by Marc R. Rose
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Steroid-Induced Glaucoma
This is a form of toxic glaucoma brought on by longterm use of oral or inhaled steroid medications such as those prescribed for asthma. Even steroid skin creams, used over long periods, are absorbed into the system sufficiently to act as an optic nerve toxin. Steroid drugs rob the body of vitamin C, and the concentration of this antioxidant in the eyes is many times higher than in the rest of the body. Chronically high stress levels have the same effect on vitamin C levels; this makes sense, because the body’s stress hormones are steroids and have the same (although less intense) action as steroid drugs. Use the natural anti-inflammatory measures I describe throughout this book.
Glaucoma Caused by Inflammation or Malnutrition
Eye infections such as those caused by herpes or other viruses, or in chronic inflammatory conditions, mean increased risk of glaucoma. What do you think most doctors will prescribe to control inflammation in the eye? Ironically, steroids, which, as you know by now, can cause glaucoma.
Malnutrition, poor absorption of crucial nutrients through the walls of the intestines, and pernicious anemia (usually caused by problems making or absorbing the vitamin B12 and often treated with B12 injections) also can lead to optic nerve damage and vision loss.
Mainstream Treatments for Glaucoma
Drugs Used to Treat Glaucoma
Drugs designed to relieve fluid pressure around the optic nerve make up the conventional treatment plan for this disease. If you have primary open-angle glaucoma or ocular hypertension, your eye doctor will probably prescribe one or more of the following medications:
Beta-blocker Eye Drops
Beta-blocker eye drops (Levobunolol, AKBeta, Betagan Liquifilm, Betoptic, OptiPranolol, Ocupress, Timolol, Betimol, Timoptic) decrease pressure by slowing the production of fluid in the eye. Side effects are common with any beta-blocker drug. You may experience depression, decreased sex drive, lowered heart rate, balance loss, or breathing problems while using this medication. It should not be used by people with asthma or by those who are already taking beta-blockers orally to treat other conditions. It’s crucial that you use only the dose prescribed; more isn’t better in this instance.
Apraclonidine HCl (Iopidine), an alpha-agonist eye drop that has the same pressure-lowering effect as the beta-blockers, is often used in addition to other medications if they are not sufficiently reducing eye pressure. Often it is prescribed to counteract the rise in eye pressure that can occur after eye surgery. A new alpha-agonist eye drop is brimonidine tartrate (Alphagan).
Epinephrine/Sympathomimetic Eye Drops
Epinephrine/sympathomimetic eye drops (Glaucon, Epinephrine HCl, Epifrin, Epinal) increase outflow through the fluid drain of the eye. Epinephrine causes stinging and burning when used, and vision may be blurry for a while after instillation. It should be used with caution in those with history of high blood pressure, diabetes, overactive thyroid gland, heart disease, stroke, or asthma. These drops can cause your blood pressure to shoot up, heart rate to speed up or become irregular, or may bring on anginal pains in susceptible people. Some people feel light-headed or faint when using these eye drops. Long-term use can lead to pigment deposits on the cornea and in the eye membranes (conjunctiva). If the drops become discolored or separated, you should throw them away. We don’t recommend these drugs because of their dangerous side effects. There are other more effective and safer drugs available.
Dipivefrin HCl (Propine, AKPro) is a substance that turns into epinephrine when dropped into the eye. The side effects are milder and it should be used by those with risk for dangerous side effects with epinephrine. Rise in blood pressure and rapid or irregular heartbeat can occur with this medication as well, but there is much less stinging with these drops.
Miotics/Parasympathomimetic Eye Drops
Miotics/parasympathomimetic eye drops (carbachol, pilocarpine, or combinations of these; there are dozens of brand names) also work to increase outflow of fluid from the eye. They have fewer side effects than other pressure-relieving eye drops.
These medications work by stimulating the muscles that change the dimensions of the lens. Resistance to outflow of fluid is reduced.
These drugs are inappropriate for some forms of secondary glaucoma and are not advisable for those who have ulcers, hyperthyroidism, cramps in the digestive tract, urinary tract obstruction, Parkinson’s disease, recent heart attack, or high or low blood pressure. In some people they can cause retinal detachment; be certain that your eye doctor checks to see if you are at risk for this problem before you start with miotics. When using these medications, use caution while driving at night or performing any task in dim light because they can adversely affect your ability to adjust to dark environments.
There are two main categories of miotic eye drops: pilocarpine and carbachol. All may sting when drops are put into the eyes, can cause headache or browache, decrease night vision, and should not be used by those who have asthma. Systemic side effects range from heart rate and blood pressure abnormalities to gastrointestinal distress, while effects on the eyes include tearing, blurred vision, and lens cloudiness with long-term use.
Carbonic Anhydrase Inhibitors
Carbonic anhydrase inhibitors (oral or drop form; trade names include Trusopt, Diamox, Neptazane) are named after the enzyme carbonic anhydrase, which is found in many tissues of the body, including the eye. Inhibition of its activity in the eye decreases eye fluid production. One of the major side effects of this drug, especially when taken orally (as a pill) can be photosensitivity, which makes the eyes more susceptible to oxidation damage—the last thing someone with glaucoma needs! Other side effects of taking it orally can include kidney stones, numbness or tingling, fatigue, lethargy, loss of appetite, depression, diminished libido, dementia, or nausea. Some people have allergic reactions to carbonic anhydrase.
These drugs are often prescribed with vitamin C, which helps to prevent kidney stones. Anyone with kidney problems should be very cautious in using carbonic anhydrase inhibitors. If you are using oral carbonic anhydrase inhibitors, you should have regular blood testing to make sure your white blood cell counts are normal. The drops tend to have far fewer negative side effects than do the pills. We strongly recommend the drops over the pills.
Prostaglandin Eye Drops (Xalatan)
Prostaglandin eye drops are a newer treatment that can control eye fluid pressure by increasing outflow of aqueous humor. They have fewer side effects than beta-blocker eye drops. A harmless change of eye color from blue or green to brown may result from use of this medication. Temporarily blurred vision and burning and stinging when drops are instilled are side effects that occur in up to 15 percent of users, but Xalatan is the new drug of choice, especially for people who don’t tolerate the other medications well. These are among the best eye drops available for treating glaucoma.
Are the Risks Worth the Benefits?
I hope you’re starting to see how the benefits of these medications may sometimes be outweighed by their risks and that you’ll make sure they’re absolutely necessary before using them. Remember, not all vision loss in glaucoma is due to high pressure within the eyes.
Aggressive treatment of slightly raised intraocular pressure hasn’t had a very good track record of sight preservation in people with glaucoma. One research group revealed that although 20 percent of the adult population has eye pressure above 21 mm Hg (mercury), only 3 percent of the eyes below 23 mm Hg and only 8.4 percent of those with pressure above 23 mm Hg have narrowed visual fields. Attempts to treat glaucoma by lowering eye pressure are akin to attempts to alleviate heart disease by lowering blood cholesterol. Not only is it not always effective, but the treatments can prove more dangerous than the disease. An overdose of those potent medications can cause serious problems.
Most patients don’t stick with drug treatment of glaucoma because of the unpleasant side effects and the lack of noticeable improvement. In one study, almost half of patients didn’t p
roperly take their medication or forgot to take them.
Surgical Treatment of Glaucoma
Surgery is a last-resort treatment for glaucoma, but it may be necessary if there is continuing damage to the optic nerve despite maximum medical therapy. For decades we have seen thousands of patients a year, and based on that experience, we can’t recommend strongly enough that you aggressively treat your glaucoma with the lifestyle and nutritional changes outlined in this book before having surgery to treat glaucoma.
You should work closely with your eye doctor in making decisions about glaucoma surgery. He or she will try to determine whether vision loss from glaucoma is likely to affect your quality of life. Your ability to use medications properly will play a role; for example, you may have trouble getting eye drops into your eyes if your hands are shaky, or side effects may be too much to handle. If you have other eye problems, these will also have to be considered.
The surgery done in most cases of glaucoma is called trabeculectomy. A pressure-relief valve is surgically created out of the eye’s natural tissues. One of the possible side effects of this surgery is that inflammation and scarring can close up the drain following surgery. The most common side effect of glaucoma surgery is bleeding into the eye that usually clears up within a few days.
One study of ninety-three patients with open-angle glaucoma who underwent trabeculectomy showed that about half of the eyes operated on needed more surgery within five years, and that two-thirds needed more surgery within ten years to keep glaucoma under control. Developing cataracts or hastening the development of cataracts is a very common side effect with all eye surgery, but especially with glaucoma surgery.
Two recent studies discovered that a preservative used in glaucoma eye drops, benzalkonium chloride, was causing allergic and inflammatory responses in up to half of patients undergoing glaucoma surgery. We’ll address this topic at length in Chapter 14, “Basic Eye Care.”
A newer surgical procedure that involves implanting a synthetic drain into the eye is showing promise in cases that don’t respond to other surgical or drug treatments.
Lasers may also be used to shrink the tissues in the fluid drain to improve drainage, but this is only a short-term solution.
Again, we want to emphasize that the aggressive use of nutritional approaches to glaucoma is especially important, since the medical treatment maze for this disease is complicated and not always effective.
Nutritional Prescription for Glaucoma
Your best bet for preventing and treating glaucoma nutritionally is to maintain a balanced diet that emphasizes fresh vegetables and fruit, and includes several servings per week of cold-water fish. Eat a variety of low-fat protein, including eggs, turkey, chicken, and soy products such as tofu and tempeh. If you are a vegetarian, be sure you’re getting plenty of vitamins A and D and the B vitamins. Avoid rancid oils, hydrogenated oils, and processed meat products such as ham and bologna.
Studies have shown that the blood vessels that feed the retina are not up to par in people who have glaucoma, so one of your primary goals is to improve blood flow to that area. (See Chapter 10 for details on improving circulation.)
Foods to enjoy: blueberries, garlic (to decrease LDL cholesterol), asparagus, eggs, carrots, spinach, cold-water fish, any foods rich in vitamin C, almonds, onions, olive oil (use this in place of other cooking oils), avocados, and watermelon. Keep dietary fat below 30 percent of daily calories. Try to manage the stress in your life so that you stay in balance, get some exercise, and avoid optic nerve toxins like MSG, aspartame, steroid medications, tranquilizer medications, antidepressants (lithium and monoamine oxidase inhibitors), antibiotics, and tobacco.
Daily Supplements for Glaucoma
Vitamin C: 1,000 mg
Vitamin E: as recommended in your multivitamin
Carotenoids: Use a mixed carotenoid supplement at different times from your ingestion of beta-carotene-rich foods. A mixed carotenoid supplement should contain approximately 25,000 IU of beta-carotene, 1 mg of alpha-carotene, 5 mg of lycopene, 6 mg of lutein, and 0.3 mg of zeaxanthin. (The first detectable sign of optic nerve fiber loss in glaucoma is the dying off of carotenoid pigments from the retina.)
Vitamin A: 5,000–10,000 IU
Quercetin: 1,000–3,000 mg
Rutin: 1,000–3,000 mg (especially helpful if you are using miotics)
Magnesium: 250–400 mg, at bedtime (calcium channel blockers, medications that do the same thing in the body that magnesium does, are used in some cases of glaucoma to open up eye blood vessels. Why use a blunt instrument [the drug] instead of the natural version that works in concert with the systems of the body?)
Vitamin B complex: as recommended in your multi-vitamin
Vitamin B12: 1,000–2,000 mcg (Since it is not well absorbed when taken orally, take it sublingually—under the tongue—or use a nasal spray or gel.)
Zinc: as recommended in your multivitamin
Coenzyme Q10: 90–200 mg (Use with ginger root capsules for added effect if you have low-pressure glaucoma; this will increase your heart’s pumping capacity.)
Carnitine: 500 mg, to strengthen the heart’s pumping power
Omega-3 oils found in fish. Eat cold-water fish (salmon, mackerel, cod) at least twice a week, or take three to six 1,000 mg capsules of fish oil daily. (DHA, a component of omega-3 oils, is a component of the optic nerve lining.)
Garlic: 1 raw clove with food; or 1,000 mg of the odorless capsules
Coleus (forskolin): 200–400 mg (Coleus is an herbal remedy that has been used for centuries to relax muscles in blood vessel walls, thus easing high blood pressure and ocular hypertension. You can buy capsules under the name forskohlhii. It has been shown to significantly decrease eye pressure in drop form, but is not absorbed well and can temporarily cloud vision. If it clouds your vision, stop using it.)
Chromium: 200–600 mg a day if you are using beta-blocker eye drops, to help boost HDL cholesterol
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IN SHORT…
1. Glaucoma, the “sneak thief of sight,” can painlessly progress for some time before it is detected. Damage to the optic nerve causes this disease, and this damage can be due to elevated eye fluid pressure, poor circulation to the optic nerve, or plugging of the fluid drain.
2. While ocular hypertension puts you at greatly increased risk for glaucoma, it does not mean you have it for sure. Aggressive drug treatment of ocular hypertension may do more harm than watchful waiting and tracking of visual field loss, along with nutritional and lifestyle changes.
3. The only symptom of glaucoma is loss of side vision, which can develop into tunnel vision and eventually complete blindness. This painless process often goes unnoticed until there is significant vision loss.
4. A summary of the nutritional “Rx” for glaucoma can be found in Appendix I at the end of this book.
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6
Preventing and Healing Cataracts
Cataracts are quite common in aging Americans, affecting two-thirds of those over seventy years of age. Every year Medicare costs for cataract surgeries amount to more than $3.4 billion. As we age, the lenses of our eyes lose flexibility. Because there isn’t any cell turnover in the lenses, they have to last a lifetime. By the age of sixty-five, only 40 percent of light rays that hit the eye pass through the lens to the retina. (It’s interesting to note that cataracts protect against macular degeneration by blocking light to the retina.) Cataracts are caused by intense sun exposure, poor nutrition, or sugar accumulation in the lens of the eye.
The aspirin-sized lens is held in place by muscles that change its shape when focusing is necessary. In the aging process, the lens becomes unwieldy, inflexible, and thick, and clarity is lost, as is the ability to focus. It feels like looking through a piece of frosted glass, with disturbing glare from bright sun or oncoming headlights. The symptoms are so subtle that many simply think they need new glasses. By the age of eighty, cataract sufferers need a 240-watt bulb to see what they o
nce could with a 60-watt bulb.
The lens of the eye becomes clouded in people with cataracts.
As the lens yellows, color vision is altered. Clothes are mismatched or stains go unnoticed by the wearer. Blurred vision can result in falls. Independence may be lost. Family members may mistakenly think the person affected is senile.
Diabetics are prone to cataracts because excess sugar in the blood causes lenses to swell and lose transparency. People who live in sunny climates also are more likely to develop cataracts that worsen more quickly than people living in more cloudy areas. Heavy cigarette smokers have cataracts twice as often and at an earlier age than nonsmokers.
A clouded lens causes light coming into the eye to scatter, creating blurred vision.
Surgical replacement of cataracts is very effective and recovery time is short, but it’s always best to use nutritional means and lifestyle modifications to prevent eye problems. Antioxidants, control of blood glucose (in diabetics), and ultraviolet protection with sunglasses and wide-brimmed hats are the best ways to keep the lenses of your eyes clear and flexible.
Mainstream Treatment for Cataracts
Of all the eye diseases covered in this book, cataracts are most likely to be surgically treated with excellent results. As early as the mid-eighteenth century, lenses clouded by cataracts were removed surgically. The most cutting-edge technique for the removal of cataracts is phacoemulsificaton, a procedure that uses a tiny vacuum tube (called a cannula) inserted into the lens capsule to ultrasonically fragment the diseased lens. The fragments are then vacuumed from the eye. If you take a look at the diagram on page 102, you’ll see the location of the lens. A new lens, called an intraocular lens, is then inserted into the capsule from which the original lens was removed.
Cataract surgery is a relatively safe, simple surgery in which the clouded lens is removed and replaced.