Alternative Treatments for Glaucoma
Alternative Treatments for Glaucoma
Introduction: Interest in and use of alternative treatments for all health issues, including glaucoma, has increased in US adults over time(6). While there are many alternative treatments that have been proposed, the research on most forms of alternative treatment is either lacking or inconclusive to prove a definitive effect on Glaucoma outcomes.
Review of alternative treatments:
Vitamins/Natural Compounds: Vitamin A: Vitamin A is an important compound for normal functioning of the retina and rhodopsin and acts as an antioxidant. Studies have some variability, but show that Vitamin A may have a protective effect in the disease course of Glaucoma. The exact nature of this association is unclear and may potentially be related to their role as antioxidants (16).
B Vitamins: There is some evidence that patients with lower levels of Vitamin B12 have a thinner retinal nerve fiber layer and it may have a neuroprotective effect on cells. While this association has been shown the evidence on specific links between vitamin B12 levels and glaucoma is tenuous. Additionally vitamin B1 has inconclusive evidence to prove a definitive link (16).
Vitamin C: Some studies have shown that Vitamin C can effectively reduce IOP, though it must be used in very high doses given intravenously and this is not clinically practical. At these levels there may be other symptoms of high doses that limit treatment including diarrhea and dehydration (12,16).
Vitamin E: There is some question as to whether Vitamin E has a protective effect as an antioxidant, though again the data is conflicting and inconclusive (16).
Bilberry: There is some evidence to suggest that Bilberry extract may decrease retinal ganglion cell death after injury, such as is the case in glaucoma, and provide a neuroprotective effect. Though this link has not yet been proven to alter the course of glaucoma in patients (7,13).
Melatonin: Glaucoma may frequently be associated with sleep disorders or psychological disorders such as depression and anxiety. Melatonin may have a retinal neuproprotective role and requires further study to determine if it can play a therapeutic role. It may be clinically limited, especially for use during the day, due to other effects of melatonin including sleepiness (1).
Omega3s: Consumption of Omega3s may contribute to overall vascular health and thus retinal health, which may provide some protective effects from oxidative stress in glaucoma. Though does not appear to be a proven link between Omega3 intake and glaucoma (14,15).
Ginko Biloba: Ginko Biloba an antioxidant and increases ocular blood flow. Given both of these characteristics it may provide a neuroprotective effect and slow the death of retinal ganglion cells, but further study is needed to prove conclusive links to glaucoma progression (7,8).
Antioxidants/Green Tea: Evidence is inconclusive on role of green tea in macular degeneration and glaucoma. Antioxidants may be useful in treatment of macular degeneration and glaucoma, while caffeine may increase IOP in some patients (15).
Consumption of Dark, Leafy Greens: Consumption of dark, leafy greens has been associated with decreased likelihood of developing glaucoma. Because most dark, leafy greens contain Vitamin A, C, K and nitrate it is unclear what the exact source of the benefit is5. Nitrate plays a role in the nitric oxide pathway which may be associated with glaucoma, while Vitamin A, C and K may also provide benefit (16).
Marijuana: Marijuana/cannabis has been shown to produce short-term decrease in IOP. Effects typically last 3-4 hours and receiving benefit would require maintaining consistent levels of cannabinoids. Thus, treatment is not currently clinically viable as the other side effects of marijuana use outweigh the short-term benefits on IOP. Further research is being conducted to address this (2,7).
Sleeping Position: Sleeping with head inclined at 20 degrees may decrease IOP overnight when individuals are in the supine position. Additionally, preferentially sleeping on one side has been shown to be correlated with worsened IOP and outcomes in the dependent side. Thus, discussing sleep habits with glaucoma patients could help improve fluctuations in IOP overnight (17,18).
Acupuncture: Acupuncture been discussed as an alternative treatment for glaucoma and some animal studies have shown acupuncture had an effect on retinal function, though there is not evidence that it will lower IOP in humans currently (11).
Meditation: Long term practice of meditation may help reduce IOP Slightly, especially in those with Acute Angle Closure Glaucoma that may be associated with stress. While it’s definitive effect on glaucoma outcomes is still unknown, given the low risk of its use along with other proven health benefits, it could be recommended for patients to add to their lifestyle (4,6).
BMI/Weight: While adjustments to a healthier diet and weight are beneficial for health overall and for blood pressure control, there is currently no definitive link between a specific BMI and glaucoma (12).
Smoking Cessation: There is mixed evidence on a direct link between smoking and direct risk of developing glaucoma. More recent studies have shown there may be a risk between heavy smoking and glaucoma as well as IOP fluctuations and smoking. While the evidence of direct causation of glaucoma is still under investigation, the risks of smoking are known. Free radical formation from smoking is damaging to ocular tissues and increases inflammation in the body. Thus, smoking cessation can still be promoted as a protective mechanism in all patients for overall and eye health (10).
Exercise: Moderate exercise can result in lowering of IOP. This effect can last several months. It also has many other health benefits, including lowered blood pressure which may also have a positive effect on IOP. Thus, given the known health benefits of exercise, this can be suggested to patients as a general recommendation for overall and eye health (6).
Conclusion: While there is a wide interest in the use of alternative treatments for glaucoma, there is still much research to be done about the effectiveness of alternative treatments and clinical feasibility. General lifestyle improvements including smoking cessation, exercise, meditation and a balanced diet that includes leafy greens may have a very modest effect on risk of development glaucoma (5,6,10). Though given the low risk nature of these interventions and proven overall health benefits, they are still feasible as suggestions to improve overall and eye health. Additional low risk benefits include sleeping on the back with head inclined to 20 degrees to limit nighttime increase in IOP due to positional changes (17,18). While there is much ongoing research into vitamins and their role in glaucoma, the research is too inconclusive at this point to be able to offer natural supplements as a treatment of glaucoma.
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