Unconventional Glaucoma Treatments
Chat Highlights
November 3, 2004

Norma Devine, Editor

On Wednesday, November 3, 2004, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Unconventional Glaucoma Treatments."

Moderator:  Welcome back to chat,  Dr. Wilson.  Our topic tonight is unconventional glaucoma treatments.  First, can you define unconventional therapy for us? 

Dr. Rick Wilson:  Since conventional treatment is made up of topical and oral medications, and laser and cutting surgery, unconventional therapy is every other kind of treatment.

P:  What are some examples of unconventional treatments?

Dr. Rick Wilson:  Exercise is the main proven unconventional treatment.  Ginkgo biloba and other herbal remedies are other examples.

P:  Are some kinds of exercise more effective than others in lowering intraocular pressure (IOP)?  

Dr. Rick Wilson:  Aerobic exercise (sustained exercise that uses oxygen, not just glycogen stored in the muscles) for 20 minutes or more 4 times a week has been shown to be effective.  One study showed it was as effective as an added medication.

P:  Did that study on exercise and glaucoma say how long the pressure-lowering effect lasted?

Dr. Rick Wilson:  One study showed an effect for several months, although the greatest effect was right after the exercise.

P:  Was that study the result of funded research?  If so, who provided the funds?  

Dr. Rick Wilson:  The first studies that I can remember were done at the Oregon Health Sciences Center in Portland, Oregon.  I do not remember whether or not they were funded. 

P:  Does any kind of exercise help to lower IOP?  

Dr. Rick Wilson:  Aerobic exercise that gets your heart rate up and keeps it there for 20 minutes helps.  More and more evidence shows that modest exercise, such as walking, can provide help with the heart, blood sugar, and blood pressure.

P:  How long does it take for aerobic exercise to be effective? 

Dr. Rick Wilson:  The effect happens acutely, but as I understand it, wears off after a few hours to start with and becomes more sustained as the training effect becomes evident.

P:  Is it known what aerobic exercise does for the glaucomatous eye?  I mean, mechanically or chemically?

Dr. Rick Wilson:  Acutely there is an increase in the partial pressure of carbon dioxide in the blood, which dilates the blood vessels.  I don't think anyone understands the physiology completely.

P:  Some eye doctors recommend taking supplements like magnesium, selenium, zinc, copper, vitamin E,  and so on.  Which of them are really useful for glaucoma?

Dr. Rick Wilson:  I once asked a neurophysiologist if there were  any proven compounds that protected neurons from stress.  He cited studies on aspirin, vitamin E, and melatonin as the only proven neuroprotective agents at that time.  None of those has been proven to help glaucoma patients, but I use baby aspirin and vitamin E on a theoretical basis and because they have been shown to help your heart and other aspects of health.  Vitamins have been proven to help macular degeneration.

P:  Is it possible to take too much Vitamin A?  

Dr. Rick Wilson:  Yes, it is.  Vitamin A is fat soluble, so it stays in your system and builds up.  If you are tempted,  never eat polar bear liver -- it contains toxic levels of Vitamin A! 

P:  Is one brand of vitamins better than others?  

Dr. Rick Wilson:  Any vitamin that adheres to the AREDS' (Age-Related Disease Study) formula would be suitable.

P:  Who sponsored the AREDS' study? 

Dr. Rick Wilson:  The AREDS' study,  a major clinical trial, was sponsored by the National Eye Institute,  a part of the Federal government's National Institutes of Health.

P:  How can we be sure that herbal remedies will not interfere with our glaucoma eye drops or other prescription medication we take?

Dr. Rick Wilson:  A big part of the problem with herbal medicines is there is no regulation of the concentration, quality, and contaminants.   Studies to ascertain the side effects of the herbal medicine are insufficient.

P:  I'm glad someone mentioned nutritional supplements, particularly copper.  Zinc has become a fairly popular supplement, especially for the eye, yet it can cause a copper deficiency.  I seem to recall reading that persons with glaucoma tend to show a copper deficiency, which is not easy to correct because even a small amount added to the diet can create new problems.  Can you comment?

Dr. Rick Wilson:  Many trace elements in the body are in balance.  As you point out, if you take too much zinc it reduces the body's copper levels.  Since we are not completely sure of all of the effects of these minerals, I would stick to a proven formula like the AREDS' one or what is recommended by the American Dietetic Association on their website.

P:  Does ginkgo biloba help glaucoma patients?

Dr. Rick Wilson:  Ginkgo biloba is supposed to be neuroprotective, but has not been proven to help glaucoma patients.

P:  I thought gingko biloba has been shown to increase blood flow to the optic nerve.  Are you saying that increased blood flow to the optic nerve doesn't strengthen resistance to optic nerve damage?

Dr. Rick Wilson:  One well-designed study of gingko did not show any long-term benefit for glaucoma.

P:  Does IOP have a relationship to blood pressure? 

Dr. Rick Wilson:  If your blood pressure goes up suddenly, your eye pressure will also go up.  If your blood pressure stays up, the eye will adjust the blood flow through the ciliary body downward, to return the eye pressure to normal.  One study found that if blood pressure stays up for two years, it will affect eye pressure.

P:  What kind of unconventional treatment is available for a nine-month-old infant with congenital glaucoma?  

Dr. Rick Wilson:  I would not recommend unconventional treatments for children, since they have not been proven, and the child's liver is not as developed to detoxify impurities.  Toxins would also be expected to have a disproportionate effect on growing bodies.

P:  Is ocular massage considered unconventional treatment, and will you please explain what ocular massage is?

Dr. Rick Wilson:  Ocular massage (digital ocular compression) is finger pressure on the eye to push fluid out of the eye.  That is not productive unless there is a surgical opening that is trying to close.  Pushing fluid through it under pressure may keep it open.  In other words, digital ocular compression is usually done after trabeculectomy to keep the "flap valve" from healing. 

Since most glaucoma specialists use digital ocular compression in at least some situations, I would consider it a conventional treatment.

Dr. Rick Wilson:  Do eye exercises, such as moving the eyes left to right, right to left, up, down and diagonally, help glaucoma patients? 

Dr. Rick Wilson:  Not that I have ever heard.

P:  Are you familiar with the Bates Method for vision improvement, a system of eye exercises and lens use that has been around for decades and for which there are many positive testimonials?

Dr. Rick Wilson:  Except for exercises that address mobility problems, such as the eyes not being directed toward the nose enough when reading, ophthalmologists have found little proven effect from eye exercises.

P:  What do you think of the use of acupuncture for glaucoma?

Dr. Rick Wilson:  I just came back from China in September, where I worked for a week in a teaching hospital, without hearing or seeing any mention of acupuncture for glaucoma.  I have heard of it being used for anesthesia for eye surgery where anesthetics were not available.

P:  Are tear duct plugs considered a unconventional treatment for glaucoma because they help to keep the medication in the eye?

Dr. Rick Wilson:  Not really, since the eye drop is formulated to give maximum effect without being retained in the tear film for longer than usual.  Increased absorption usually increases the duration of the drop, but not its effect.  Since you would be taking the next drop on schedule (at least I hope you would), the added duration would not help. 

P:  I have normal-tension glaucoma (NTG).  It has been suggested that I take a low dose (20 mg) of Prozac to improve circulation,  mainly for my Raynaud's (cold-hands syndrome).  If Prozac  helps circulation in the small vessels of my extremities, do you think it might help ocular perfusion?  

Dr. Rick Wilson:  I am for anything that improves circulation, especially in NTG.

Moderator:  Thank you, Dr. Wilson.  Good night.

End of highlights for November 3, 2004.

On November 10, Dr. Wilson discussed "Coping With the Fear of Blindness" in the Chat room. Click here for highlights of that meeting.

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