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DESCRIPTION
Glaucoma affects about three million adult Americans, making it one of the leading causes of blindness. Glaucoma is a serious eye disease characterized by abnormally high intraocular pressure, which is the pressure that the fluids within the eyeball exert on the other parts of the eye. If this pressure is unrelieved, it damages, the retina and ultimately destroys the optic nerve, resulting in vision loss and even total blindness. The condition usually affects people over forty, and is more common in women than in men. Those with the highest risk of developing glaucoma are people of African ancestry; people with diabetes, high blood pressure (hypertension), severe myopia (nearsightedness), or a family history of glaucoma; and those taking corticosteroid preparation. Many cases of glaucoma go undetected until vision loss begins.
FREQUENT SIGNS & SYMPTOMS
There are two basic categories of glaucoma.
The more severe (and, fortunately, less common) form of this disorder is called acute glaucoma, closed-angle glaucoma or narrow-angle glaucoma. This type accounts for less than 10 percent of reported cases, but it comes on quickly and requires urgent medical attention. If left untreated, it can irreversibly damage the optic nerve, which carries visual images from the eye to the brain, causing blindness - sometimes in a matter of days. Attacks of this type of glaucoma occur when the channel through which the eye's fluids normally drain become constricted or obstructed. This is usually due to narrowing or hardening of the exit channels from the eyes, and it results in extreme pain, poor vision, and even blindness. It is considered a medical emergency. Early warning signs that a problem may be developing include:
Symptoms of the acute attack itself include:
- Eye pain or discomfort mainly in the morning.
- Blurred vision.
- Seeing halos around lights.
- Inability of the pupils to adjust to a dark room.
These symptoms come on very rapidly and may be accompanied by nausea and vomiting. Permanent vision damage can occur in as little as three to five days, making treatment within the first 24 to 48 hours imperative.
- Throbbing eye pain.
- Loss of sight, especially peripheral vision.
- Pupils that are fixed in a mildly dilated condition and do not respond to light properly.
- A sharp increase in the pressure in the inner eye, especially on one side.
The most common form of glaucoma, accounting for 90 percent of all cases of this disorder, is chronic open-angle glaucoma. Chronic glaucoma usually appears in middle age and seems to have a genetic component. One out of five sufferers has a close relative with the condition. Health care providers often refer to chronic glaucoma as the "sneak thief in the night" because it comes on gradually to steal your vision. In open-angle glaucoma, there is no physical blockage and the structures of the eye appear normal, but the drainage of fluid nevertheless is inadequate to keep the intraocular pressure at a normal level. While the acute form of glaucoma is a frightening prospect, especially to those in high-risk categories, chronic glaucoma is much more insidious because it almost never manifests any symptoms until very late in the condition. By that time, vision may be irreversibly damaged. The most pronounced symptoms of open-angle glaucoma are:
Other possible symptoms include:
- The loss or "darkening" of peripheral vision. Peripheral vision is the ability to see "out of the corner of the eye" and the loss of this ability leaves a person with "tunnel" vision.
- A marked decrease in night vision or the inability of the eye to adjust to darkness.
- Chronic low-grade headaches (often mistaken for tension headaches).
- The need for frequent changes in eyeglass prescription.
- And/or seeing halos around electric lights.
Secondary glaucoma and it is usually associated with another eye disease or disorder, such as an enlarged cataract, uveitis (an inner-eye inflammation), and eye tumor, or an eye injury. People suffering from diabetes are also susceptible to neovascular glaucoma, a particularly severe form of the disease.
Congenital glaucoma is an extremely rare condition affecting babies, 80 percent of cases occur by age 1. In infants, teary or cloudy eyes, unusual sensitivity to light and enlarged corneas are signs of congenital glaucoma.
CAUSES
Glaucoma probably has many causes, but it is closely related to stress and nutritional problems, and is closely related to other disorders such as diabetes and high blood pressure (hypertension).
The eye's lens, iris, and cornea are continuously bathed and nourished by a water-based fluid called aqueous humor. As new fluid is produced by cells inside the eye, excess fluid normally drains out through a complex network of tissue called drainage angle, where the cornea and iris meet. An imbalance between the rate of production of aqueous humor and the rate of drainage will bring on chronic, or open-angle, glaucoma. This is the most prevalent form of the ailment and generally develops slowly with age.
Some people apparently inherit a condition of the inner eye in which the iris can block normal drainage channels. When this happens, the fluid does not drain out of the eye fast enough, and the sudden pressure from fluid buildup causes acute glaucoma. In newborns, defects in the drainage angle are the cause of congenital glaucoma. Both conditions need prompt medical attention to prevent potential loss of sight.
Problems with collagen, the most abundant protein in the human body, have been linked to glaucoma. Collagen acts to increase the strength and elasticity of tissues in the body, especially those of the eye. Collagen and tissue abnormalities at the back of the eye contribute to the "clogging" of the tissues through which intraocular fluid normally drains. The result is elevated inner eye pressure that leads to glaucoma and related vision loss. Conditions characterized by errors of collagen metabolism are frequently associated with eye disorders.
PREVENTION
There's no sure way to prevent glaucoma, but early treatment helps slow the disease. If you are in a high-risk group for glaucoma, get regular eye checkups (at least once every two to three years) or follow your health care provider's recommended schedule. Risk factors for developing glaucoma include:
- Being of African, Hispanic, Inuit, Irish, Japanese, Russian or Scandinavian descent.
- Having a family history of glaucoma
- Being older than age 40
- Having poor vision
- Having diabetes
- Taking steroidal medications
- Having high blood pressure
TREATMENT
DIAGNOSIS
Procedures for glaucoma screening are brief and painless. Your optometrist will routinely measure your inner-eye pressure (IOP) with an air-puff tonometer; an ophthalmologist may use a more sensitive instrument called an applanation tonometer. But the mere presence of higher-than-normal pressure within the eye does not mean that you have glaucoma: Slight pressure in your eye without evidence of damage to your optic nerve is called ocular hypertension. In most cases, this condition calls only for repeat testing at regular intervals to check for early signs of nerve damage.
If glaucoma is suspected, your ophthalmologist may dilate your eyes and examine the optic nerve with a hand-held ophthalmoscope or other lens. You should have a visual field test, which measures your peripheral, or side, vision.
Congenital glaucoma is difficult to diagnose because a child under a year old cannot describe the symptoms. If the cornea in your child's eye appears cloudy, a congenital condition may be present. Babies are routinely checked for the disorder at birth, but if you suspect congenital glaucoma, see a pediatric ophthalmologist at once.
CONVENTIONAL MEDICAL TREATMENT
There is no cure for glaucoma, and any damage to vision is irreversible. Treatment of glaucoma requires measures to control the flow and drainage of aqueous humor in the eye, restoring the normal balance of inner-eye pressure. Chronic glaucoma may not be noticed until it has progressed to a relatively advanced stage, but it can usually be controlled. Both medical and surgical approaches have high rates of success in treating chronic glaucoma but you can help yourself by relieving stress and getting regular eye exams. Acute glaucoma is different: If the pressure of excess fluid in the eye is not relieved quickly, the result can be blindness.
Appropriate therapy depends on the nature and stage of the ailment. Your ophthalmologist may not prescribe any therapy for ocular hypertension when the pressure in your eye is minimal; periodic evaluation with close monitoring of your peripheral vision and of the appearance of the optic nerve may be sufficient.
Chronic open-angle glaucoma is typically managed or can often be controlled through the use of medication, usually in the form of eye drops. Several types of these medications are available. Often an ophthalmologist has to experiment a little to find the specific one that works most effectively for a particular individual. However, many people with glaucoma find that the eye drops cause severe headaches and other side effects. This problem can often be alleviated by changing the prescription. If headaches persist, it may help to adjust the schedule for taking the medication so that it interferes with normal activities as little as possible.
There are several classes of eye drops. Those that contain epinephrine or pilocarpine help increase fluid outflow but may have undesirable side effects: Pilocarpine may cause headaches and blurred vision; epinephrine may cause excessively red, teary eyes and in rare cases may aggravate heart problems. Eye drops containing beta-adrenergic blockers such as timolol, betaxolol and levobunolol may have heart or lung side effects. Eye drops called prostaglandins -- such as latanoprost (Xalatan), travoprost (Travatan), unoprostone ophthalmic (Rescula), or bimatoprost (Lumigan) -- may cause lighter colored eyes to turn brown in some people. Some other drops can cause allergic reactions in the eye. Oral carbonic anhydrase inhibitors help decrease fluid production but may cause stomach upset or tingling hands and feet. Because of potential drug interactions, your ophthalmologist should know before prescribing eye drops about any other medications you take.
If your eye drops fail to control intraocular pressure and your chronic glaucoma does not respond to medication, or if you cannot tolerate the side effects, your health care provider may recommend one of several surgical techniques. These include, but are not limited to:
Trabeculoplasty creates 50 to 100 small laser burns at the drainage angle, where the iris and cornea meet, making tiny holes in the meshwork through which the aqueous fluid normally drains thus opening up blocked drainage channels and increasing the outflow rate of aqueous fluid. This relatively brief procedure can be done in an ophthalmologist's office.
Trabeculectomy creates an artificial channel for fluid outflow in advanced cases in which the inner-eye pressure is high and the optic nerve continues to be damaged. Results vary, but generally the success rate is high.
CONSIDERATIONS
Surgery has certain advantages over medication, such as reduced out-of-pocket costs. However, it has disadvantages as well. An estimated 40 percent of people who undergo surgery for glaucoma experience no improvement, and the procedure may have to be repeated; approximately 15 percent report a decline in their quality of life after surgery.
The conventional treatment for acute closed-angle glaucoma is to immediately reduce eye pressure by employing an osmotic diuretic agent, followed by surgery. These osmotic agents (applied as eye drops) almost always act immediately to alleviate symptoms. However, surgery is still recommended because without it, the attacks are likely to recur, and each attack can cause additional irreversible vision damage. Using only osmotic agents can lull a person into thinking that his or her condition is improving while in fat it is worsening rapidly.
Agents that act to dilate the pupils, such as ephedra and belladonna, should be avoided at all costs.
Vitamin C supplementation has been demonstrated to lower intraocular pressure in several clinical studies. Nearly normal tension levels have been achieved in some people who were unresponsive to conventional therapies. Intravenouse administration of vitamin C has yielded even greater initial pressure reduction, but close monitoring by a health care provider is necessary to determine required dosage. The role vitamin C plays in collagen formation may be the key to its action.
Bioflavonoid supplementation prevents the breakdown of vitamin C in the body before it is metabolized. It also improves capillary integrity and stabilizes the collagen matrix by preventing free radical damage. The bioflavonoid rutin is known to help in lowering ocular pressure when used in conjunction with conventional drugs. Bilberry extract is particularly rich in this beneficial flavonoid compound. It is also good for diabetic retinopathy.
Corticosteroids can induce glaucoma by destroying collagen structures in the eye. If you must take corticosteroids, you should take the smallest amount possible and for the shortest possible time. If you have glaucoma, you should avoid these medications entirely.
Beta-blocking eye drops, which are often prescribed for people with glaucoma, have a number of side effects. They tend to cause unfavorable changes in blood fats, lowering the proportion of high-density lipoproteins (the so-called "good" cholesterol) to low-density lipoproteins (or "bad" cholesterol). In addition, the incidence of hip fracture among beta-blocker users is roughly three times greater than that seen in the general population. This is attributed to the dizziness and fainting experienced by some people who take these medications. Vision loss compounds the risk of falls and other accidents. Hip fracture is a major health threat among postmenopausal women.
Forskolin, an extract from the coleus plant, has been reported by Yale University to be effective for glaucoma, without causing side effects.
HERBAL & HOLISTIC RECOMMENDATIONS
Unless otherwise specified, the dosages recommended here are for adults. For a child between the ages of 12 and 17, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12, use 1/2 the recommended dose, and for a child under the age of 6, use 1/4 the recommended amount.
HERBS
- Bilberry contains flavonoids and nutrients needed to protect the eyes from further damage. Fresh blueberries and red raspberry leaf can be used also.
- Chickweed and eyebright are good for all eye disorders.
- Eye baths using warm fennel tea, alternating with chamomile and eyebright, are helpful. Or use an eye dropper and apply 3 drops to each eye three times a day. Always dilute any herbal preparations used in the eyes. Caution: do not use chamomile on an ongoing basis, as ragweed allergy may result. Avoid it completely if you are allergic to ragweed.
- A combination of gingko biloba extract and zinc sulfate may slow progressive vision loss.
- Rose hips supply valuable flavonoids and vitamin C.
- Avoid the herbs ephedra (ma huang) and licorice.
RECOMMENDATIONS
- Follow the supplementation program outlined below.
- If your ophthalmologist recommends medication to control glaucoma and it is working to your satisfaction, continue to use it faithfully. Also take vitamin C in high doses, but only under supervision.
- Avoid prolonged eye stress such as watching television, reading, and using a computer for long periods. If you must engage in close work for any length of time, take periodic "focus breaks" and every 20 minutes or so, raise your eyes and focus on something in the distance for a minute or so.
- Avoid tobacco smoke, coffee, alcohol, nicotine, and all caffeine.
- Drink only small amounts of liquid at any given time.
- Avoid taking high doses of niacin (over a total of 200 mg daily).
Nutrients Supplement Suggested Dosage Comments Very Important Choline
And
Inositol
Or
Lecithin1,000-2,000 mg daily.
As directed on label.Important B vitamins for the eyes and brain.
A good source of choline and inositol.Glutathione 500 mg twice daily, on an empty stomach. Take with 50 mg vitamin B6 and 100 mg vitamin C for better absorption. A powerful antioxidant that protects the lens and maintains the molecular integrity of the lens fiber membranes. Omega-3 essential fatty acids As directed on label. Take with meals. Protects and aids repair of new tissues and cells. Rutin 50 mg 3 times daily. An important bioflavonoid that works with vitamin C and aids in reducing pain and intraocular pressure. Vitamin A
Plus
Natural beta-carotene
Or
Carotenoid complex (Betatene)50,000 IU daily. If you are pregnant, do not exceed 10,000 IU daily.
25,000 daily, with meals.
As directed on label.Needed for good eyesight. Essential in formation of visual purple, the substance necessary for night vision. Vitamin B complex 50 mg 3 times daily, with meals. Use a sublingual form. Injections (under a health care provider's supervision) may be necessary. Whenever stress is a factor, B-complex injections are a good idea. Vitamin C with bioflavinoids 10,000 - 15,000 mg daily, in divided doses. Under a health care provider's supervision, you can increase the dose to 30,000 mg daily. Reduces intraocular pressure. Vitamin E 400 IU daily. Helpful in removing particles from the lens of the eye. Antioxidant properties protect the lens and other eye tissues. Helpful Taurine Plus from American Biologics As directed on label. An antioxidant that protects the lens of the eye. Multivitamin and mineral complex
With
SeleniumAs directed on label.
200 mcg daily.All nutrients are needed to aid in healing and to reduce intraocular pressure.
A potent antioxidant that works with vitamin E.Zinc lozenges 50 mg daily. Do not exceed a total of 100 mg daily from all supplements. Essential in activating vitamin A from the liver. Very beneficial in glaucoma therapy. Use zinc sulfate form.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You have symptoms of acute glaucoma. You need immediate medical attention to prevent potentially permanent eye damage or blindness.
You become drowsy, fatigued or short of breath after using eye drops containing beta-adrenergic blockers such as timolol, betaxolol or levobunolol. The medication may be aggravating a heart or lung problem.
You are prescribed drugs for other ailments. Many medications, especially those used to treat stomach and intestinal disorders, as well as some allergy or medications, may aggravate glaucoma.
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch
LINKS
The Glaucoma Foundation
