What is Glaucoma?
Glaucoma is a form of optic nerve damage and is one of the leading causes of vision loss and blindness in the United States. Glaucoma refers to a category of eye disorders often associated with a dangerous buildup of internal eye pressure (intra ocular pressure or IOP).
The front part of the eye is filled with a clear fluid called aqueous humor. This fluid is always being made in the back of the eye. It leaves the eye through channels in the front of the eye in an area called the anterior chamber angle, or simply the angle. Anything that slows or blocks the flow of this fluid out of the eye will cause pressure to build up in the eye. In most cases of glaucoma, this pressure is high and causes damage to the major nerve in the eye, called the optic nerve. The optic nerve is the transmitter of visual images from the eye to the brain.
There are several types of glaucoma, but the vast majority of cases appear to be hereditary and usually develop in middle age. Having your eyes checked regularly (every two to three years after age 40; and every one to two years after 60) will help reveal glaucoma-related changes that can be treated before any eye damage occurs.
Types of Glaucoma
Glaucoma is the second most common cause of blindness in the United States. There are four major types of glaucoma:
•Open-angle (chronic) glaucoma
•Angle-closure (acute) glaucoma
Open-angle (chronic) glaucoma is the most common type of glaucoma.
-The cause is unknown. An increase in eye pressure occurs slowly over time. The pressure pushes on the optic nerve and the retina at the back of the eye. Open-angle glaucoma is painless and does not have acute attacks. The only signs are gradually progressive visual field loss, and optic nerve changes
-Open-angle glaucoma tends to run in families. Your risk is higher if you have a parent or grandparent with open-angle glaucoma. People of African descent are at particularly high risk for this disease.
Angle-closure (acute) glaucoma occurs when the exit of the aqueous humor fluid is suddenly blocked. Acute or Narrow Angle glaucoma can develop suddenly and is considered a medical emergency requiring immediate treatment. With Narrow Angle Glaucoma, symptoms that occur suddenly can include blurry vision, halos around lights, intense eye pain, nausea and vomiting. If you have these symptoms, make sure you see an eye care practitioner or visit the emergency room immediately so steps can be taken to prevent permanent vision loss.
-If you have had acute glaucoma in one eye, you are at risk for an attack in the second eye, and your doctor is likely to recommend preventive treatment
-Dilating eye drops and certain medications may trigger an acute glaucoma attack
Congenital glaucoma often runs in families (is hereditary).
-It is present at birth
-It results from the abnormal development of the fluid outflow channels in the eye
Secondary glaucoma is caused by:
-Drugs such as corticosteroids
-Eye diseases such as uveitis
What are the symptoms? At first, there are no symptoms. Vision remains normal, and there is no pain, but over time you may notice that your peripheral (side) vision is gradually deteriorating – you can see objects in front of you clearly but may miss objects to your side. If the disease remains undiagnosed and untreated, you will eventually lose the ability to see objects to the side and out of the corner of your eyes. Without any treatment, you will gradually be able to see less and less in front of you until no vision remains.
Glaucoma often is called the “silent thief of sight,” because most types typically cause no pain and produce no symptoms until noticeable vision loss occurs.
For this reason, glaucoma often progresses undetected until the optic nerve already has been irreversibly damaged, with varying degrees of permanent vision loss.
What are the causes?
Ophthalmologists once believed that glaucoma was caused by liquid in the eye not draining properly (liquid normally flows in and out of the eye) and that the pressure from the trapped fluid damaged the optic nerve. However, we now know that you can have glaucoma-related vision loss even when your intra-ocular (inside the eye) pressure is normal – and you can have high intra-ocular pressure without developing glaucoma. While increased eye pressure does mean that you are at an increased risk for glaucoma, the disease itself can be diagnosed only when the optic nerve is damaged.
An ophthalmologist can usually detect those individuals who are at risk for glaucoma before nerve damage occurs. The doctor also can diagnose patients who already have glaucoma by observing their nerve damage or visual field loss.
Awareness and early detection of glaucoma are extremely important because this disease can be successfully treated when diagnosed early. While everyone is at risk for glaucoma, certain people are at a much higher risk and need to be checked more frequently by their eye doctor. The major risk factors for glaucoma include the following:
• Age over 45 years
• Family history of glaucoma
• Black racial ancestry
• History of elevated intra-ocular pressure
• Nearsightedness (high degree of Myopia), which is the inability to see distant objects clearly
• History of injury to the eye
•Use of cortisone(steroids), either in the eye or systemically (orally or injected)
•Farsightedness (hyperopia), which is seeing distant objects better than close ones (Farsighted people may have narrow drainage angles, which predispose them to acute [sudden] attacks of angle-closure glaucoma.)
Treatment for Glaucoma
Treatment may include eye drops or oral medication or both. Some of these drugs work by causing the eye to make less fluid. Others lower pressure by helping fluid drain from the eye.
In addition to drugs, surgery may be recommended. One procedure, laser trabeculoplasty, helps reduce intra-ocular fluid by stretching the natural drainage holes in the eye and allowing the fluid to drain better. While this procedure works well at reducing pressure, its effects can wear off over time.
Sometimes, ophthalmologists recommend incisional surgery (an outpatient procedure) to improve fluid flow out of the eye by enlarging the drainage holes with a surgical instrument. This carries a small risk of infection and bleeding and can also cause undesirable changes in intra-ocular pressure, scarring, and loss of vision, although these complications are considered unusual. Sometimes surgery doesn’t work, and even when it does, you’ll still need to use drops or take drugs afterward.
Other considerations for Glaucoma
An ophthalmologist’s care is vital. But there is some evidence that you can also help ease the condition by making the following lifestyle adjustments:
Dietary changes: Lower caffeine intake. Studies have shown that coffee can produce a 13% reduction in retinal blood flow. This is especially important in patients that have existing retinal damage and who are losing vision.
Exercise: Aerobic exercise has been shown to reduce mean intra-ocular pressure when compared to previously sedentary glaucoma patients. This has the same result as the pressure lowering properties of glaucoma medication. If you do not have a regular exercise program now is the time to start.
Stop smoking: smoking has been shown to contribute to the condition. Smoking can raise the intra-ocular pressure by 5.0 mm Hg or more. Nicotine has been shown to reduce retinal blood flow by 16%. Tobacco also robs the body of 25 mg of vitamin C per cigarette. Smokers have an increase in lipids (both fat and cholesterol) which increases the risk of severe cardiovascular disease. These factors produce narrowing of the retina blood vessels that carry valuable nutrients to the eye.
Sunlight :UV and Blue Violet sun rays increase the risk of developing free radicals. A good pair of sunglasses which block 100% of UVA and UVB and block at least 85% of blue violet sun rays.
Hypothyroidism: If you have glaucoma (or symptoms of glaucoma) it is important to have your thyroid checked. Many cases of low tension glaucoma have been reported related to low thyroid functioning. Hypothyroidism can lead to a condition called myxedema which results in a buildup of mucopolysaccharides throughout the body. Increase in mucopolysaccharides in the eye may block the outflow of aqueous producing elevations of intra-ocular pressure.
Supplements: Antioxidants may help improve outflow of fluid in the eye and lower the intra-ocular pressure. Antioxidants may also protect the optic nerve by blocking oxygen free radical vasoconstriction which may lead to ischemia. Antioxidants may also protect the optic nerve from the inflammatory affects of infection and inflammation. Recommended antioxidant vitamins include Vitamin E, C and Beta carotene.
Other vitamins helpful with Glaucoma:
•Vitamin B12 – Vitamin 12 may have a protective effect on the optic nerve and prevent visual loss in glaucoma.
•Magnesium – Magnesium deficiency is associated with systemic hypertension. It may have a role in blocking the affect of calcium which causes vasoconstriction of blood vessels. The use of magnesium has been shown to improve retinal circulation in some cases of retinopathy.
•Selenium – is a vital antioxidant which protects the immune system by preventing the formation of free radicals. It is especially important to combine Selenium with Vitamin E. They act together to aid in the production of antibodies and to help maintain a healthy heart, liver and eyes.
•Chromium – Studies have shown that Chromium will lower lipid levels in the body and increase the levels of good cholesterol (HDL). Chromium may be especially important in patients taking beta blockers.
•Amino Acids – Glutathione is a powerful antioxidant that protects retinal cells from UV radiation.
•Fatty Acids – Diets deficient in Omega- 3 fatty acids have been shown to result in visual impairment. In one European study Omega- 3 fats improved the vision in 6 out of 7 patients with macular degeneration.
•Quercetin – A Bioflavinoid found in foods such as red onions has been shown to be potent in preventing the damage of fat tissue in the eyes from UV light. It also inhibits histamine release and relaxes the smooth muscles of blood vessels.
•Bilberry. Studies have shown that Bilberry may improve oxygen delivery to the eye and act as an antioxidant and may have a protective effect on the eye and prevent further damage from the glaucoma.
•Ginkgo Biloba – Ginkgo’s primary clinical application has been in the treatment of vascular insufficiency. Many studies have demonstrated improvement in circulation in patients with arterial insufficiency. In addition to improving retinal circulation, Ginkgo also has a protective affect against free radicals.
Here at the Center for Natural and Integrative Medicine, our Ophthalmologist, Dr. Kenneth Andronico specializes in natural eye health and can devise a plan for preventive and anti aging eye health.
Dr. Andronico takes great satisfaction uncovering the underlying causes of his patients’ medical health decline, helping them improve their lives through an integrative approach that focuses on the bio-chemically unique aspects of each patient and then individually tailoring treatment to restore balance. he believes that health is a blend of body, mind and spirit. He takes an integrative approach to health and wellness and treats anti-aging the same way. His conclusion: Aging is normal– but premature aging, what many of us undergo between our 40’s and 60’s, is not. The research also concludes that most aspects of premature aging can be reversed using non-invasive procedures and teatments. Anti-aging is not just about looking good; it’s about physical and psychological wellness. For more information or to schedule an appointment, please call our office at (407) 355 9246
Dr. Andronico is available for appointments on Mondays and Tuesdays.