Healthy Lifestyle
Chat Highlights
January 8, 2003

On Wednesday, January 8, 2003, Dr. Jeff Henderer, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Healthy Lifestyle."

Moderator:  In general, how would you define a healthy lifestyle for glaucoma patients?

Dr. Jeff Henderer:  A healthy lifestyle is one in which there is a balance of life activities.  That should help to reduce stress.  Eating right helps, as does exercise.   

P:  Has it been shown that glaucoma is more prevalent or progresses more rapidly in people who are sedentary, sleep-deprived, under great stress, or have other health problems, such as diabetes or malnutrition? 

Dr. Jeff Henderer:  I am not sure about that for primary open-angle glaucoma, the most typical glaucoma.  I suspect that diabetics are at some risk, but I wouldn't call it excessive for that type of glaucoma.  Stress probably doesn't help.  I would also not advise yoga, where you stand on your head.  That raises IOP (intraocular pressure).

P:  Are there any specific foods that are good or bad for glaucoma?

Dr. Jeff Henderer:  I'm not aware of any foods in particular.  I suspect that a great deal of water drinking may temporarily raise IOP, and hypertension (high blood pressure) isn't good for IOP over the long term.

P:  How can stress from the job, problems at home, etc., be avoided?

Dr. Jeff Henderer:  I wish I knew!  I suppose that you must learn to deal with problems one at a time, to try to complete tasks so you don't feel overwhelmed.  At least that's how I try to deal with stress. 

P:  It sounds like learned helplessness.  Life is face-paced and full of stress these days. 

Dr. Jeff Henderer:  Well, not exactly.  You should not feel powerless in the face of this disease. You can live a healthy life, and take care of your health.  "Seek the joy of being alive," we always said at camp. For the most part, this is a slowly progressive disease that can usually be controlled. Don't feel hopeless!

P:  What are the best vitamins for eyes?

Dr. Jeff Henderer:  That's not really well known.  I suspect that anti-oxidants are useful -- things like Vitamin A, C and E.  Zinc has been shown to be useful in an animal model of glaucoma.

P:  Do you know of any supplements that might be harmful?

Dr. Jeff Henderer:  I am not aware of any known harmful supplements taken by themselves.  Ginkgo biloba, aspirin, or any blood thinner that thins the blood too much are not a good idea.  

P:  Does ginkgo thin blood?  Then why is it recommended by some glaucoma specialists?

Dr. Jeff Henderer:  Ginkgo does thin the blood.  The thinking is that it reduces the stickiness of platelets, if I remember correctly.  That likely helps with blood flow, and therefore oxygen delivery to the eye.

P:  Will intense cardiovascular workouts affect my glaucoma?  

Dr. Jeff Henderer:  No. I think that unless you have pigmentary glaucoma, you'll probably be okay.  

P:  How about weight training?

Dr. Jeff Henderer:  Exercise tends to lower IOP, and the benefits of blood flow to the eye can't be overstated.

P:  Are there any restrictions on activity for people who have had trabs (trabeculectomies) or shunt surgery?

Dr. Jeff Henderer:  Yes and no.  It depends on the way the surgery is working, the appearance of the bleb, and what the IOP is.  If the IOP is low or the bleb is very thin, I wouldn't advise a lot of straining.  Having a bleb is pretty much the end of contact lens use, too.

P:  Would yoga headstands and the like be a problem for a patient with normal-tension glaucoma?

Dr. Jeff Henderer:  I don't think that would be the only cause.  One cause might be low blood pressure.  That is most common in older people, but can be an explanation for glaucoma even at very low IOP.  A lot of NTG (normal-tension glaucoma) patients have IOPs that are in the upper part of the normal range.  They will be affected by things that raise IOP, just like any other glaucoma patient. 

P:  A healthy lifestyle also includes visiting doctors and dentists from time to time.  But I’m concerned about the medications used or prescribed by general practitioners and dentists, supposedly for my health.  Not once have I ever been asked if I had glaucoma, and I think that some of the medications I’ve been given may not be appropriate.  Can you comment?

Dr. Jeff Henderer:  You have a good point.  The interaction between drugs is not asked about,  and that applies to eye doctors, too.  We don't know the interactions of most drugs, but it is safe to say that the more medications, the more chance there is for interactions.  Fortunately, it seems as though most medications seem to coexist fairly well.

P:  This afternoon my dentist asked me to inquire about the effect of using epinephrine in a glaucoma patient.  She uses two kinds, common in dentistry.  One is the Novocain injection for upper teeth and remains localized (or so it is claimed).  The other, epinephrine, is contained in a string that's wrapped around a tooth for certain procedures, including crown work.  Epinephrine enters the bloodstream and is rather powerful.  It made my heart race and I started shaking and crying almost uncontrollably.  What do you say?  What if a glaucoma patient is using a beta blocker?  

Dr. Jeff Henderer:  Epinephrine is not so good if the patient has narrow angles, as it can dilate the pupil and cause an attack of glaucoma.  Other than that, it is actually one of the old treatments for glaucoma.  Propine is the epinephrine pro-drug that was most commonly used.

P:  Does drinking alcohol have an adverse effect on glaucoma?

Dr. Jeff Henderer:  I'm not aware that there is any inherent problem with alcohol and glaucoma.

P:  Does moderate alcohol consumption do the same thing as ginkgo?

Dr. Jeff Henderer:  That I don't know for sure.  I didn't think that alcohol "thinned" the blood.  I thought that red wine was supposed to help with cardiovascular disease.

P:  How about smoking cannabis to lower IOP?

Dr. Jeff Henderer:  Cannabis is certainly an excellent way to lower IOP, but there are two problems.  First, you have to smoke so much that you'd be high all the time (the time of effect is too short).  Second, you reduce blood flow to the eye, and that doesn't help. In any case, last year the U.S. Supreme Court outlawed the use of pot for any medical condition.

P:  Would the drug Marinol or any non-psychotropic marijuana derivatives that may be found to reduce IOP be exempt from the Supreme Court decision?

Dr. Jeff Henderer:  As far as I know, the decision applied only to pot and was really directed at the clubs that buy it for members to use, often to counter the effects of HIV wasting or as chronic pain control.

P:  Strange world.   In Canada, the Supreme Court said the government MUST provide pot for medicinal use.

Dr. Jeff Henderer:  Strange world, indeed.

End of highlights for January 8, 2003.

On January 15, Dr. Wilson discussed "Drug Allergies" in the chat room. Click here for highlights of that meeting.

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