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Glaucoma

MagazineApril 2009 (Vol. 20 Issue 1)Glaucoma

In glaucoma, there is elevated pressure within the eye caused by an obstruction in the flow of the aqueous humor, the fluid that fills the eye

In glaucoma, there is elevated pressure within the eye caused by an obstruction in the flow of the aqueous humor, the fluid that fills the eye.

Acute glaucoma is accompanied by extreme eye pain, blurred vision, redness of the eye and dilation of the pupil. Nausea and vomiting can also be symptoms. If untreated, acute glaucoma results in com-plete-and permanent-blindness within two to five days.

Chronic glaucoma may produce no symptoms at all, except for a gradual loss of peripheral vision over a period of years. In addition, there may be headache, blurred vision and a dull pain in the eye.

Conventional treatments

Acute glaucoma can be treated with eyedrops to constrict the pupil and draw the iris away from the cornea, osmotic agents to lower intraocular pressure, acetazol-amide to reduce fluid formation and surgical iridectomy to create an exiting pathway for the aqueous humor.

Chronic glaucoma is usually con-trolled by pilocarpine eyedrops, carbonic anhydrase inhibitors, epi-nephrine (adrenaline) eyedrops or timolol, a beta-adrenergic blocker.

It is curious to note that, while epinephrine is used in the main-stream treatment of glaucoma (Anderson KN et al. Mosby's Medical, Nursing & Allied Health Dictionary, 5th edn. St Louis, MO: Mosby, 1998: 694), its near equivalent in medical herbalism-Ephedra sinica (ma huang)-is contraindicated (HerbalGram, 1995; 34: 22-7, 42-3, 56-7; Health Canada. Advisory Not to Use Products Containing Ephedra or Ephedrine. Ottawa, Ontario, Canada: online at:

Nevertheless, conventional treat-ments come with a number of drawbacks. Eyedrops can cause blurred or dim vision, night-blind-ness, and redness and itching ofthe eye.

The side-effects of oral options include gastrointestinal disorders, skin rash, fatigue, impotence, weight loss and depression.

Happily, there are many effective alternative treatments.

Acupuncture

According to traditional Oriental medicine, glaucoma is due to a state of depleted Kidney Yin. This causes Wind and Fire in the Liver and Gall Bladder to ascend, disrupting the chi (Qi) in those channels (Bensky D. Acupuncture: A Comprehensive Text. Seattle, WA: Eastland Press, 1984: 681).

Acupuncture has proved to be clearly effective in the treatment of glaucoma in its early stages, although the intraocular pressure needs to be regularly monitored. If the condition is allowed to progress to more severe stages, other methods must be considered in addition to acupuncture.

Phytotherapy

Herbal treatment generally involves three botanical medicines:

- Coleus forskolii root contains forskolin, a small molecule shown to reduce pressure within the eye, applied in a 1-per-cent formulation as eyedrops (S Afr Med J, 1987; 71: 570-1; Jpn J Oph-thalmol, 1986; 30: 238-44; Lancet, 1983; i: 958-60).

- Ginkgo biloba (maidenhair tree) extract at a dose of 160 mg/day for four weeks, followed by 120 mg/day, has resulted in improve-ment (Klin Monatsbl Augenheilk, 1980; 177: 577-83).

- Salvia miltiorrhiza (Chinese sage) root proved to have long-term therapeutic success when used as an injectible solution

(2 g in 1 mL of solution) admin-istered intramuscularly daily to 121 patients (with a total of 153 eyes), all of whom had middle-

or late-stage glaucoma that could only be controlled to within normal ranges by either surgery or the use of miotics, drugs that constrict the pupil (Chin Med J, 1983; 96: 445-7).

Supplements

Supplements may also be effective, judging by the results of uncon-trolled clincal trials reported in the literature (Werbach MR. Textbook of Nutritional Medicine. Tarzana, CA: Third Line Press, 1999: 395). These used:

- alpha-lipoic acid (150 mg/ day)

- vitamin B12 (5000 mg/day)

- chromium (200 mg/day)

- magnesium (400 mg/day)

- thiamine (50 mg/day).

Dietary factors

Certain dietary measures may also be important, as two small studies appear to suggest that intraocular pressure can be increased within two hours of having consumed caffeinated espresso, but not decaffeinated espresso (Ophthal-mology, 1989; 96: 1680-1; Ophthalmology, 1989; 209: 11-3).

Combined approach

A combination of supplements and dietary measures have been shown to be successful in cases involving hundreds of West African patients who had primary glaucoma. The patients were treated with a combination of:

- vitamin A (180,000 IU/day)

- vitamin C (3 g/day)

- vitamin E (200 IU/day).

As many of these patients were also protein-deficient, a 20-g pro-tein supplement was also provided every day. In most cases, ocular tension was reduced to normal within one week (Nutr Metabol, 1977; 21 [suppl 1]: 268-72).

Harald Gaier

Harald Gaier, a registered naturopath, osteopath, homeopath and herbalist, practises at The Allergy and Nutrition Clinic, 22 Harley Street, London, and the Irish Centre of Integrated Medicine, Co. Kildare (www.drgaier.com).


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