Adam's Corner

Bright Eyes!

About two years ago, I was asked to speak to Peg Morse’s[1] Vision Group at the Newbury Court retirement home. It turned out to be the worst talk I ever gave.

Don’t get me wrong – I’ve always enjoyed speaking with Peg. And the other people who came were also nice, attentive, and engaged. For my part, I showed up prepared, with an outline, notes, and even a diagram of the eye. So why did this talk go so badly?

Well, I started out introducing myself, then right away I pulled out the diagram. “Here,” I said, “This is a diagram of the human eye. Can you all see?”

“No!” came the responses in a chorus, “We can’t see it. That’s why we’re here!”

After that, I had very little left to talk about. You see, we can do a lot more to maintain our vision than we can to restore it once it’s gone. That’s not to say you can’t get some back, depending on what’s you’re dealing with. But no matter what it is, don’t wait until it gets bad to do something about it.

This article is going to talk about glaucoma. Next month will cover macular degeneration and cataracts.

The optic nerve starts in the back of the eyes and leads to the brain[2]. In glaucoma, this nerve is damaged, slowly and incrementally. First, people lose peripheral vision, then their central vision goes as well.

In most cases, the optic nerved is damaged by pressure (called intra-ocular pressure, or IOP) caused when a fluid called aqueous humor builds up inside the eye[3]. In a healthy eye, aqueous humor isn’t stagnant: it’s constantly being made, and simultaneously diffusing out of the eye and reentering the blood stream. In glaucoma, however, the tissue it filters through breaks down and outflow is obstructed. Looking more closely, we see that this breakdown is due to decreasing levels of a compound called hyaluronic acid.

(Yes, this is the same hyaluronic acid that doctors inject into your knees for arthritis – the same hyaluronic acid that keeps young skin looking fresh and firm. In fact, hyaluronic acid is everywhere in the body. Its role is to hold fluid in the tissues, keeping them hydrated.)

Part of hyaluronic acid breakdown is simply due to aging. But we can also blame a great deal of it on the damaging effects of oxidative stress (or the flip side of that coin, a deficiency in antioxidants).

So what can we do about this? First, quit smoking. Then try to increase antioxidant levels in your eyes. The problem is, it’s hard for antioxidants to get up in there. Luckily, we have alpha-lipoic acid[4]. ALA is both water- and fat-soluble and can get right up into the eye where it not only helps mop up damaging free radicals, but also recycles vitamin C. And since vitamin C is needed to make fresh hyaluronic acid, you’ve got a two-pronged attack. Actually, it’s a three-pronged one: ALA helps prevent nerve damage – and remember, glaucoma is all about pressure damaging a nerve. So with ALA you reduce pressure two ways and protect the nerve at the same time!

Unfortunately, I am aware of only one trial where ALA was actually tested in people with glaucoma. But the results were great! In this Russian study, glaucoma patients were given up to 150 mg ALA or placebo twice daily for two months. Normally, in a trial like this, you’re simply looking to preserve vision, or lower IOP. Here, the vision in nearly half the patients taking ALA actually improved! Furthermore, people had better results the worse off their vision was to begin with.

Beyond ALA, two herbs of especial relevance to hyaluronic acid are gotu kola (Centella asiatica) and hawthorn berry[5] (Crataegus spp.) Gotu kola increases the production of hyaluronic acid, and hawthorn berry decreases its breakdown. While I’m unaware of any research connecting either of these specifically to glaucoma, you should still consider both because they’re safe, cheap, and make sense – hawthorn, especially. It’s a wonderful heart tonic with good research behind it. It’s full of antioxidants. It very slowly and gently lowers blood pressure (which can help glaucoma). Or you could try taking hyaluronic acid itself. Hyaluronic acid was part of Debra’s dry eye protocol for a year. Now she takes gotu kola and hawthorn berry.

Catching glaucoma early is important, since damage to the optic nerve is so hard to reverse. The Glaucoma Research Foundation recommends complete eye exams at ages 35 and 40, then every 2-4 years until you’re 60, and every 1-2 years from there on. It’s especially important to be tested if you’re at high risk. Those with a family history of the disease have a 4-9 times elevated risk. Black people are 6-8 times more likely to have glaucoma than white people. People of Japanese extraction or with a history of heart disease are more likely to suffer from Normal Tension Glaucoma.

Conventional treatment of glaucoma involves lowering IOP, either through drugs[6], or through an implant that lets fluid drain from the eyes. There are also a number of natural approaches one can use. Perhaps the most publicized is the use of marijuana. Little point in writing about that at this time….

What else?

While there is some compelling research showing that vitamin C can lower IOP, I wouldn’t bank on it working for you. In almost all the research, vitamin C was given intravenously, achieving blood levels much higher than you can get taking pills. In the only study where oral vitamin C was helpful, people took 227 mg of vitamin C per pound of body weight. At that dose, you get diarrhea.

Vitamin B1 has also been shown to be lower in people with glaucoma.

Vitamin B12 can protect against some kinds of nerve damage. In one small, inconclusive trial, glaucoma patients taking 5 mg a day of B12 showed no loss of vision over 5 years. If you try B12, look for a special form called methylcobalamin, which is better at healing the nervous system.

Fish oil and borage oil may also help, although this isn’t entirely clear either. But since fish oils are so good for you in 101 ways anyway, why not just take some? In fact, take them by the handful. I’m serious!

In one German study, acupuncture lowered IOP, both 15 minutes and 24 hours after treatment.

In some studies, the herb Coleus forskohlii has been remarkably effective at lowering IOP when applied in eye drop form. Unfortunately, I’ve never seen coleus eye drops for sale, and I don’t know enough about making them to give anyone directions. So keep your eyes open for this one!

Finally, there’s Bilberry extract. Bilberry is pretty well-researched in another eye problem called macular degeneration. Although there isn’t much research on glaucoma with this herb, it’s easy to see how it should be helpful, since it, too, can stabilize hyaluronic acid. Like ALA, bilberry isn’t so much a treatment for glaucoma specifically, as it’s a nutrient which is useful for the eye in general – and the body as a whole. Garden variety American blueberries will also work (about 2/3 as effective as their darker, European cousins).

…. Adam Stark

[1] Peg was 99 at the time. She’s turning 101 in August. Happy birthday!

[2] Technically speaking, the optic nerve is actually a part of the brain – the eyes truly are the “window to the soul!”

[3] There’s also Normal Tension Glaucoma, a similar loss of vision even when IOP is normal. People with this disease are more likely to suffer from migraines, implying that blood vessel spasms might be cutting off blood to the optic nerve. Even though IOP is normal here, lowering IOP still helps slow the progression of the disease. In one study, the herb Gingko biloba (120 mg of the standardized extract in divided doses) was able to partially restore vision in Normal Tension Glaucoma within 4 weeks.

[4] Also known simply as “lipoic acid,” or “thioctic acid.” While natural R(+)-lipoic acid seems to work better than the regular stuff, its higher price may or may not make it worthwhile. And while dihydro-lipoic acid appears better in a test tube, the jury is still out on how it will fare in the human body.

[5] Most hawthorn preparations include extracts of the leaf and flower. Unless you have heart trouble, stick to the berry.

[6] In one study, 18 patients on the prescription drug Timolol were given 90 mg of CoQ10 for 6 weeks. The CoQ10 didn’t interfere with the Timolol, but it did delay some of the side effects Timolol tends to have with the heart.

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