Glaucoma

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

Signs and Symptoms

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

What Causes It?

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

Who's Most At Risk?

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

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

What to Expect at Your Provider's Office

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

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

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

Treatment Options

Prevention

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

Treatment Plan

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

Drug Therapies

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

Surgical and Other Procedures

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

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

Complementary and Alternative Therapies

A comprehensive treatment plan for glaucoma may include a range of complementary and alternative therapies.

Nutrition

Nutritional tips include the following.

• Eat foods rich in bioflavonoids and carotenes such as dark berries dark leafy greens and yellow and orange vegetables.
• Eliminate food allergens.
• Reduce foods that may dramatically alter levels of sugar in your blood such as sweets fruits and refined foods.

Potentially beneficial nutrient supplements include the following.

• Vitamin C (500 to 1 000 mg three times per day)
• Vitamin E (400 to 800 IU per day) and vitamin A (10 000 IU per day) or beta carotene (25 000 IU per day) thiamine (10 mg per day)
• Coenzyme Q10 (100 mg one to two times per day) which may minimize side effects of certain drug therapies
• Zinc (30 mg per day) and selenium (200 mcg per day)
• Omega-3 fatty acids (300 to 500 mg daily)
• Melatonin (2 to 5 mg before bed)

Herbs

The use of herbal remedies may offer relief from symptoms. Herbs are generally available as dried extracts (pills capsules or tablets) teas or tinctures (alcohol extraction unless otherwise noted). Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes).

• Bilberry (Vaccinium myrtillus) 100 to 200 mg two times per day
• Rutin 20 mg three times per day for associated allergies
• Hawthorn berries (Crataegus monogyna) 200 mg two times per day especially for high blood pressure
• Ginkgo (Ginkgo biloba) 120 mg two times per day to improve circulation
• Combine equal parts of ginkgo hawthorn bilberry and elderberry (Sambucus nigra) in a tea (three cups per day) or tincture (60 drops two times per day) to strengthen vascular tissues and improve circulation.

Homeopathy

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

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

Prognosis/Possible Complications

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

Supporting Research

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

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

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

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

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

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

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

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

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

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

Scalzo R. Therpeutic botanical protocol for glaucoma. Protocol J Botan Med. 1996; 2(1):78-79.

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

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.