned that he had glaucoma. Knowing that the best medical and surgical treatment would likely leave him blind before age 50, he embarked on his continuing investigation of alternative, complementary, and integrative medical approaches to the treatment, prevention and rehabilitation of glaucoma and other eye and vision conditions. 30 years later, he continues to maintain his vision without suppressive eye drops or invasive eye surgery.