Botanical agents that may be helpful for treating and managing cataracts include Vaccinium myrtillus (bilberry), a close relative of blueberry, which is high in bioflavonoid complex anthocyanosides.26 Anthocyanosides have been shown to protect both the lens and the retina from oxidative damage. Bilberry also helps patients to adapt to bright light, but research on effects on night vision have produced mixed results. Pulsatilla pratensis (pulsatilla) has historically been used internally for the treatment of senile cataracts; however, careful attention must be used when prescribing this toxic herb. Cineraria maritime (silver ragwort) has been used in the form of eye drops for treating patients who are in the early stages of senile cataracts; but, note that use of this herb is contraindicated for patients with glaucoma.27
GLAUCOMA: DESCRIPTION AND ETIOLOGY
Glaucoma is the second leading cause of blindness in the United States. The term glaucoma describes a group of eye conditions involving increased pressure within the intraocular mechanism. Glaucoma is characterized by a neuropathy of the optic nerve, usually the result of the increased pressure within the eyeball. Closed-angle glaucoma occurs when the chamber angle is narrowed or completely closed because of forward displacement of the final roll and root of the iris. The closure obstructs the flow of aqueous humor and results in increased pressure. Open-angle glaucoma results from increased resistance to the outward flow of aqueous humor.
The changes in normal pressure accommodation can ultimately lead to blindness and account for more than 150,000 cases per year. In many circumstances, the cause is unknown. In some cases, however, glaucoma is caused by an underlying pathologic condition that must be arrested. Therefore, it is important for people with glaucoma to be diagnosed by, and to remain under the care of, an ophthalmologist. Regular eye examinations are especially important for patients with high-risk profiles. These include patients with familial histories of the disorder, African-American patients (who have a four to six times higher incidence of glaucoma), patients with long-term metabolic disorders (e.g., diabetes mellitus, thyroid-hormone dysre-gulation), patients who take high-dose oral corticosteroids for prolonged periods of time, patients with food sensitivities or allergies,28 or patients who are more than 40 years old.1
With regard to clinical signs and symptoms, it is important to note that acute-angle closure glaucoma is painful while chronic open-angle glaucoma (COAG) is not. Thus, the presence or absence of pain is not always a clear indicator of whether a patient has glaucoma or not.6 Other indicators include a frequent need to change prescriptions for glasses or contact lenses, impaired adaptation to dark environments, seeing halos around lights, mild headaches, or undefined visual disturbances. In addition, COAG may be totally asymptomatic and may require a work-up with intraocular pressure measurement, slit-lamp examination, visual fields assessment, and gonioscopy. Fundoscopic examination may reveal an enlarged cup size within the optic disc. If glaucoma is suspected, or if a patient is at a high risk for developing glaucoma, referral to an ophthalmologist for further evaluation is essential to gain a greater understanding of the degree of ocular dysfunction.29
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