Glaucoma

Glaucoma often has no symptoms
Nerve cells in the eye die slowly
Vision off to the side is affected first
Once vision is lost, it can't be regained
Glaucoma is related to high eye pressure and low blood supply
Treatment is not just with eye drops
Management control needs to be kept tight to save sight

Target low eye pressure and accept minimal variance
Observation should be regular

Glaucoma is a very common optic nerve disease. It can be caused by a high intraocular pressure (>21mmHg) but has also been linked with low blood flow (by day - labile blood pressure, or at night nocturnal dipping). Left to its own devices, glaucoma can silently and slowly erode the optic nerve over many years resulting in tunnel vision and ultimately even blindness.

Treatment is all about slowing the progress and preserving eyesight. A complete halt can be difficult to achieve and certainly the damage cannot be reversed. Standard care with glaucoma eye drops lower the intraocular pressure with takes mechanical stress off the optic nerve fibres as they enter the eye and sharply bend 90 degrees to course over and plug into the retina; it would also aid blood entry to the optic nerve head vessels against the lesser pressure gradient.

Is there any other way to assist blood flow? It makes complete sense to have a general vascular review to exclude anaemia, vitamin deficiency (B12 & folate), high cholesterol and diabetes.  A 24 hour blood pressure record can be most revealing, especially look for highs and lows. Any symptoms of fitful sleep and daytime somnolence should be investigated to exclude obstructive sleep apnoea.

 

Sometimes aspirin is a treatment option to consider, it's anti-platelet effects thin the blood slightly. Other suggested dietary supplements and manoeuvres presented here carry some logic but are less certain and more controversial area of medical science:

a) Ginkgo Biloba – many in the profession believe and some evidence supports an increase in blood flow to the brain and eye. Care is needed if already on blood thinning medicine like aspirin or warfarin and non-steroidal anti-inflammatory drugs.

b) Blackcurrants – new evidence to support an increase blood flow to the eye comes from Japan.

c) Almonds – loaded with magnesium, may help stabilise blood pressure avoiding the highs and lows.

d) If blood pressure is found to be low at times by day it might be the case to try and boost it by adding more salt to food, or more rarely by taking a mild sub-type of steroid tablet called fludrocortisone.

e) If blood pressure drops >20% at night, take either a V8 vegetable health drink or cup of hot Bovril in the late evenings (salt & fluid load), and sleep flat or if anything head slightly down (gravity assisted brain perfusion). For severe drops at a particular early hour, an idea might be to try setting a second alarm clock to disturb from deep sleep slightly.​

 

For those particularly interested, I suggest further reading on the topic of Flammer syndrome.

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Is there anything else which can be done? Well, yes - neuroprotection. There is an increasing body of evidence supporting the potential beneficial effect of CoQ10 in protecting neuroretinal cells from oxidative damage. Consider self-purchase add-on therapy with COQUN tablets.

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If over the years your glaucoma becomes completely stable - please let me know! If you wish to show your appreciation please consider a small charitable donation to my Paediatric Clinic Fund. Thank you!