Glaucoma: Are You Protected?

A man with glasses is smilingGlaucoma occurs about five times more often in African-Americans, and blindness from glaucoma is about six times more common. In addition to this higher frequency, glaucoma often occurs earlier in life in African-Americans—on average, about 10 years earlier than in other ethnic populations.

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The disease is often a silent killer — it has no obvious symptoms early on. In fact, as many as half of all people with glaucoma do not know they have the condition. Regular eye exams are important for diagnosing and treating glaucoma — and early treatment is key to saving eyesight.

Glaucoma is actually a group of diseases that can harm the optic nerve, the part of the eye that transmits images to the brain. In most cases, glaucoma occurs when there is an increase in the normal fluid pressure inside the eye. That pressure can damage the optic nerve, causing vision loss and blindness.

Doctors don’t know what causes glaucoma, but they have noted certain risk factors:

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•    Being 65 years of age or older
•    Having a family history of glaucoma
•    Being of African, Asian, or Spanish descent
•    Being nearsighted or farsighted
•    Having had a past eye injury

The Types of Glaucoma

Open-angle glaucoma is the most prevalent type of this eye disease, but it’s not the only one:

•    Open-angle glaucoma. In healthy eyes, eye fluids flow into, out of, and around the eye at the open angle where the cornea and iris meet; this angle acts like a drain. Open-angle glaucoma occurs when the fluid doesn’t flow out easily from this drain, causing a build-up of fluid pressure in the eye. That pressure can damage the optic nerve, leading to decreased peripheral (side) vision and vision loss. In the early stages of the disease, people with this type of glaucoma have no symptoms — no pain or changes in vision. They may not know they have it until the disease progresses and their peripheral vision becomes affected. Over time, they lose more of their side vision and can eventually become blind.
•    Normal-tension glaucoma. Sometimes damage to the optic nerve can occur in people with normal eye pressure. Doctors are not sure why this happens, but risk factors for normal-tension glaucoma, also called low-tension glaucoma, include a family history of any type of glaucoma or a history of cardiovascular disease.
•    Angle-closure glaucoma. This rare type of glaucoma happens when the iris blocks the drain part of the eye. Because eye fluid cannot drain out, pressure can build very quickly, leading to vision loss. Symptoms of angle-closure glaucoma include headache, eye pain, nausea, redness of the eye, and blurred vision. Anyone with these symptoms should seek immediate medical attention. Without treatment, you can lose your sight in just one or two days.
•    Congenital glaucoma. This rare, sometimes inherited, type of glaucoma is present at birth. A defect in the drainage system of the eye builds fluid pressure inside the eye, damaging the optic nerve. Symptoms of congenital glaucoma are a cloudy-looking cornea, sensitivity to light, and excessive tearing.

What Is Secondary Glaucoma?

Secondary glaucoma can develop because of an eye injury, eye surgery, inflammation, certain eye tumors, or advanced cataracts. This type of glaucoma can also be a side effect of some drugs, such as corticosteroids. Types of secondary glaucoma include:

•    Pigmentary glaucoma. Pigment granules from the back of the iris break off and block eye drainage.
•    Pseudoexfoliative glaucoma. A flaky material peels off the outer layer of the eye’s lens and impedes proper drainage.
•    Traumatic glaucoma. Caused by an eye injury, this glaucoma can occur immediately afterwards or years later.
•    Neovascular glaucoma. Often linked to diabetes, neovascular glaucoma is marked by the abnormal formation of blood vessels that grow over the iris, blocking drainage.
•    Iridocorneal endothelial syndrome. This rare form of glaucoma usually occurs in one eye, as cells from the back surface of the cornea spread over its drainage area.

How Glaucoma Is Diagnosed

Because glaucoma symptoms are usually not noticeable until the disease has progressed, early detection and screenings are essential. It can be such a gradual thing that you could be asymptomatic until you lose most of your vision.

Adults who have no signs or risks for eye disease such as glaucoma should get a baseline eye screening exam starting at age 40. If you have any risk factors for glaucoma, screenings should be done every two years, regardless of your age. People age 65 and older should see their eye doctor every one to two years to check for glaucoma and other eye diseases, because risk increases with age.

During a glaucoma exam, your doctor will conduct a tonometry test to measure the pressure inside the eye, as well as an ophthalmoscopy to look at the inside of the eye — the optic nerve in particular. The eye exam may also include a visual acuity test to determine how well you see at various distances, a visual field test to measures your peripheral vision, and a pachymetry test, which measures the thickness of your cornea.

Ways You Can Manage Glaucoma

In the early stages of glaucoma, medication in the form of eye drops or pills can help. Medication can lower pressure in the eye by causing the eye to make less fluid or by helping fluid drain from the eye.

If medication doesn’t help, doctors may recommend surgery. One type of surgery for glaucoma is laser trabeculoplasty, in which a laser is used to stretch the drainage holes to help fluid drain better. If laser surgery isn’t effective, or if the problem occurs again over time, doctors may suggest conventional surgery. This procedure is called filtering microsurgery and involves making a new drainage hole for fluid to leave the eye.

With early detection and treatment, many patients with glaucoma can retain their eyesight and ward off vision impairment.

Natural Remedies For Glaucoma

eye doctor examLook out for the health of your eyes—steer clear of this condition caused by pressure within the eyeball. According to research or other evidence, the following self-care steps may help prevent vision loss:

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What You Need To Know:

  • Give C a try for healthier eyes
    Reduce intraocular pressure by taking at least 2 grams a day of vitamin C
  • Go for the Ginkgo
    To improve vision in cases of normal tension glaucoma, take 120 mg a day of a standardized extract of the herb Ginkgo
    biloba
  • See an expert
    Visit an optometrist or ophthalmologist for regular eye tests that can detect the early signs of glaucoma

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These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full glaucoma article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

Dietary changes that may be helpful
At least two older reports claimed that allergy can be a triggering factor for glaucoma. Although an association between allergy and
glaucoma is not generally accepted in conventional medicine, people with glaucoma may wish to consult a physician to diagnose and treat possible allergies.

Other therapies
Surgical procedures, such as laser trabeculoplasty and trabeculectomy, can increase fluid drainage from the eye to relieve pressure.

Vitamins that may be helpful
Several studies have shown that supplementing with vitamin C can significantly reduce elevated intraocular pressure in individuals
with glaucoma. These studies used at least 2 grams per day of vitamin C; much larger amounts were sometimes given. Higher quantities of vitamin C appeared to be more effective than smaller amounts.

Doctors often suggest that people with glaucoma take vitamin C to “bowel tolerance.” The bowel-tolerance level is determined by progressively increasing vitamin C intake until loose stools or abdominal pain occurs, and then reducing the amount slightly, to a level that does not cause these symptoms. The bowel tolerance level varies considerably from person to person, usually ranging from about 5 to 20 or more grams per day. Vitamin C does not cure glaucoma and must be used continually to maintain a reduction in intraocular pressure.

Many years ago, the flavonoid rutin was reported to increase the effectiveness of conventional medication in people with glaucoma. The amount used—20 mg three times per day—was quite moderate. In that study, 17 of 26 eyes with glaucoma showed clear improvement. Modern research on the effects of rutin or other flavonoids in people with glaucoma is lacking.

Supplementing with 0.5 mg of melatonin lowered intraocular pressure of healthy people, but there have been no studies on the effects of melatonin in people with glaucoma.

Magnesium can dilate blood vessels. One study looked at whether magnesium might improve vision in people with glaucoma by enhancing blood flow to the eyes. In that trial, participants were given 245 mg of magnesium per day. Improvement in vision was noted after four weeks, but the change did not reach statistical significance.

Alpha lipoic acid (150 mg per day for one month) improves visual function in people with some types of glaucoma.

Surveys have shown that Inuit people, who consume large amounts of omega-3 fatty acids, have a much lower incidence of some types of glaucoma than do Caucasians. Although there have been no studies on the use of omega-3 fatty acids to treat glaucoma, one study found that cod liver oil (a rich source of omega-3 fatty acids) reduced intraocular pressure in animals.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful
In a double-blind study, supplementation with a standardized extract of Ginkgo biloba in the amount of 40 mg three times a day for four weeks partially reversed visual field damage in people with one type of glaucoma (normal tension
glaucoma).

Studies in healthy humans, including at least one double-blind trial, have repeatedly shown that intraocular pressure is lowered by direct application of forskolin, a constituent of the Ayurvedic herb Coleus forskohlii. Until ophthalmic preparations of coleus or forskolin are available, people with glaucoma should consult with a skilled healthcare practitioner to obtain a sterile fluid extract for use in the eyes. Direct application of the whole herb to the eyes has not been studied and is not advised.

Dan shen (Salvia miltiorrhiza), a traditional Chinese herb, used either alone or combined with other Chinese herbs for 30 days was reported to improve vision in people with glaucoma. However, the herb was administered by muscular injection, a preparation that is not readily available in North America or Great Britain. It is not known whether oral use of the herb would have the same
effect.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.