The conventional approach to managing glaucoma includes a proper referral to an ophthalmologic surgeon for a thorough evaluation. When surgical intervention—an iridotomy—is performed, the majority of patients will be totally cured and have no visual loss.30 However, when surgery is performed, there are potential risks that must be weighed. Specific adjuvant ACM modality management may include the use of nutrients and herbs to strengthen the vasculature of the eye and provide antioxidant protection. Homeopathy may be effective for acute pain relief. Regular aerobic exercise may also be helpful for treating the condition.31,32 Dietary changes that may be influential in preventing the progression and occurrence of glaucoma, as well as hastening recovery from iridotomy include reducing or eliminating exposure to allergens that produce altered vascular permeability and increased intraocular pressure. All known food allergens should be eliminated. In addition, it is important to reduce foods that may dramatically alter blood glucose, such as simple sugars, high glycemic index fruits, and refined foodstuffs. The diet should also provide foods rich in bioflavonoids and carotenes, such as dark seasonal berries, dark leafy greens, and yellow=orange vegetables. These foods will provide valuable micronutrients for ocular functioning.33-35
Vitamin C is perhaps the most extensively researched ACM agent for treating glaucoma. The vitamin has reduced elevated intraocular pressure significantly in numerous studies.36 These studies used at least several grams per day of vitamin C, but the intake varied widely. ACM physicians who prescribe the vitamin for managing COAG vary widely in the amounts they prescribe.37 Usually, physicians will advise patients to take oral doses of vitamin C equal to "bowel tolerance.'' Prescriptions ranging from approximately 5 to 20 or more g per day have been shown to be effective for treating increased intraocular pressure. Of course, vitamin C does not cure glaucoma and must be used continually to reduce ocular pressure.38
Several botanical agents have been shown to be helpful for managing glaucoma.
Rutin, a bioflavonoid with collagen-stabilizing effects, was historically used to reduce intraocular pressure in glaucoma.39 The amount used—20 mg, three times per day—was quite moderate. In one study, 17 of 26 people showed clear improvement.39 Although the benefits of rutin or other bioflavonoids for people with glaucoma have been recognized, they have not been investigated thoroughly.
Intraocular pressure follows a very temporal variation, with the lowest pressure commonly occurring in the early morning hours. Research has shown that intraocular pressure also parallels fluctuations in cortisol levels, with high cortisol conferring higher intraocular pressures. Diurnal variations in intraocular pressure are more pronounced in people with glaucoma, leading scientists to believe that a connection exists between intraocular pressure levels and other diurnal variants in the body. Because melatonin levels peak around 2 am, a time when intraocular pressure is on a downward trend, researchers studied melatonin's effect on intraocular pressure.29,40,41 Less than 1 mg of melatonin has lowered pressure within the eyes of healthy people,41 but there is only a limited amount of research on the effects of melatonin on people who have glaucoma.
Coenzyme Q10 has been shown to reduce significantly the deleterious influence of the beta-blocker medication timolol, which is used to lower intraocular pressure.42 Additional antioxidant activity may be generated by 150 mg of alpha-lipoic acid daily. Studies have revealed improved visual function in people with either stage 1 or stage 2 glaucoma taking alpha-lipoic acid daily for one to two months.43
Epidemiologic and animal studies point to a possible protective effect of omega-3 fatty acids against glaucoma. Both topical administration of prostaglandin E3 and D3 and intramuscular injections of cod liver oil (which is high in omega-3 fatty acids) led to decreased intraocular pressure in animal studies.42,44 Epidemiologic evidence has revealed a low prevalence of chronic open-angle glaucoma among Inuits on a native diet high in omega-3 fatty acids.45 The preliminary data from these investigative reports have led researchers to assume that essential fatty acids may be potent tools for managing glaucoma and other ocular diseases. At this point, more research is a reasonable next step.29
Glaucoma is not solely caused by increased intraocular pressure, being that approximately 20% of patients have normal intraocular pressure levels.30 It is in this subcategory of patients that magnesium has been studied. One study examined whether magnesium might improve vision in people with glaucoma by enhancing blood flow to the eyes (patients with normal intraocular pressure in which optic-nerve damage is caused by vasospasm leading to a decreased blood supply to the optic nerve). In this trial, participants were given 245 mg of magnesium per day. Improvement in vision was noted after four weeks, but the change did not quite reach statistical significance.46
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