Best New Treatment Advances for Glaucoma

One of my patients, Carol, came to see me, after a visit to the ophthalmologist, with great fear that she was going to go blind. She was told she had glaucoma in both eyes and needed to use drops to lower the pressure in the eyes. The doctor explained that if the pressure didn’t come down with the drops, she would need surgery to prevent permanent blindness. She was not looking forward to putting drops in her eyes for the rest of her life, and for sure didn’t want surgery. Of course, she came to me for help.

Glaucoma is a degeneration of the optic nerve. The nerve gradually loses neurons and gets smaller, leading to a steady loss of vision. This generally starts from the outside peripheral vision where there are fewer nerves. Then it progressively goes into the center of the eye. The loss of nerves is happening all over, but since there are fewer nerves in the peripheral vision, it is first noticed there. Most people who have mild glaucoma don’t even notice that they have a loss of vision. At some point they may have difficulty reading, or driving at night, and go to the eye doctor only to find that glasses won’t fix their sight. It’s too late – the nerve isn’t working.

Glaucoma is often thought of as high pressure in the eyes. It used to be thought that excessive pressure caused a lack of blood flow in the retina and optic nerve causing damage. Some doctors still believe this because is what was taught in medical school and it seems to make sense. However, there are a few problems with this hypothesis.

High Pressure without Glaucoma

A 20-year study of sixteen hundred people with high eye pressure showed 75% never develop glaucoma.[1] High eye pressure is common. By 40 years of age about 5% of people have high pressure in the eyes, but without glaucoma, or damage to the optic nerve. Around 75 years of age that increases to 8%.[2] Their eye pressure measures high, but they don’t have any vision changes or signs of optic nerve damage. (Interestingly, high eye pressure is associated with low systemic blood pressure.)

Normal Pressure Glaucoma

The other confounding factor in the theory of high eye pressure causing glaucoma is that there are many people with glaucoma, who lose their vision, but have normal pressure. In the United States up to 48% of those with glaucoma have normal eye pressure. In Japan it is up to 66%![3] This is called “Low-Tension Glaucoma.” In other words, these people are showing damage to the optic nerve, and losing their vision, but they don’t have high pressure in the eyes.

Pressure is NOT the Cause

If half of people with glaucoma have normal pressure, and only a fourth of those with high pressure in the eyes get glaucoma, why are we still saying high eye pressure causes glaucoma? It takes a LONG time for knowledge gained by research to reach the doctors providing care in the “trenches.” (This is a good reason to have a functional doctor on your side. 😊 ) Glaucoma, or damage to the optic nerve, is NOT caused by high pressure in the eyes. The pressure in the eyes is just a symptom of inflammation, which is sometimes associated with glaucoma, but not a cause.

Focusing on eye pressure to prevent loss of vision is like trying to prevent damage to your car’s engine with a blown gasket and the oil light on by filling it with more oil. That may turn the oil light off for a time, but the engine with an oil leak will still be more likely to get overheated and seize up. Stopping every few miles to add more oil may help a little, but you must fix the problem to prevent destruction of your engine.

In the same way, the current treatments for glaucoma that all revolve around lowering pressure in the eyeballs is misguided at best. Most people are having surgeries, injections, and putting drops in their eyes to lower the pressure unnecessarily because, despite high pressure, they will not get glaucoma. Moreover, treating high pressure only drops the risk of blindness by about half.[4] When you consider that 75% of those treated would never have developed glaucoma, it becomes obvious the current treatments are not adequate! We need something that really works so nobody goes blind.

Low Energy is the Cause

The first step in finding a good treatment is to know the cause. Since there are so many with glaucoma who don’t have high pressure, we may be able to determine a cause by looking at these people. The most consistent risk factors for low-tension glaucoma are:

• People with a family history of normal-tension glaucoma, such as people of Japanese ancestry
• People with a history of systemic heart disease such as irregular heart rhythm.[5]

There seems to be one or more genetic defects, in some people that makes them more susceptible to glaucoma, probably due to a loss of mitochondria, which make energy for cells. The optic nerve requires a huge amount of energy compared to other cells, so it is especially susceptible to a lack of mitochondria. The other risk factor, heart disease with irregular rhythm, is also caused by a lack of energy, but in the heart. This gives us some important information about what the real cause of glaucoma may be.

Inflammation doesn’t seem to be the cause; it is often associated with glaucoma because those who have low energy are often deficient in antioxidants. However, those who have low pressure glaucoma may have good levels of antioxidants so, they don’t get high pressure in the eyes, but they still lose mitochondria.

Thus, the problem is energy. Since human beings are visual, the optic nerve is in constant use, making it more susceptible to a loss of power.  In mice used as a model for glaucoma, it was found that mitochondrial deficits account for the loss of nerve cells.[6] This is also the relationship of glaucoma and heart disease. People with arrhythmias lack mitochondria in the heart so they don’t have enough energy.

How to Increase Energy and Decrease Pressure

Thus, a program for rebuilding mitochondria should help most people with glaucoma. We already know how to improve mitochondrial function – it’s simple:

Exercise sufficient to get winded, or short of breath, produces an enzyme called AMPK which causes more mitochondria to grow. It seems the best way to do this is with HIIT – interval training exercises. This is where you put out your maximum effort for ten seconds, then a light effort for 30 seconds. Only 10 minutes per day, or 30 minutes per week, is sufficient.

Fasting periodically helps the body to cleanse, detox, and grow more mitochondria.

• Any time you have an empty stomach you are fasting.
• The more time with an empty stomach, the better.

There are many ways to fast that will produce results. For example, not eating or drinking for one day each week, or three days in a row once a month. Many people do “intermittent fasting” where they fast every day, having a 5-hour window of eating two meals at 7am and noon. Any of these works well.

Nutrient supplements can allow more energy to be produced, as well as reduce oxygen free-radicals:

Niacinamide – vitamin B3, otherwise known as niacin or nicotinamide. The mitochondria need large amounts of this B-vitamin. If we don’t eat enough, it can be made from tryptophan, an amino acid found in meat, milk, and other protein sources. Tryptophan is often not absorbed well because it competes with other amino acids. This leads to low levels of niacinamide, and poor mitochondrial function. One study showed that mice that are genetically pre-disposed to glaucoma did not get it if they were given niacinamide in high doses (500mg per kilogram, or 35 grams per day for an average person). It is interesting to note that the pressure in the eyes of the mice did not change; they still had high pressure, but did not get glaucoma.[7]

A human study using 1.5 grams of niacinamide per day showed a significant decrease in progression of glaucoma.[8]

Coenzyme Q-10 – CoQ10 is not a vitamin because we make it out of cholesterol. Those taking medications for high cholesterol often have less coQ10, which may contribute to both inflammation and lack of energy. In the same mice as above, researchers gave large doses of coQ10 to the young mice before they had any signs of glaucoma and found it prevented glaucoma.[9]

Magnesium – Magnesium may help glaucoma in two ways. First, it is necessary for energy production, and is a common deficiency, and second, it dilates blood vessels. In one study, participants with glaucoma and visual field deficits were given 122mg of magnesium twice a day. In only four weeks, significant improvement was noted in their vision.[10]

Anthocyanins – (the color in Bilberry, Blueberry) within 2 weeks one placebo-controlled study showed a significant decline in eye pressure.[11]

Carotenoids – (Carotene, Lutein, Astaxanthin, Zeaxanthin) a review article of multiple studies showed significant synergistic effect of various carotenoids in protecting the optic nerve from damage.[12]

Crocin/Crocetin – (Saffron) protects the retinal cells and nerves from damage by decreasing inflammation in the eyes.[13]

So, where does the list end? It doesn’t! There are hundreds of known anti-inflammatory chemicals. These all work synergistically to help your eyes. If you eat processed foods, you get none of these. You don’t get niacinamide, CoQ10, magnesium or any of the antioxidants that are found in real food. Artificial colors have no benefit, but natural ones do. Each time you eat carrots, spinach, or kale you get tiny amounts of these. We cannot afford to eat anything that is not supplying nutrients. Sure, you can take a blueberry extract, but that doesn’t have all the benefits of eating a variety of antioxidants. There is so much more to prevention than just focusing on one illness (like glaucoma).

Avoid all processed or prepared foods. Don’t eat anything that does not nourish your body. Enjoy real foods. If you don’t like vegetables, eat them anyway. My mom used to hide kale in fried rice, broccoli in macaroni and cheese, and wheat germ in cookies. Everything she made would have one or more nutritious ingredients. One of her friends told her that it was a waste to put wheat germ in her cookies because it was such a tiny amount of nutrition, but she was not swayed. She told her friend, “I use up about three bottles of wheat germ every year, and that adds significantly to my children’s nutrition!”

Another way to get good nutrition is to make smoothies with fruit and vegetables. Add kale, spinach, and chard to your berry smoothie once or twice per week. Also, tomato sauce has lots of lutein; use it in your meals. It’s the small and simple choices we make daily that determine our nutrition. Eat fish every Friday. Eat liver and onions periodically. Eat fruit, vegetables, nuts, seeds for snacks. Don’t buy bags of chips – get blueberries, carrots, raspberries, oranges, and kiwi instead. This is the way to prevent glaucoma – as well as heart disease, cancer, arthritis, and a host of other illnesses.

Supplement Recommendations

Having said that, some who have glaucoma, or even elevated pressure in the eyes without glaucoma, may need a supplement. Those with genetic predisposition, such as those of Japanese descent, may want to take extra doses of the nutrients above to prevent glaucoma. There is a tendency to decrease our CoQ10 production as we age. Also, if we don’t have good protein digestion and absorption, we may not get enough vitamin B3 from food. Those who have low pressure glaucoma or arrhythmias of the heart might be low in energy. In such cases it is wise to take supplements.

• Niacinamide 1,000mg twice per day
• CoQ10 100mg twice per day
• Magnesium about 200mg twice per day

Also, there are many supplements with carotenoids, look for a good quality brand. You can now buy “Eye Vitamins” which contain these and other ingredients. They have been studied, and they do make a difference to those with eye disease.

Back to Carol: after a discussion, Carol changed her ways. She started having antioxidant-rich fruit and vegetable smoothies and added more fruit and vegetables to her diet. She also took magnesium, niacinamide, and CoQ10. She got off her medication for acid reflux because it prevents the absorption of magnesium. She stopped eating at night, so she no longer has acid reflux. Her eye pressure came down. She stopped the eye drops, and – this is important – she goes to see an ophthalmologist once a year to check on her optic nerve.

If you are concerned about it, and especially if you have relatives with the disorder, the measures above will prevent glaucoma. But even if you already have it, glaucoma is treatable, but be careful of the old treatments that only consider eye pressure. Medications and surgery that only reduce eye pressure may reduce your risk of blindness, slightly, but do not address the problem. The real issue is energy produced by mitochondria. Instead, give them the nutrients they need, and they will keep you young, energetic – and sighted.

 

 

 

 

 

Sources:

[1] https://www.sciencedaily.com/releases/2021/04/210415142827.htm

[2] https://www.brightfocus.org/glaucoma/article/ocular-hypertension-and-glaucoma

[3] https://www.sciencedirect.com/topics/medicine-and-dentistry/normal-tension-glaucoma

[4] https://www.sciencedaily.com/releases/2021/04/210415142827.htm

[5] https://www.glaucoma.org/glaucoma/normal-tension-glaucoma.php

[6] Science 2017; 355, 756-760. Vitamin B3 modulates mitochondrial vulnerability and prevents glaucoma in aged mice. Williams, P. A. et al.

[7] Science 2017; 355, 756-760. Vitamin B3 modulates mitochondrial vulnerability and prevents glaucoma in aged mice. Williams, P. A. et al.

[8] Invest ophthalmol vis sci. 2019, 60:2509-2514; Nicotinamide Deficiency in Primary Open-angle Glaucoma; Kauassi Nzoughet J. et al.

[9] Neural Regen Res. 2019; 14:197-200; Evidence on Neuroprotective properties of Coenzyme Q10 in the treatment of Glaucoma; Martucci, A.; Nucci, C.

[10] Ophthalmologica 1995; 209:11-13; The Influence of Magnesium on Visual Field and Peripheral Vasospasm in Glaucoma; Gaspar, Az, et al.

[11] Randomized Controlled Trial J Ocul Pharmacol Ther. 2013 Feb;29(1):61-7. doi: 10.1089/jop.2012.0071. Epub 2012 Oct 9. Effects of black currant anthocyanins on intraocular pressure in healthy volunteers and patients with glaucoma; Hiroshi Ohguro 1, Ikuyo Ohguro, Saeko Yagi

[12] Nutrients. 2021 Jun 6;13(6):1949. doi: 10.3390/nu13061949. Carotenoids in the Management of Glaucoma: A Systematic Review of the Evidence; Drake W Lem 1, Dennis L Gierhart 2, Pinakin Gunvant Davey

[13] Int J Mol Med. 2016 Jan;37(1):225-32. doi: 10.3892/ijmm.2015.2418. Epub 2015 Nov 23. Crocin protects retinal ganglion cells against H2O2-induced damage through the mitochondrial pathway and activation of NF-κB; Bochang Lv 1, Tao Chen 2, Zhiguo Xu 1, Fuquan Huo 3, Yanyan Wei 2, Xinguang Yang