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  Glaucoma/Risk  
 
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Signs, symptoms and indicators | Contributing risk factors | Other conditions that may be present | Recommendations

 

Glaucoma is a group of diseases that can lead to damage to the eye's optic nerve and result in blindness. Open-angle glaucoma, the most common form of glaucoma, affects about 3 million Americans--half of whom don't know they have it. It has no symptoms at first. But over the years it can steal your sight. With early treatment, you can often protect your eyes against serious vision loss and blindness. In many people, increased pressure inside the eye causes glaucoma. In the front of the lens of the eye is a space called the anterior chamber. A clear fluid flows continuously in and out of this space and nourishes nearby tissues. The fluid leaves this anterior chamber at the angle where the cornea and iris meet. When the fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye.

Open-angle glaucoma gets its name because the angle that allows fluid to drain out of the anterior chamber is open, as it should be. However, for unknown reasons, the fluid passes too slowly through the meshwork drain. As the fluid builds up, the pressure inside the eye rises. Unless the pressure at the front of the eye is controlled, it can result in damage to the optic nerve at the back of the eye and cause vision loss.

At first, open-angle glaucoma has no symptoms. Vision stays normal, and there is no pain. As glaucoma remains untreated, people may notice that they get tunnel vision - although they see things clearly in front of them, they miss objects to the side and out of the corner of their eye. Over time, without treatment, the remaining forward vision may decrease until there is no vision left.

Conventional treatment by doctors includes medications for newly diagnosed glaucoma, laser surgery (a safe and effective alternative) or conventional surgery to create a new drain to relieve the pressure.

Although open-angle glaucoma is the most common form, some people have other forms of the disease.

Low-tension or normal-tension glaucoma: Optic nerve damage and narrowed side vision occur unexpectedly in people with normal eye pressure. People with this form of the disease have the same types of treatment as open-angle glaucoma.

Closed-angle glaucoma: The fluid at the front of the eye cannot reach the angle and leave the eye because the angle gets blocked by part of the iris. People with this type of glaucoma have a sudden increase in pressure. Symptoms include severe pain and nausea as well as redness of the eye and blurred vision. This is a medical emergency. Without treatment, the eye can become blind in as little as one or two days. Usually, prompt laser surgery can clear the blockage and protect sight.

Congenital glaucoma: Children are born with defects in the angle of the eye that slow the normal drainage of fluid. Children with this problem usually have obvious symptoms such as cloudy eyes, sensitivity to light, and excessive tearing. Surgery is usually the suggested treatment, because medicines may have unknown effects in infants and be difficult to give to them. The surgery is safe and effective. If surgery is done promptly, these children usually have an excellent chance of having good vision.

Secondary glaucomas: Can develop as a complication of other medical conditions. They are sometimes associated with eye surgery or advanced cataracts, eye injuries, certain eye tumors, or uveitis (eye inflammation). One type, known as pigmentary glaucoma, occurs when pigment from the iris flakes off and blocks the meshwork, slowing fluid drainage. A severe form, called neovascular glaucoma, is linked to diabetes. Also, corticosteroid drugs - used to treat eye inflammations and other diseases - can trigger glaucoma in a few people.
 

 
 

Signs, symptoms & indicators of Glaucoma/Risk:
 
 
Symptoms - Head - Eyes/Ocular  Seeing visual halos
  Enlarged blind spot
 In glaucoma, as the nerve fibers die from compression due to increased intraocular presssure, the blind spot tends to enlarge and enlongate. This is one of the diagnostic hallmarks of glaucoma.


Counter-indicators:
  Absence of seeing visual halos
 
 

Risk factors for Glaucoma/Risk:
 
 
Personal Background  African ethnicity
 Blacks over the age of 40 have a higher risk of glaucoma.

Symptoms - Head - Eyes/Ocular

  (Family) history of glaucoma
 A family history of glaucoma is a risk factor for developing glaucoma. Both parents contribute genes to their children. Genes are the material which control all the cells that make up the human body. If an ancestor had open angle glaucoma, the 'glaucoma gene' may have been passed on to subsequent generations. We currently have no way of knowing which descendents will develop glaucoma and which ones will not be affected. Family history also appears to play a role in two syndromes which may predispose individuals to open angle glaucoma. These are called Pigmentary Dispersion Syndrome and Pseudoexfoliation Syndrome.
 
 

Glaucoma/Risk suggests the following may be present:
 
 
Nutrients  Vitamin B1 Requirement
 38 pateints with chronic open-angle glaucoma (average age of 63 years) were found to have significantly lower blood vitamin B1 (thiamine) levels than 12 normals (average age 53 years) despite roughly equal dietary intakes, suggesting poor thiamine absorption. [Ann Ophthalmol 1979; 11( 7): pp.1095 - 1100]

In glaucoma, thiamine deficiency may be associated with optic nerve atrophy whose symptoms may be at least partly reversible upon restored thiamin status. Most cases of moderate optic atrophy associated with hypovitaminosis B could be cured with 100mg thiamine and vitamin B complex given IM for 10 days and followed by oral supplements. Patients with early or moderate cupping improved visually, and their fields remained static or improved slightly. Intraocular pressure only improved somewhat.
 
 

Recommendations for Glaucoma/Risk:
 
 
Botanical  Coleus (Coleus forskohlii)
 Studies in healthy humans, including at least one double-blind trial, have shown that direct application of an ophthalmic preparation of forskolin to the eyes lowers eye pressure, thus reducing the risk of glaucoma. [Lancet 1983;1: pp.958-60, Klin Monatsbl Augenheilkd 1984;185: pp.522-6] Direct application of the whole herb to the eyes has not been studied and is not recommended.

Diet

  Caffeine/Coffee Avoidance
 Based on the experimental evidence, caffeine use is not a factor to be concerned about in glaucoma management. [Editorial in Ophthalmology, 1990; 97( 8): pp.965 - 6]

However, a single dose of caffeinated coffee (but not decaffeinated coffee) can increase intraocular pressure in persons with glaucoma. [ Ann Pharmacother 2002;36(6): pp.992-5]

  Therapeutic Fasting
 While the intraocular pressure in glaucoma falls during a fast, it would be a mistake to remove medication prematurely and fail to monitor eye pressure carefully. Glaucoma can be helped by fasting but you should not assume the gains made during the fast will be permanent.

  Reduced Water Consumption
 Caution is recommended regarding excessive water consumption at one sitting. It appears to be safer to use smaller quantities throughout the day. It is well known that rapid ingestion of large volumes of fluid will increase aqueous production and cause an elevation in intraocular pressure. Perhaps patients with glaucoma should be instructed to limit their fluid intake to no more than 8 ounces per hour. [ Ophthalmology 1990; 97( 8): pp.965 -6]

  Reduced Protein Diet
 Based on a case-control study of 400 eye patients, including 52 with ocular hypertension and/or glaucoma, the pigmentary-dispersion glaucomas, and likely also pseudoexfoliative glaucoma, are strongly associated with excessive protein intake (greater than 3 times the US RDA) [J Am Coll Nutr 10( 5): 536, 1991]

Drug

  Conventional Drugs / Information
 Nearly all the medications for glaucoma are aimed at reducing eye pressure. Lowering IOP is even proving to be beneficial for about two-thirds of patients with normal pressure glaucoma.

Often, glaucoma is treated first with medication or laser therapy is tried. If these treatments fail or are thought likely to fail, filtration surgery is offered. However, in certain situations (especially when medication cannot be tolerated) filtration surgery may be used initially.

With new glaucoma drugs, such as topical alpha2-selective adrenergic agonists, topical carbonic anhydrase inhibitors, and topical prostaglandin analogs, medical therapy is slowly changing.

Lab Tests/Rule-Outs

  Eye Doctor / Ophthamologist

Nutrient

  Alpha Lipoic Acid
 150mg per day improves visual function in people with both stage I and stage II glaucoma. [Vestn Oftalmol 1995;111: pp.6-8]

Vitamins

  Vitamin C (Ascorbic Acid)
 Supplementing with vitamin C can significantly reduce elevated intraocular pressure in individuals with glaucoma. Higher quantities of vitamin C appear to be more effective than smaller amounts and the benefit is lost if vitamin C is discontinued. The suggested minimum dose is 2gm per day. [J Holistic Med 1981;3: pp.167-72.]

Glaucoma patients who took at least 10gm vitamin C daily had a significant reduction in intraocular pressure, with an average decline of 5.6 mm of pressure. [J Orthomol Med 1995; 10: pp.165 - 8]
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Very strongly or absolutely counter-indicative
May do some good
Likely to help







GLOSSARY

Anterior:  In the front or forward part of the organ or toward the head of the body.

Cataract:  A steadily worsening disease of the eye in which the lens becomes cloudy as a result of the precipitation of proteins. Most cataracts are caused by the functions of the body breaking down. Eye trauma, such as from a puncture wound, may also result in cataracts.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Cornea:  Transparent structure forming the anterior part of the eye.

Corticosteroid:  Steroid hormone produced by the adrenal cortex.

Diabetes Mellitus:  A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Glaucoma:  A disease of the eye characterized by vision loss due to an increase in the pressure of fluid within the eye. This rise in pressure results from a build-up of aqueous fluid and leads to progressive damage to the optic nerve that transmits visual signals to the brain. Over time, glaucoma can lead to a gradual loss in peripheral vision. There are usually no signs that you're developing glaucoma until vision loss occurs.

Milligram:  (mg): 1/1,000 of a gram by weight.

Nausea:  Symptoms resulting from an inclination to vomit.

Thiamine:  (Vitamin B-1): A B-complex vitamin that acts as a coenzyme necessary for the conversion of carbohydrates into glucose, which is burned in the body for energy. It is essential for the functioning of the nervous system.