Hi,
Is there anyone from New Zealand on this group? I am considering moving
there for several years and therfore would like to know as much about
health system and most of all about glaucoma treatment there.
I will come up with more detailed questions once I know that there is
anybody out there who can help me.
Thanks
Doris
Dr. Ritch:
I hope you won't mind shedding some light on this for me. I am very hungry
for information on this. I have had "atypical migraines" since I was 14. I
also have angle closure glaucoma which is secondary to retinopathy of
prematurity. My pressure has been somwhat stable (between 15 and 25 for the
most part) for the last ten years. I have experienced vision loss over the
last two years which doctors cannot find a cause for since there is no
change in the condition of my retina or other eye structures. The migraines
were very much out of control from 1999 until about ten months ago. I would
like to know if they may have contributed to this loss and how and whether
any of this might be reversible. Migraines are now controlled with
magnesium, taurine, and L-tyrosine as well as avoidance of triggers. The
only ones remaining are the ones triggered by weather. During the time when
they were out of control, I was on a total of 13 medications for migraine,
asthma/allergies, and immune suppressants after a cornea transplant. I am
now off everything but my Alphagan. My allergies are completely under
control with alternative treatment, and my pressure is holding around 15. I
would really like to make contact with someone who is familiar with the
impact of complicated migraine on vision.
Thanks.
Sarah J. Blake
Personal mail to: myhouse@...
http://www.growingstrong.org
Sarah Blake offers technology training, life skills training, information
and referral services, peer support, and presentations tailored to the needs
of various groups. For more information, please visit:
http://www.growingstrong.org/sarah/services.html
To diagnose glaucoma, you need visual field loss and optic disc cupping.
However, about 25% of ocular hypertensive patients have thick corneas and
many have normal IOP. In the past, these people were often treated. 30
years ago, they were just about all treated.
R
Robert Ritch, MD
Professor of Clinical Ophthalmology
Chief, Glaucoma Service
Surgeon Director
The New York Eye and Ear Infirmary
310 East 14th Street
New York, NY 10003
Medical Director and
Chairman, Scientific Advisory Board
The Glaucoma Foundation
Private (Admin Asst: Karen Cheifetz) - Tel: 212-673-5140
kcheifetz@...
Patient Appointments - Tel: 212-477-7540
Fax: 212-420-8743
e-mail: ritchmd@...
http://www.glaucoma.net
http://www.nyee.edu
<SNIP
Many, many thanks for posting this. A lot of food (!) for thought.
Not specifically to do with glaucoma, so forgive me if I stray off topic --
however I did think it tied in closely to recent discussions.
In today's Montreal Gazette there is an article by Joe Schwarcz, Director of
McGill University's Office for Science and Society (www.OSS.McGill.ca).
In it he points out another aspect of alternative medicine that should be of
concern to anyone buying supplements and OTC products. Although it deals
with cancer I doubt if the situation it describes would be much different
for glaucoma. And the really interesting thing is the sources Schwarcz
quotes
later in the piece.
+++
Sunday » October 26 » 2003
For advice, look in the right places
JOE SCHWARCZ
Sunday, October 26, 2003
"My mother hasn't been dieting but has lost about 20 pounds in a month and
she feels tired all the time. What can you recommend?"
That's the question my students were to ask when approached by a salesperson
in a health food store. It was part of an assignment to investigate the
reliability of advice provided by such establishments. Of course, there is
only one reasonable answer to such a question and that is "tell your mother
she should go and see a physician."
That answer was given in about 50 per cent of the cases. But the rest of the
salespeople offered a bewildering array of vitamins, "glandulars," protein
powders, creatine supplements, chromium pills, exotic juices, magnetic
bracelets and drops of "aerobic oxygen." One advised drinking distilled
water and eating only organic produce. Another came up with a truly
startling diagnosis for the weight loss: "I bet your mother has a microwave
oven in her kitchen and uses Teflon pans."
Although this was to be only a learning experience for students, the results
were so interesting that I thought they merited publication. Unfortunately,
since we had not planned on a rigorous study, the students had not
documented the evidence to a degree that would pass scientific muster. So
you can imagine my interest when I saw a recent paper in a peer reviewed
publication, Breast Cancer Research, with the title: Health food store
recommendations: implications for breast cancer patients. Edward Mills and
his colleagues had sent research associates of varying ages into health food
stores in the Toronto area to browse the shelves until approached by an
employee. They would reveal that their mother had been diagnosed with breast
cancer and seek suggestions. The study was approved by the institution's
ethics committee and the associates schooled in what questions to ask and
what to divulge. Each encounter was documented after the researcher left the
store.
Altogether 34 stores were visited and in 27 of these recommendations were
made for the use of some sort of "natural health product." A total of 33
different treatments were suggested. These included the usual vitamins, a
cacophony of botanicals, shark cartilage, garlic, grape seed extract,
dehydrated vegetables, antioxidants, herbal tees and, in one case, a
preparation made from the Venus fly trap. Only one common feature links all
these products: a lack of scientific efficacy for the treatment of breast
cancer.
The most commonly recommended product was Essiac, an herbal remedy that
contains burdock, Indian rhubarb, sorrel and slippery elm. It was first
popularized in the 1930s by Rene Caisse, a Canadian nurse (Essiac is her
name spelled backwards) who claimed to have learned of this cancer cure from
Indian medicine men. Essiac has been tested both in humans and animals and
has shown no anti-tumour activity.
Fewer than a quarter of the employees discussed the potential for
interaction between prescription drugs and natural health products and only
three mentioned the possibility of any adverse effects. Two employees
claimed that their recommended products could cure breast cancer and,
perhaps most disturbing, was the suggestion by one salesperson that
Tamoxifen, an established breast cancer treatment, be discontinued. The
recommendations did not come cheap; on average they would cost $58 a month,
some as much as $600. Finally, only 44 per cent of the employees encountered
recommended visiting a health care professional, and even then, the majority
suggested a visit to a naturopath.
By now, some of you may be thinking that I'm reporting on a study that was
carried out by some medical or pharmaceutical establishment types, bent on
showing the frailties of the natural health movement. As the argument often
goes, these people are worried that their "slash, burn and poison" methods
used to treat cancer are going to be replaced by gentle, effective natural
methods. Profits are at stake, so they supposedly look to design studies
that will discredit the "opposition." Well, this study was not funded by, or
carried out by physicians or drug companies. Edward Mills, the lead author,
is director of research at the Canadian College of Naturopathic Medicine!
He, like many others involved in the pursuit of effective natural products,
is disturbed by the unreliable and sometimes dangerous advice given in
health food stores.
The ideal way to cut down on the confusion that surrounds the treatment of
breast cancer is to prevent the disease in the first place. Presently, there
is no consensus on the relationship between diet and breast cancer, but
being overweight is a risk factor. This is probably because fatty tissues
are not only capable of storing estrogen but are also adept at converting
male hormones produced by the ovaries and adrenal glands into estrogen. High
levels of this hormone have been linked to some breast cancers.
Estrogen production can also be reduced with physical activity.
Post-menopausal women who exercise moderately for roughly two hours a week
can reduce their breast cancer risk by as much as 20 per cent. Younger women
who work out for at least four hours a week during their reproductive years
can reduce it by 50 per cent Exercise works for girls as well. We know that
early onset of menstruation is linked to more intense hormone exposure
throughout life and therefore to breast cancer. A large study of
elementary-school girls found that just five hours of exercise a week can
delay puberty and lower the threat of the disease.
Exercise is good. And that advice is based on science. It is more reliable
than what you might hear in a health food store. Just ask the director of
research at the Canadian College of Naturopathic Medicine.
This is a really difficult topic because there are so many variables. It can't be done with a short or even medium answer. I will have to do this in parts because I'm swamped and have been pingponged with committee meetings.
First, there are 2 broad categories of risk factors for glaucoma: IOP and non-pressure-dependent damage. The latter can be divided into decreased blood perfusion to the eye for many reasons - low blood pressure, migraine, sleep apnea, Raynaud's, atrial fibrillation, etc etc, and there is not a large literature on these. The classic normal-tension glaucoma patient is a thin, myopic woman with cold hands and low blood pressure. Then there are events at the optic disc itself, and there may be factors, such as genetic mutations, or just gene variants, which predispose to damage, either directly to the retinal ganglion cells or supporting glia.
We have drugs to lower IOP. Whatever the IOP, the lower you make it, the greater the blood perfusion to the eye. We have no drugs specifically to improve ocular circulation that have been proven - drugs reported include calcium channel blockers and betaxolol. We have no drug for neuroprotection. The memantine trial still has 2 years to go. I have been using Ginkgo biloba extract. More on that later.
I think that Chinese traditional medicine can be good for circulation, neuroprotection, and the immune system. None of this has been shown to be of benefit in a controlled prospective trial. Everything is by extrapolation and guesswork. For instance, there was only one controlled trial of bilberry the last time I looked about a year ago and the results were negative re improving night vision.
There are decent websites and alot of crackpot websites. There are alot of people selling alot of junk and preying on fear. Basically, you can't substitute for lowering IOP, just try to add to it. The question is what to add.
Here's a talk I gave in 2001 at the American Academy of Ophthalmology. This is all I can do today. Back to work.
Herbs, potions and incantations. My topic today is the potential role of complementary and alternative medicine in the treatment of glaucoma.
o Alternative medicine has been defined by the National Center for Complementary and Alternative Medicine as treatments and healthcare practices not taught widely in medical schools, not generally used in hospitals, and not usually reimbursed by medical insurance companies. Alternative therapy comes in many ways, shapes, and forms, from time-honored and formalized systems of knowledge to spurious and unsubstantiated nonsense. It includes Chinese traditional medicine, Ayurvedic medicine, and native medicinal plants from all continents, as well as more recent, unproven and often spurious forms of healing.
o Alternative medicine also includes vitamins, amino acids, and minerals. Lest anyone be overly skeptical, the October Archives contained two papers from the Age-Related Eye Disease Study Research Group. These prospective, placebo-controlled trials of antioxidants plus zinc, showed a statistically significant chance of slowing the progression of age-related macular degeneration, but no effect on cataract formation. Unfortunately, all of our information regarding the potential role of supplements and alternative therapy for glaucoma still relies on inferential analysis rather than controlled studies, and there is even very little of that.
o In preparation for this talk, I set about to scour the globe to see what I could find that might be applicable to treating glaucoma, and I found some very interesting items.
o The medicinal use of plants goes back to the dawn of mankind and even before. Chimpanzees, when sick, will eat bitter-tasting plants which have no nutritional value. Wild chimpanzees suffering from parasitic diseases eat the pith of a genus of plants called Vernonia. Sesquiterpene lactones and steroid glucosides appear to be the active agents. Vernonia species are also used by Ethiopians to control tick infestations in their cattle.
o Species of the genus Aspilia contain potent stimulators of uterine contraction. Female chimpanzees eat Aspilia leaves more frequently than do males. Aspilia also contains thiarubrine A, a highly potent antiviral and anticancer agent, which was first discovered during observations of chimpanzees. This is not simple instinct, but learned behavior, and it makes us wonder just when in evolution such ability began to develop and also the extent to which cultural attributes may be genetic.
o Every human society in history has used medicinal plants. Written textbooks of Chinese Traditional Medicine date back 5000 years. The Egyptians and the Mayans recorded extensive details in hieroglyphics. India, Persia, Greece and Rome developed codified bodies of knowledge, taught initially by apprenticeship and later in universities. During the Middle Ages, widely renowned schools of medicine drew students from many countries to Toledo, Seville, Cairo, and Baghdad.
The advent and eventual domination of synthetic drugs, along with the emphasis in medical training on specific agents for specific disorders led to the demise in the West of herbal medicines, which are usually extracts containing many different compounds. Throughout most of the 20th century, traditional herbal medications became looked upon with scorn and disdain. In the past few years, however, in no small part due to the rise of the Internet, complementary and alternative medicine has exploded into a $27 billion a year industry.
We tend to forget that many of our most important drugs were extracted from plants prior to their synthesis in laboratories. Digitalis was originally extracted from foxglove, a common garden flower. Quinine, aspirin, and taxol were all extracted from tree bark. Pilocarpine, the first topical antiglaucoma drug, was isolated from Pilocarpus microphyllus, found in the Brazilian rain forest. I would like to recommend this book, Honey, Mud, Maggots, and Other Medical Marvels, as light, entertaining, and interesting reading.
We stand now at an unprecedented threshold. In the future, we will control our own evolution through genetic engineering. Genes for every aspect of human behavior, appearance, function and intelligence will be susceptible to modulation. Tissue and organ replacement and regeneration will become routine. Disease as we now know it may disappear, perhaps even mortality. However, we're not there yet, and people are still going blind from glaucoma every day. So, is there something else that we can do now that we are not doing that can benefit our patients? To lead into how complementary and alternative medicine might be useful for glaucoma, let's look at an overview concept of glaucoma and its various risk factors.
o Glaucoma is a progressive optic neuropathy characterized by a specific pattern of optic nerve head and visual field damage, which represents a final common pathway resulting from a number of different diseases which can affect the eye. Most, but not all, of these disorders are associated with elevated intraocular pressure. However, elevated IOP is not the disease itself, but the most important known risk factor for progressive glaucomatous damage.
In this figure, glaucomatous optic nerve damage, whether mild or extensive, represents the final common pathway. Elevated IOP is a proximate step leading to the damage. This is where we've been concentrating our treatment for the past hundred years. However, we have largely ignored the fact that elevated IOP is caused by dysfunction of the trabecular meshwork, and this in turn has specific causes. X, Y, and Z represent different entities which lead to trabecular damage by specific mechanisms. For example, these could represent pigment dispersion syndrome, exfoliation syndrome, or autosomal dominant juvenile open-angle glaucoma with a TIGR/myocilin mutation.
In addition to elevated IOP, we now have come to recognize the importance of non-pressure-dependent risk factors for glaucomatous damage. In the past decade, the blood supply to the optic nerve head has become a focus of increasing attention, and disorders which interfere with the perfusion pressure of the optic nerve head and posterior pole have been and are being identified as risk factors for glaucomatous damage. After a hiatus of over a generation, at least in this country, it is again being suggested that even elevated intraocular pressure may produce its damage by causing or increasing ischemia at the level of the optic nerve head and lamina cribrosa. Here again, ischemia can be caused by specific disorders, although they are much less well known than the anterior segment risk factors. For instance, X', Y', and Z' could represent increased platelet adhesiveness, nocturnal hypotension, or atrial fibrillation.
Abnormalities at the level of the lamina cribrosa may predispose some patients to glaucomatous damage, but these are even more poorly delineated and we have no means at present to determine their existence in patients. The concept of secondary degeneration and the development and use of neuroprotectants to shield the eye against damage from both IOP-dependent- and non-IOP-dependent risk factors, is providing still another increasingly active area of interest and investigation.
o Neuroprotection has been covered already this morning. I would like briefly to mention a couple of additional potentially relevant compounds.
Free radicals have figured prominently in general theories of aging. They induce plasma membrane lipid peroxidation, causing a chain reaction of damage to membrane-associated enzymes and receptors. They facilitate the release or potentiate the effect of excitatory amino acids, and both may work together to bring about neuronal cell injury.
One compound which has not yet made it into the glaucoma literature is platelet activating factor. This alkylphospholipid is essential for the induction of platelet aggregation independent of arachidonic acid. It is one of the most potent lipid mediators known, producing effects at femtomolar concentrations. Its concentration increases significantly after ischemic injury. It increases vascular permeability; lysosome release, superoxide synthesis, leukotriene production and calcium uptake. It enhances glutamatergic excitatory synaptic transmission and may amplify excitotoxicity produced by excess glutamate release during neuronal injury. Its role in the causation of progressive glaucomatous nerve damage remains uninvestigated.
o Nothing at this point in alternative medicine has been shown to achieve a practical and sustained lowering of IOP except marijuana and, since that is at least technically considered not to be freely available, I won't cover it here. Thus, potentially beneficial treatment approaches would be those which improve ocular blood flow, provide neuroprotection, or affect the immune system in one way or another, whether to counteract autoimmune disease, as propounded by Marty Wax, or to stimulate beneficial autoimmunity, as described by Michal Schwartz and her colleagues in Israel. I would like to concentrate primarily on one preparation that has been extensively investigated and which I feel has the greatest chance of being valuable for glaucoma.
o Ginkgo biloba is the sole survivor of the earliest known Order of trees, having originated at the beginning the Permian Era about 250 million years ago. It dominated the earth for 40 million years, but is now thought to be extinct in the wild.
o Leaf extracts were described in the earliest known texts of Chinese medicine from about 3000 BC for treating asthma and bronchitis. I reviewed the literature in this paper which contains about 350 references complete up to October 1998. If anyone would like a copy, just e-mail me and I'll send one.
Ginkgo biloba extract, or GBE, is presently the most commonly prescribed drug in Germany. In the United States, it is freely available as a nutritional supplement. It has been claimed effective in a variety of disorders associated with aging, particularly cerebrovascular insufficiency and Alzheimer's disease.
o GBE contains over 60 known bioactive compounds, half of which are not found anywhere else in the plant Kingdom. The standardized German extract used most widely in clinical research, EGb 761, contains 24% ginkgo flavone glycosides, 6% terpene lactones, approximately 7% proanthocyanidines, and other, uncharacterized compounds. The characterized flavonoids include kaempferol, quercetin, and isorhamnetin. There are about 25 brands of GBE on the market and the majority do not appear to be highly standardized. The studies published in the past several years, both in vitro and in vivo, tend to have been much more rigorous in their methodology and better controlled than earlier studies.
What are some of the reported actions of GBE that would provide extrapolative or inferential evidence for a possible benefit in patients with glaucoma? Numerous studies have indicated that GBE protects against free radical damage and lipid peroxidation. Its antioxidant potential is equivalent to those of ascorbate, vitamin E, and glutathione.
o The biflavonoids, bilobetin and ginkgeten, inhibit production of TNF-alpha, reduce expression of inducible nitric oxide synthase, and reduce expression of COX-2.
The terpene compounds, ginkgolides and bilobalides, are found nowhere else in Nature. The ginkgolides are the most powerful platelet activating factor inhibitors known.
o GBE protects against ischemia-induced alterations of mitochondrial respiratory activity. It preserves mitochondrial metabolism and ATP production in the presence of ischemia and other injury, and retards morphologic changes and oxidative damage associated with mitochondrial aging. GBE inhibits glutamate-induced neurotoxicity and may interfere with excess glutamate production. It protects against ischemia-reperfusion injury in a number of different systems through various hypothesized mechanisms.
o GBE protects cultured hippocampal neurons against cell death induced by nitric oxide, ß-amyloid, and phospholipase A2. In cell culture, it inhibits production of TNF-alpha induced by bacterial lipopolysaccharide and NF-kB activation induced by hydrogen peroxide.
o Physiologically, GBE improves peripheral and cerebral blood flow, decreases blood viscosity, inhibits platelet aggregation, and inhibits thrombus formation. It relaxes vascular smooth muscle and increases glucose uptake and glycogen synthesis.
o GBE improves symptoms of intermittent claudication and exercise tolerance in patients with peripheral vascular disease. Raynaud's phenomenon, a manifestation of vasospasm, is considered a non-pressure-dependent risk factor for glaucomatous damage. We have been highly impressed with the improvement in symptomatology exhibited by many patients with Raynaud's phenomenon treated with GBE.
Topical application of Ginkgo preparations has been reported to prevent or ameliorate contact dermatitis and atopic dermatitis. An allergic dermatitis related to the fruit of the tree has no bearing on the leaf extract.
o In several placebo-controlled trials, GBE has slowed down progression of Alzheimer's disease and symptoms related to cerebrovascular insufficiency. In the eye, it reduces ischemia-reperfusion injury in rat retina and inhibited angiogenesis in a rat model of retinopathy of prematurity.
o GBE has been reported to prevent ERG changes induced by platelet activating factor and by chloroquine and to protect against ERG changes in diabetic retinopathy. It reduced retinal edema and necrosis in a rat model of central retinal artery occlusion. It inhibited preretinal proliferation in an model of tractional retinal detachment and improved experimental vitreoretinopathy with retinal detachment and epiretinal membrane formation.
o Both GBE and vitamin E protect photoreceptors against light-induced toxicity, bringing up the question as to whether we should be giving patients these agents prior to surgery.
o In collaboration with Alon Harris's group, we performed a double-masked crossover study of normal volunteers using color Doppler imaging. Volunteers were given 40 mg GBE or placebo tid for 3 days with 2 weeks between study arms. GBE increased ophthalmic artery end-diastolic velocity by a mean of 24% as opposed to 3% by placebo. There was no effect on peak systolic velocity and no effect on the parameters in the central retinal artery or the short posterior ciliary arteries. Follow-up studies are both underway and planned.
o The supermarket tabloids may have overblown things a little bit, but I think there is certainly a potential role for Ginkgo extract in glaucoma and more investigation is warranted. From a teleological standpoint, remember that this tree dominated the earth during the rise of the dinosaurs which, in the beginning at least, were cold blooded. Maybe it was all the Ginkgo in their diet that enabled them to run around faster and take over the world.
o Several other extracts that have been investigated for their effects in other systems and disorders may also have benefit in glaucoma and are worth looking into.
GINSENG. The ginseng root has been used for over 2000 years, in the belief that it is a panacea and promotes longevity. In textbooks of Chinese traditional medicine, its effectiveness reaches mythical proportions. Pharmacological effects of ginseng have been demonstrated in the CNS and in the cardiovascular, endocrine, and immune systems. In addition, ginseng has been ascribed antineoplastic, antistress and antioxidant activity. Ginseng pharmacology is highly complex. There are many species and their activity can vary not only between species but within the same species raised in different places. The compounds of interest are the ginsenosides, which belong to a family of steroids named ginsenoside saponins. Ginsenosides Rb-1 and Rg-3 attenuate glutamate-induced neurotoxicity, reduce calcium influx into cells in the presence of excess glutamate, and inhibit lipid peroxidation. Another ginsenoside, Rg-1, inhibits dexamethasone binding to glucocorticoid receptors. Further
investigation is necessary to determine any value they might have for glaucoma.
o ANGELICA SINENSIS: Also known as Dang gui root, or dong quai, has been used in China to improve cardiovascular function. It inhibits expression of I-NOS and inhibits oxidation of LDL's.
o SALVIA MILTIORRHIZA: Asian red sage, or dan shen, contains salvialonic acid B, a highly potent antioxidant. It inhibits TNF-alpha-induced activation of NF-kappaB and has been reported to protect against retinal ganglion cell loss in a rabbit model of glaucoma.
o HAWTHORNE: Various species of Crataegus, or Hawthorn, have been traditionally used for angina, arrhythmias, and congestive heart failure. In one placebo-controlled study, Hawthorn significantly improved exercise tolerance in patients with CHF. The components of this extract may have potential as anti-ischemic and lipid-lowering agents.
o VACCINIUM MYRTILIS: Or bilberry, has been touted widely for its effects against eye disease and is found in numerous preparations. It was supposedly used by RAF pilots during World War II to see better at night. In the one controlled study which I was able to find, it had no effect on night visual acuity or contrast sensitivity and as yet has no proven benefit.
o COLEUS FORSKOLII: Is the source of forskolin, which is heavily touted on the Internet and which was investigated by several groups in the 1980s. It reduces aqueous secretion in vitro and in vivo but only one human single-dose study suggested that topical application lowers intraocular pressure. Steve Podos thinks that it might have caused tachyphylaxis and was thus abandoned.
o RED WINE: We've all heard about the potential value of red wine in coronary artery disease. Alcohol itself increases HDL levels, although it doesn't seem to have affected mine, and reduces platelet aggregation. Polyphenols in red wine exhibit cancer preventative properties, stimulate vasodilation, and inhibit oxidation of low-density lipoproteins. They inhibit platelet aggregation, and inhibit synthesis of pro-atherogenic eicosanoids. Quercetin, a polyphenol in red wine and also in Ginkgo extract, inhibits production of i-NOS. The value of red wine in the treatment of glaucoma remains to be established, but at least I've never heard anyone argue against it.
o GREEN TEA: Has also been getting attention lately for its potential neuroprotective properties. Aqueous extracts of green tea have been stated to quench reactive oxygen species such as singlet oxygen, superoxide and hydroxyl radicals, to prevent the oxidative cross-linking of proteins, and to counteract the oxidative insult from cigarette smoke. Green tea extract was reported to retard progression of lens opacity in a rat model.
o This talk would be incomplete without mention of vitamin E, which is being investigated in many systems. There is increasing evidence for an effect in slowing Alzheimer's disease, while reports regarding slowing of cataract progression have been mixed. In one study, it inhibited proliferation of Tenon's capsule fibroblasts in vitro.
Methylcobalamin was reported to have beneficial effects on visual field progression in normal-tension glaucoma and to protect against glutamate-induced neurotoxicity in retinal cell culture.
o Finally, some other compounds, although not herbal, include glucosamine, which has been shown to inhibit iNOS. Free fatty acids increase ocular blood flow and may other beneficial actions. Magnesium, an NMDA receptor inhibitor, was reported to improve both nailfold capillary responses and visual fields in patients with cold-induced vasospasm who had either POAG or normal-tension glaucoma. s-allylmercaptocysteine, found in garlic, was reported to lower IOP in rabbits.
So what are we supposed to do with all this? Clinical trials on the effects of one or another supplement on the progression of glaucomatous damage are difficult because these agents are freely available and not patentable. I think that evidence is going to have to be inferential, from study on their effects in vitro and in animal models. Until then, we need to try to make educated guesses.
Herbs, Potions and Incantations: The Role of Alternative Medicine in the Treatment of Glaucoma
Robert Ritch, MD
I. Definition of Alternative Medicine
A. Treatments and healthcare practices not taught widely in medical schools, not generally used in hospitals, and not usually reimbursed by medical insurance companies (General Information Package, National Center for Complementary and Alternative Medicine Clearinghouse. Silver Spring, MD, USPHS Publication)
B. The use of medicine began long before the 19th century
1. Plants used for medicinal purposes by virtually every society
2. Pre-human use of medicinal plants
a. Leaves of Aspilia (Asteraceae), used medicinally in Africa, are also eaten by wild chimpanzees when sick and contain potent antibiotic and anticoagulant activity, and potent stimulators of uterine contraction, the latter perhaps explaining why female chimpanzees consume Aspilia leaves more frequently than do males
b. Vernonia amygdalina, used by Ethiopians for tick control, is ingested by wild chimpanzees sometimes suffering from parasite-related diseases
c. This is probably learned, not instinctive, behavior
C. Wide range of categories, from long-standing and widely accepted and well-tested approaches to spurious and quack remedies
1. Chinese traditional medicine
2. Ayurvedic medicine
3. Other "native" medicines, e.g. Africa, South America
4. Plant extracts
5. Animal extracts
6. Vitamins, minerals
7. Other treatment modalities
D. Pharmaceutical approaches
1. Single molecule (usually synthetic) therapy for diseases
2. Many modern medications originally extracted from plants
a. Pilocarpine
b. Digitalis
c. Taxol
3. Blurred spectrum between over-the-counter remedies and what is considered as alternative medicine
4. One way to look at it: herbal remedies are usually extracts containing a number of different compounds
E. Until recently, all forms of alternative medicine were often lumped together and ignored and even ridiculed
1. Rapidly expanding usage in Western society
2. Role of New Age philosophy and Internet
3. Establishment of National Institute of Complementary and Alternative Medicine, NIH
4. Now a multi-billion dollar business
5. Increasing calls for regulation
6. Controlled clinical trials difficult because of lack of patentability in many cases.
II. Definition of glaucoma: A progressive optic neuropathy which represents the final common pathway of a number of different disorders which affect the eye. Most, but not all, of these are associated with elevated IOP, which is the most important known risk factor for optic nerve damage, but is still only a risk factor and not the disease itself.
A. In diseases which affect the anterior segment, there are several steps in the pathophysiology prior to the development of elevated IOP
B. Ocular blood flow, or decreased perfusion to the optic nerve head and/or posterior segment is a common characteristic of many risk factors implicated in non-IOP-dependent glaucomatous damage
C. Secondary degeneration
1. Concept based on the finding that neuronal damage in the central nervous system may progress even when the primary cause of damage is alleviated.
2. Neuronal death may be viewed as occurring in three steps
a. Axonal injury
b. Death of the injured neuron
c. Injury and death of previously intact neurons through secondary degeneration
3. Neuroprotection refers to the preservation of those neurons which initially were undamaged or only marginally damaged, but are at risk from toxic stimuli released by damaged cells. Neuroprotection is useful even when the exact cause of a disorder is undefined, as the therapy occurs at the level of the dying cells and not at the initial injury.
D. Treatment theoretically could be aimed at
1. Origin of various disorders which lead to glaucoma
2. Mechanisms of various disorders which lead to glaucoma
3. Treatment of IOP (remains the standard at present)
4. Treatment of non-IOP-dependent risk factors, e.g. improvement of ocular blood flow
5. Protection of retinal ganglion cells
III. The role of alternative medicine in the treatment of glaucoma
A. Lowering of IOP
1. Cannabis
2. Aerobic exercise
3. No consistent known or proven effect of other treatments
B. Most potential treatments either improve circulation or have neuroprotective properties
IV. Ginkgo biloba extract
A. Sole survivor of the Order of the earliest known trees, having originated in the Permian period approximately 250 Myr ago
1. First used in Chinese traditional medicine about 3000 BCE for treating asthma and bronchitis
2. Most commonly prescribed drug in Germany
3. Freely available in the USA as a nutritional supplement
B. Claimed effective in a variety of disorders associated with aging, including cerebrovascular disease, peripheral vascular disease, dementia, tinnitus, bronchoconstriction, and sexual dysfunction
C. Pharmacology
1. Over 60 known bioactive compounds, about half of which are found nowhere else in nature
2. Standardized extract contains 24% ginkgo flavone glycosides (flavonoids), 6% terpene lactones (ginkgolides and bilobalide), approximately 7% proanthocyanidines, and other compounds
3. Antioxidant activity
a. Comparable to water soluble antioxidants such as ascorbate and glutathione and lipid soluble ones such as alpha-tocopherol and retinol acetate
b. Significant protective effects against free radical damage and lipid peroxidation in various tissues and experimental systems
c. Increases levels of glutathione and glutathione sulfide reductase activity
d. Preserves mitochondrial metabolism and ATP production in various tissues and partially prevents morphologic changes and indices of oxidative damage associated with mitochondrial aging
e. Effective scavenger of peroxyl and superoxide radicals and nitric oxide; may inhibit production of nitric oxide
4. Ginkgolide B is one of the most potent antagonists of platelet activating factor found in nature
a. Blocks PAF binding to platelets and inhibits PAF-induced platelet aggregation
b. Decreases free fatty acid concentrations and enhances blood flow in the gerbil brain following ischemia-reperfusion injury
D. Reported physiologic actions
1. Blood flow / hypoxia-ischemia
a. Improvement of peripheral and cerebral blood flow
b. Improvement of hemorheologic indices, decreasing blood viscosity and increasing erythrocyte deformability
c. Inhibition of arterial thrombus formation
d. Prolongation of survival time of mice under lethal hypoxia
e. Protects myocardium against hypoxia and ischemia-reperfusion injury
f. Increased ophthalmic artery blood flow 24% in double-masked crossover study of normal volunteers
2. Smooth muscle
a. Increased skin perfusion; potential value in treatment of Raynaud's phenomenon, a risk factor for glaucoma
b. Prevented vasomotor changes of extremities in mountain climbers
3. Neuroprotection
a. Substantial experimental evidence for neuroprotective properties in conditions such as hypoxia/ischemia, seizure activity, cerebral edema, and peripheral nerve damage
b. Pretreatment prolongs survival of rat cerebellar neurons after exposure to hydrogen peroxide
c. Facilitates recovery from and reduces impairment due to penetrating brain injury in rats and reduces the extent of brain swelling seen histologically in response to injury
d. Improves motor function and behavioral performance after induced cortical injury
4. Eye disease
a. Reduces ischemia-reperfusion injury in rat retina
b. Reduces microscope light-induced phototoxicity
c. Preserves ERG under various insults
d. Inhibits preretinal proliferation in experimental tractional retinal detachment
e. May protect against progression of diabetic retinopathy
E. Medicinal uses
1. Asthma
2. Cognitive function
a. In double-masked, controlled studies of patients with cerebral insufficiency and organic memory impairment, GBE significantly improved mental performance and memory
b. Extensive evidence for slowing progression of Alzheimer disease
c. Overall, symptoms of cognitive dysfunction are reduced approximately 25%, with memory, concentration, and alertness the first symptoms to be relieved
3. Peripheral vascular disease
a. Raynaud's phenomenon
b. Intermittent claudication
c. Healing of skin disorders
F. Side effects
1. Scattered reports of bleeding
2. Gastrointestinal symptoms
3. GBE and numerous other alternative therapy agents can potentially potentiate warfarin activity. The true risks of these interactions and effects are difficult to characterize due to the limited number and nature of existing reports.
V. Other Compounds
A. Common compounds with ascribed neuroprotective activity
1. Cannabinoids
2. Aspirin
3. Methylcobalamin
4. Melatonin
B. Food extracts with ascribed benefits requiring further investigation
1. Red grape skins
2. Green tea
3. Fish oil
4. Bilberry - one controlled study failed to find any effect on night vision
C. Vitamins, minerals, small molecules
1. Vitamin C
2. Vitamin E
a. Protects against phototoxicity
b. Retards progression of cataract and ARMD
c. Increases glutathione levels
3. Forskolin (Coleus forskolii)
4. Glucosamine
5. Lipoic acid - increases glutathione levels
6. Magnesium
7. Carnosine
8. Glucosamine
9. Selenium
D. Traditional medicines requiring further investigation
1. Ginseng (Panax spp)
a. Many different active compounds; different species have different activities
b. Ginsenosides, a diverse group of steroidal saponins, target a myriad of tissues, producing a complex array of pharmacological responses
c. Anticancer activity
d. Neuroprotective against ischemia-reperfusion injury
e. Ginsenoside-Rb1 blocks protein tyrosine kinase activation
f. May possess potential therapeutic efficacy against TNF-alpha mediated disease
g. May protect neurons from oxidative damage produced by exposure to excess glutamate
2. Salvia miltiorrhiza (Dan Shen; Asian Red Sage)
a. Salvianolic acid - powerful water-soluble anti-oxidant
b. Anti-inflammatory activity
c. Used in treatment of atherosclerosis
d. Inhibits TNF-alpha-induced activation of NF-kappaB
e. Reported to prevent RGC death in a rabbit model of glaucoma when given intravenously
3. Trifola (Trifolium pratense L.; red clover)
a. Genistein - isoflavone with estrogenic activity
b. POAG increases in women after menopause.
E. Preparations which affect drug metabolism
1. St. John's wort
2. Grapefruit juice
VI. Nonmedicinal Therapy
A. Exercise
B. Acupuncture
VII. Journals
A. Alternative Medicine Review
B. Am J Chinese Med
C. J Asian Natural Product Research
D. J Ethnopharmacology
E. J Natural Products
F. Phytochemistry
G. Planta Medica
References
Aonuma H, Koide K, Masuda K, Watanabe I: Retinal light damage: Protective effect of a-tocopherol. Jpn J Ophthalmol 1997;41:160-167.
Attele AS, Wu JA, Yuan CS: Ginseng pharmacology: multiple constituents and multiple actions. Biochem Pharmacol 1999 Dec 1;58(11):1685-93
Bastianetto S, Ramassamy C, Dore S, et al: The ginkgo biloba extract (Egb 761) protects hippocampal neurons against cell death induced by ß-amyloid. Eur J Neurosci 2000;12:1882-1890.
Bastianetto S, Zheng WH, Quirion R: The Ginkgo biloba extract (EGb 761) protects and rescues hippocampal cells against nitric oxide-Induced toxicity: involvement of its flavonoid constituents and protein kinase C. J Neurochem. 2000;74:2268-2277.
Baudouin C, et al: Effects of Ginkgo biloba extracts in a model of tractional retinal detachment. Lens Eye Toxic Res 1992;9:513-519.
Boldyrev AA, et al: Biochemical and physiological evidence that carnosine is an endogenous neuroprotector against free radicals. Cellular and Molecular Neurobiology 1997;17:259-271.
Bouzas EA, Karadimas P, Mastorakos G, Koutras DA: Antioxidant agents in the treatment of Graves' ophthalmopathy. Am J Ophthalmol 2000;129:618-622.
Cohen RA, Gebhardt BM, Bazan NG: A PAF antagonist reduces corneal allograft inflammation and neovascularization. Curr Eye Res 1994;13:139-144.
Cheung F, Siow YL, Chen WZ, O K: Inhibitory effect of Ginkgo biloba extract on the expression of inducible nitric oxide synthase in endothelial cells. Biochem Pharmacol 1999;58:1665-1673.
Cho JY, Yoo ES, Baik KU, Park MH, Han BH. In vitro inhibitory effect of protopanaxadiol ginsenosides on tumor necrosis factor (TNF)-alpha production and its modulation by known TNF-alpha antagonists. Planta Med 2001 Apr;67(3):213-8
Chung HS, Harris A, Kristinsson JK, Ciulla TA, Kagemann C, Ritch R: Ginkgo biloba extract increases ocular blood flow velocity. J Ocular Pharmacol Ther 1999;15:233-240.
Contestabile A: Antioxidant strategies for neurodegenerative diseases. Expert Opin Therapeutic Patents 2001;11:573-586.
Dharma S, Bazan HE, Peyman GA, Atef MS: Production of PAF in photocoagulated retinas. Curr Eye Res 1991;10:1031-1035.
Droy-Lefaix MT, Vennat JC, Besse G, Doly M: Effect of Ginkgo biloba extract (EGb 761) on chloroquine induced retinal alterations. Lens Eye Toxic Res 1993;9:521-528.
Dutta-Roy AK, Gordon MJ, Kelly C, et al: Inhibitory effect of Ginkgo biloba extract on human platelet aggregation. Platelets. 1999;10:298-305.
Fugh-Berman A. Herb-drug interactions. Lancet 2000 Jan 8;355(9198):134-8
Guidetti C, Pracchini S, Lucchini S, et al: Prevention of neuronal cell damage induced by oxidative stress in vitro: effect of different Ginkgo biloba extracts. J Pharmacy Pharmacol 2001;53:387-392.
Haas AL, Boscoboinik D, Mojon DS, Bohnke M, Azzi A: Vitamin E inhibits proliferation of human Tenon's capsule fibroblasts in vitro. Ophthalmic Res 1996;28:171-175.
Head KA: Natural therapies for ocular disorders part two: cataracts and glaucoma. Alternative Medicine Review 2001;6:141-166.
Janssens D, Delaive E, Remacle J, Michiels C: Protection by bilobalide of the ischaemia-induced alterations of the mitochondrial respiratory activity. Fundam Clin Pharmacol 2000;14:193-201.
Kikuchi M, Kashii S, Honda Y, et al: Protective effects of methylcobalamin, a vitamin B12 analog, against glutamate-induced neurotoxicity in retinal cell culture. Invest Ophthalmol Vis Sci 1997;38:848-854.
Kim YC, Kim SR, Markelonis GJ, Oh TH. Ginsenosides Rb1 and Rg3 protect cultured rat cortical cells from glutamate-induced neurodegeneration. J Neurosci Res 1998 Aug 15;53(4):426-32
Kobayashi MS, Han D, Packer L: Antioxidants and herbal extracts protect HT-4 neuronal cells against glutamate-induced cytotoxicity. Free Radic Res 2000;32:115-124.
Lim JH, Wen TC, Matsuda S, Tanaka J, et al: Protection of ischemic hippocampal neurons by ginsenoside Rb1, a main ingredient of ginseng root. Neurosci Res 1997 Jul;28(3):191-200
Lin N, Bazan HE, Braquet P, Bazan NG: Prolonged effect of a new PAF antagonist on ocular vascular permeablity in an endotoxin model of uveitis. Curr Eye Res 1991;10:19-24.
Liu J, Burdette JE, Xu H, et al. Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms. J Agric Food Chem 2001 May;49(5):2472-9
Miller AL. Botanical influences on cardiovascular disease. Altern Med Rev 1998 Dec;3(6):422-31
Muth ER, Laurent JM, Jasper P. The effect of bilberry nutritional supplementation on night visual acuity and contrast sensitivity. Altern Med Rev 2000 Apr;5(2):164-173.
Pierre S, Jamme I, Droy-Lefaix MT, et al: Ginkgo biloba extract (EGb 761) protects NaK-ATPase activity during cerebral ischemia in mice. NeuroReport 1999;10:47-51.
Polak K, Schmetterer L, Luksch A, et al: Free fatty acids/triglycerides increase ocular and subcutaneous blood flow. Am J Physiol Regulatory Integrative Comp Physiol 2001;280:R56-R61.
Ranchon I, Gorrand JM, Cluzel J, Droy-Lefaix MT, Doly M: Functional protection of photoreceptors from light-induced damage by dimethylthiourea and Ginkgo biloba extract. Invest Ophthalmol Vis Sci 1999;40:1191-1199.
Rhee DJ, Katz LJ, Spaeth GL, Myers JS: Complementary and alternative medicine for glaucoma. Surv Ophthalmol 2001;46:43-55.
Ritch R: Potential role for Ginkgo biloba extract in the treatment of glaucoma. Med Hypotheses 2000;54:221-35.
Sastre J, Pallardo FV, Garcia de la Asuncion J, Vina J: Mitochondria, oxidative stress and aging. Free Radic Res 2000;32:189-98
Tagami M, Yamagata K, Ikeda K, et al: Vitamin E prevents apoptosis in cortical neurons during hypoxia and oxygen reperfusion. Lab Invest 1998;78:1415-1429.
Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm 2000 Jul 1;57(13):1221-7
Weichel O, Hilgert M, Chatterjee SS, Lehr M, Klein J: Bilobalide, a constituent of Ginkgo biloba, inhibits NMDA-induced phospholipase A2 activation and phospholipid breakdown in rat hippocampus. Naunyn-Schmiedeberg's Arch Pharmacol 1999;360:609-615.
Westman J, Drieu K, Sharma HS: Antioxidant compounds EGb-761 and BN-520 21 attenuate heat shock protein (HSP 72 kD) response, edema and cel changes following hyperthermic brain injury - An experimental study using immunohistochemistry in the rat. Amino Acids 2000;19:339-350.
Xiaohong Y, Jing-Ping OY, Shuzheng T. Angelica protects the human vascular endothelial cell from the effects of oxidized low-density lipoprotein in vitro. Clin Hemorheol Microcirc 2000;22(4):317-23
Xuan B, Zhou YH, Yang RL, et al: Improvement of ocular blood flow and retinal functions with puerarin analogs. J Ocular Pharmacol Ther 1999;15:207-216.
Yamazaki Y, Hayamizu F, Tanaka C : Effects of long-term methylcobalamin treatment on the progression of visual field defects in normal-tension glaucoma. Curr Therap Res 2000;61:443-451.
Youdim KA, Joseph JA: A possible emerging role of phytochemicals in improving age-related neurological dysfunctions: a multiplicity of effects. Free Radic Biol Med 2001 Mar 15;30(6):583-94
Robert Ritch, MD
Professor of Clinical Ophthalmology
Chief, Glaucoma Service
Surgeon Director
The New York Eye and Ear Infirmary
310 East 14th Street
New York, NY 10003
Medical Director and
Chairman, Scientific Advisory Board
The Glaucoma Foundation
Private (Admin Asst: Karen Cheifetz) - Tel: 212-673-5140
kcheifetz@nyee.edu
Patient Appointments - Tel: 212-477-7540
Fax: 212-420-8743
e-mail: ritchmd@earthlink.net
http://www.glaucoma.net
http://www.nyee.edu
Personally the only "natural" remedy that seems to be working for me is to have a positive outlook, eat the right foods and exercise regularly. I could never understand why people who insist on forever dieting and depriving their body of essential nutrients, which I'm certain affects the body in a negative way believee that a vitamin is a better alternative. Most women that I have known for years and who were either crash dieting and even anorexic now in their late 30s and 40s have health problems. Ranging from osteoporosis, athritis, nervous disorders and generally being fatigued all the time and looking very frail.
I haven't checked this out in any detail, but this site looks promising:
http://www.childrensglaucoma.com/links.html
Hello everybody,
I have a question. Does anyone know of websites that explain what
glaucoma is to children very well or talks about children with
glaucoma?
Thank you
Hi all,
Matthew Cope <cope@...
<<Do the supplements help? Who knows? How do we define help? How do we measure the effect?
If you practice acupuncture, homeopathy, nutritional therapy, etc. specifically for the glaucoma and your visual field tests stop deteriorating or even start improving; or if your pressures came down and stayed down; that would be pretty good evidence that some thing good is happening as a result of what you are doing.
but it would need to be for a long period of time...because the way my glaucoma damage has progressed, is periods of stability followed by periods of decline. These stable plateaus last for a year or 2. I sure wish I could figure out what causes the periods of rapid d ecline.
if the alternative therapy you are trying happens to co-incide with one of the stable plateaus, obviously you have learned nothing from the experiment...that is why it has to go on for years....that way if you get a stable plateau that lasts for e.g. 10 years, maybe from that you could conclude you have accomplished something wonderful.
sometimes, if you have experimented with an alternative therapy and you stop because, for examp,e, it is becoming too costly, and as soon as you stop you go into a major decline...what can you conclude? was the decline caused by stopping of the therapy? or would it have happened anyway, since that seems tobe the way glaucoma damage progresses in my case?
<< Maybe theres only a placebo effect that makes me think I feel better,
and that is an important result. If you feel better and more relaxed, that alone could be beneficial to your vision.
<<Im not saying they dont work. Im saying they havent been proven to work.
exactly.
and as you point out, studies will likely never be done on a significant scale, because the drug companies are unique in being able to afford these kinds of large-scale studies.
that is why some of us use ourselves as guinea pigs....and the results of our experiments can only be considered to be un-scientific data.
I cautiously try some harmless things, such as vitamin supplements. I even went to a Chinese herbalist for a while...but it cost $40 a week, and I had trouble affording it after a while...i think i would have to maintain that regiment for the rest of my life, and i just can't afford it. They do sell special electric cookers to prepare the blend on a dily basis...but it is still time-consuming; You might be interested in knowing that the main ingredient for vision problems in DRIED LOCUSTS!! not for the faint of heart. I do not think these herbs are dangerous. The herbalist I visited was extremely well-known in Chicago, nothing bad ever came of his preparations. But he finally died (of old age) and his daughter toook over his business but she is not as knowledgeable as he was...yet, anyway.
I would be more than willing to drink locusts and wolfberries for the rest of my life if it improved my visual fields. But i could not afford it; and this herbalist was not covered by my HMO. During the time I was visiting Dr.Lao, the visual fields were stable; Dr. Lao said the herbal blend was designed to strengthen the optic nerve and the retina so that whatever condition was causing the glaucoma, the eyes would be able to withstand it. He also used a pulse diagnosis so he could know what elsle in teh body needed strengthening or calming, and that also went into the blend. I never stopped taking my glaucoma meds during this time, and my ophth was kept informed of whatever Dr. Lao was doing for me.
<<Ive been very lucky with prescription meds so far.
I have had quite a few side-effects with my various meds...pilocarpine in particular made me feel as if my head was being ripped apart...
<< My pressures and visual fields have been stable and unchanged for 2-3 years.
mine have been getting steadily worse since the 80's when my condition was diagnosed, in spite of all the meds and the trabs. Do I conclude fromt his they are ineffective and a form of medieval quackery? I think the mysterious nature of glaucoma makes it lend itself more to alternative therapies...since they do not really know what CAUSES it, people feel free to experiment more...also when their best standard methods fail, people naturally turn to alternative methods out of desperation.
<< would be to go off the Xalatan and Cosopt for a few months and have regular examinations. But Im not going to take the risk of becoming a guinea pig to test the theory or prove a point!
i do NOT believe anyone should put themselves at risk by any of the experimenting they do. You need to do some solid investigating before you take the plunge...problem with alternative treatments, the solid research is not always there, and you only have ccircumstantial evidence to go by.
<<I am obviously aware that other people havent been as lucky.
yes...and that is why i feel i do not have as much to lose as you do...and at the same time, if i lose what little i have, i may be losing MORE than you do.
that is why i am very cautious with my experimenting.
If I ever come across anything where I have real improvement to report, i will do so. I would have been happy to recommend Dr. Lao, except he is now deceased, and i have not worked enough with his daughter to know yet how good she is.
Deena
I'm wondering if there's a connection between glaucoma and high cholesterol.
Does anyone know if eyedrop chemicals affect the blood and if so, how?
Thanks, Joan W
I had a new test done today that measured the thickness of my cornea. My Dr. told me that if the cornea is thin, one is more likely to have higher pressures. The thicker the cornea the less chance of pressure getting out of control. Mine he said was normal which surprised him. He said he expected it to be thin. Has anyone else heard of this test? Eve
He told me the name of the test, but I do not remember what he called it. BTW: my pressure runs between 12-to15, but that is with using my eye drop meds.
What my Opthamologist explained to me is that if you have thin
corneas your pressures might actually read lower than what they
really are. You could be getting a reading of say 15 with thin
corneas which in reality as far as eye health goes is actually more
like in the 20's. And if you have thick corneas the opposite is true-
you could have readings in the 20's which in reality are more like
the teens.
Has he discussed this with the prescribing ophthalmologist? This is not a
decision to be undertaken lightly.
It may be that lowering his pressures has not arrested the progress of his
glaucoma as effectively he might have wished, but stopping the drops will in
all likelihood *raise* the pressures -- and that cannot be a desirable thing
in a glaucoma patient -- it will in all likelihood *accelerate* the progress
of the disease.
I've Googled niacin and glaucoma and come up with the same result as you --
many cautions and warnings to consult your doctor, but so far, none that
explain *why*.
Bottom line I would urge your friend to discuss his decision and the use of
niacin *fully* with the prescribing ophthalmologist. If that doesn't produce
a satisfactory result he should seek a second opinion from a *qualified*
opinion (i.e. from an ophthalmologist, not a sales clerk in a health food
store or a web site selling supplements).
I fear your friend risks going blind sooner rather than later if he
continues on his present course.
A friend with severe glaucoma has been taking Niacin, along with other supplementation. In fact, he stopped taking his drops because he feels that keeping the pressures lower has not stopped the damage to his optic nerve from progressing.
Anyway, my question is: I read somewhere that Niacin is detrimintal to glaucoma patients. However, I can not find that information again. A sent an email to a vision website and they said it was fine. I did a search and found a nutritional site that said glaucoma patients should not take Niacin, but it didn't explain why not.
Can anyone help me with this?
You're right on the latter - it depends. There's no way to predict. There
are probably other modifying genes involved. I would guesstimate several
years.
RR
I have a question which I'm hoping someone out there will be able to
answer. I've got pigmentary glaucoma and am on three medicines
(Lumigan, Alphagan, Cosopt) which have been keeping my pressures stable
around 15 for about a year now. There's reason to believe my pigmentary
may be burning out (e.g., my eye's not liberating much new pigment). My
understanding is that over time the eye can absorb pigment, so that, if
new pigment is not deposited, the eye pressure can eventually improve.
I'm wondering how long I would have to wait for my eye to absorb enough
pigment so that I would notice some drop in my IOP (assuming my
pigmentary is burning out)? Are we talking several years, decades? or
is it one of those questions for which the answer is: it depends.
thanks --David
This message was content scanned for viruses by the TLU McAfee Webshield.
Hi everyone,
A short introduction ;-)
My Name is Nick Wilson and I joined your group to learn more about
Glaucoma. I don't have Glaucoma but I run a website discussion board
that has a seciton on this condition.
I have RP (retinitis pigmentosa) and am just looking to find out what
the main concerns of Glaucoma patients are to better write for my site.
(address below).
Thanks all, look forward to seeing what the list talke about ;-)
--
Nick W
http://www.eyesightnews.com // News & Discussion about Eyesight
I certainly hope they're not taking tissue from newborn children!
Do you have a reference to a website (in English!) about this?
Sherry
I used my dictionary for that word ---
In norwegian it's called a fosterhinne.
It is the membran which is around a baby in
the mothers stomach.
Hope this makes it clearer.
Sorry, I don't know any english website about
this, But the address to the norwegian is:
http://www.nrk.no/programmer/tv/puls/3164780.html
Gudny
What is the foetus from a newborn child?
Seems to me it's either a foetus or a newborn child.
Yesterday we could hear on the the news that a "new"
glaucoma operation was developed at Ullevål Hospital
in Oslo, Norway.
To cover the cap they make in the eyeball they use
membrans of the foetus from newborn children.
The adventage is lower risk of the tissue to be pushed
off and also lower risk of inflamation they say.
Greetings,
Gudny in Norway
This sounds like dangerous quackery to me.
What is an "alternative medical doctor"? Does he have an MD or a
ophthalmology degree?
What are the studies to support the assertions he is making? What is the
evidence?
This stuff -- which is sold through health food stores -- is also used of
teeth whitening, by the way.
Here's what I suggest: contact your ophthalmologist IMMEDIATELY and ask for
an informed opinion. The longer you wait, the more likely you are to lose
your eyesight sooner rather than later.
Dear Friends,
I have been taking two supplements (A-C Carbamide and Iplex) for
the past two weeks that one "alternative" medical doctor claims will
eliminate the symptoms of glaucoma and makes it possible to go
off or reduce dependence on eyedrop medications after 6 months. I
haven't had any check-ups since starting so I don't know how it is
impacting my IOP. However, I have experienced more frequent
urination and discomfort of my tongue while taking 3 capsules a
day of A-C Carbamide. According to the product description, A-C
Carbamide "promotes the osmotic transfer of tissue fluids ... and
facilitates osmosis." Since we glaucoma sufferers have a fluid build-
up in our eyes, than something that promotes the release of some
of this fluid seems intuitively beneficial. However, I would feel better
if I could find actual medical or other studies that demonstrate this
benefit of Carbamide specifically for the eyes. Is anyone aware of
this type of research?
John
I was a child with a crosseye. I saw two of everything. I started with the
eye doc about two years of age, and it took a long time to straighten it
out. The child in question can't see well. Joan W
Looker
I am not sure I understand the question. Are you looking for the latest a child should be seen in order to correct cross eyes or how old they are before they don't have to be seen anymore? Before age 2 is the optimal time to start treatment. After age 6, the success rate is very low. So the earlier the better. You need to see a Pediatric ophthalmologist not an optometrist. Get someone with good training and a lot of it. Optometrists don't have the schooling that an ophthalmologist has.
Ruth
Well, I know this is not the right place to ask, but since I think it is an
easy question to be answered here, could anyone tell me the limit age from
which a child needs to be seen by an ophthalmologist because of cross-eyed?
Thanks.
Looker
Etiquette, a form of kindness
This message is not directed to anyone specifically, it's an automatic email
sent to every member of the Glaucoma mailing list. This is gently directed to
everyone as a polite reminder.
Two things you can do to be kind to other list members is to put your replies
to a message at the top. Some members of the list need to use reader software
and they always start at the top. If you've replied at the bottom of a message,
people with reader software have to listen to the parts of a message they've
already heard and could skip otherwise.
This ties in to another problem for people with reader software, and also
those that receive the digest version of the list.
This problem comes when someone posts say a 30 line message, not to mention
Thanks,
For the info !
I am still on Lumigan , but off Alphagan and will go back for Doctor
Check up soon !
cess,
On Sun, 28 Sep 2003 13:53:07 -0400 (EDT) Henry Greenspan
<hgreensp@...
Hi Cess.. you can buy a product call Proview and check your own pressure when every you want. You can buy it at most drug stores, WalMart, KMart etc. However, many of them will have to special order it for you. It is not something then may have in stock. I got mine from KMart and then called me the next day to pick it up, It costs about 75.00, plus tax etc.
It will take you about a week to learn how to use it properly. I was ready to take it back, but once I got the hang of it, I find it is wonderful. I have taken my pressure in Dr. office and then had them take the pressure... WOW... in my case it was right on. I know it can be off from time to time about 1 or 2 points , depending on how you are using it. There are many on this list who have Proview..... Some love it and there are others who just never really got the hang of it. My DR. now recommends it to all his patients. Hope this helps. Others may wish to comment on this procedure. Eve
Re: Cess's question--Cess, I hope you're doing any "experimenting"
re: going on or off medication in consultation with your doc.
If it's safe to do so, probably the only way to know whether
one of your meds might be a factor would be a controlled trial
off of it; again, only if that is certified safe for you to do.
In general, it is not impossible that there is
a connection. A great many (in some studies, more than half)
of a medication's adverse effects are not known
until after a medication has been approved and is in wide use,
and, of course, each of us will have our particular, individual
responses.
More specifically, Alphagan is derived from Clonidine,
a blood pressure medication for which impotence is a known, if rare,
adverse effect. Alphagan is considered more "selective"
for the eye than Clonidine, and thus less likely to have
Clonidine's side effects. On the other hand, "selectivity"
is relative, and so some clonidine-like effects in some
people would seem conceivable.
Lumigan is a less likely contributor, although some
of the prostaglandin drugs--particularly Travatan--have been
associated with prostate problems as a rare side effect.
So there is that lesser chance of some involvement there.
Good luck!
HG
Thanks Matthew! I tried this test (well, not sure if it's the same one
being discussed, but was one from England) and was surprised to find that my
visual fields were normal! Darn and here I thought I had a miraculous
healing <rbg
wasn't even tested with this method.
Mixed feelings about the effectiveness. Yes, it can get people thinking
about glaucoma, however, if I didn't know I had the condition and took the
test, I'd take a deep sigh of relief and think all is well. I think the
test should have stressed this more that it didn't mean the person was ok
and to get a dilated eye exam and pressure check anyway!
Sherry
Got this from a glaucoma news group:
+++
Here's my take on these "Check your visual field at home on your PC"
type of tests (this is not a new thing...there have been others).
First of all, a Humphrey field analyzer has a screen that more or less
wraps around you to test a much larger angle of your field. The 30-2,
the most commonly used field testing program, tests the central 30
degrees of your field. As most people are 16 to 20 inches away from
their monitors, the monitor takes up a much smaller area of your
retina, maybe the central 5 - 10 degrees. This will vary, of course,
depending on the size of one's monitor and the distance from the
screen. In glaucoma, by the time your field loss is significant enough
to encroach on the central 5 degrees, you have already lost a very
large area of vision and probably have greater than 85-95% optic nerve
damage.
While there is some basic usefulness in these types of tests, it
ONLY resides in there ability to get some people thinking and talking
about glaucoma. It may raise concern just enough in a few to get an
eye exam where they otherwise might not. It is very important to keep
in mind that even the most sensitive field tests (e.g. the SWAP
blue-on-yellow test, which detects glaucoma earlier than the standard
field test) do not detect any field loss till the optic nerve
essentially has a 0.6 cup or greater. In other words, some optic
nerve damage has clearly already occurred before field loss shows up.
Mostly, this online field test is a fun little exercise to be tried at
home, but it should NEVER take the place of routine follow-up and
annual field tests in your ophthalmologist's office. I can't stress
that enough. Hope that helps.
Sincerely,
Rick Cohn, MD
Glaucoma Specialist
Winter Park, FL
+++
Dr. Cohn is kind of the Dr. Ritch of that news group, by the way. I wonder
if they know each other...
Tiredness and lethargy are known side effects of Alphagan although we are
not aware of any other reports of impotence on this combination of drops
(beta blockers can cause this problem). Lumigan is not commonly known to
have any effect in the areas you mention. It would be worthwhile talking to
you eye specialist about these problems to see if an alternative combination
of medications will be less difficult to use, but in the mean time, do make
sure that you are blocking your tear duct after instilling the drops, by
pressing gently in the corner of your eye by your nose for about a minute
after each drop. These side effects only occur if the drug is able to get
into your blood stream and this usually happens through the membrane which
lines the tear duct.
I hope this helps.
David J Wright FIAM
Chief Executive
International Glaucoma Association, 108C Warner Road London SE5 9HQ Reg
Charity No:274681
Please reply to: d.wright@...
WORKING TO SAVESIGHT THROUGHOUT THE WORLD: The International Glaucoma
Association is a Registered Charity No: 274681 and is dependant on donations
from its members and friends to be able to provide its service across the
world. The Association does not receive any support from the government or
statatory bodies. Web site: www.iga.org.uk
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Hi! I'm a 59 year old female who has been diagnosed with the beginnings of glaucoma in March 2003, and this July, was told I also have the beginnings of macular degeneration (dry). My POP is hovering around 18. I'm on 2 drops/day each eye of DIPIVEFRIN HCL 0.1% OPSOL. I've been taking 1 VITALUX tablet per day for the past 4 years or so, but have bumped this up now to 2 tabs per day.
Just wondering if anyone out there with the same problem and would appreciate a reply as to how they are coping, including what sort of specialists they are seeing, meds, etc. Thank You for replying.
Lorraine
My pharmacist just told me today that NSAIDS can raise intraocular pressure.
This after I've been on Celebrex, Vioxx, Bextra, which are all NSAIDS. Even
aspirin is. Any comments on this? Joan W
Quoting RShatkowsk@...:This is Brittney, you know what I did a few years
aga was ask my doctor for her personal numbers and she happily gave them to
me!! My mom promised her we would not abuse them. My doc in the case of a 911
wants to know even if she is not on call bcuz the doctor on call may not be
able to help me!! I will be going to Washington dc for a national acolyte
festival at the national cathedral for 4 days. This is a long time and my doc
always wants me to feel secure!! Maybee your doc can do this. FHS Brittney
Hello,
A Combination of Lumigan and Alphagan Drops for Glaucoma has
resulted in Tiredness, Drowsyness and Impotency in a seventy seven year
old Man !
Does any one Have any of the same problems, with the same Drops, or
is it just me !
Please let me Know Your Thoughts on This Subject !
Cess
We saw the PO yesterday and Rebekah's eye is much better. She dropped the prednisone from 4 drops a day to 3. We go back in 3 weeks. It was going to be 2, but I told her we already had an appointment in 3 weeks, so we are just going to keep that one. We got lectured for not coming in right away. I said Whoa! What a minute. It was an hour before I found out about the accident. We 2 hours from the hospital when the accident happened. We got lost for 1 hour when we got to DC, we went to the wrong hospital and sat in their waiting room for an hour. Then we sat in the ER for 5 1/2 hours before being seen. I told her I was none to happy about blood on the floor and dust bunnies in the corner. She said there is always a resident on call-except not in the middle of the night and we should have gotten there sooner. Next time call her. But Children's won't put your call through to her. I know from experience. Next time (hopefully there won't be a next time) I will either go to John
Hopkins or drive down to Duke depending on how bad I think the situation might be. We almost left Children's and headed to Duke when they told us we would be waiting until 7am to see a doctor. I was outside on the phone trying to make childcare arrangements when my husband came out and said wait-there are only 2 people in front of us. So we waited-for 4 1'/2 more hours. We should have just headed to Duke. At least everything turned out okay. Dr. Miller said we were lucky, it could have been much worse. Rebekah got another lecture about wearing her goggles. I don't think we will need to lecture her again. She is pretty convinced she MUST wear them at all times when playing sports. Unfortunately, she had to learn the hard way.
Ruth
Ruth, you are such a wonderful mother. I can't say how much I admire you.
One thing I'd like to say that I know you're thinking. Rebekah has to start
being more responsible about using her goggles. You need to sit her down, if
you haven't already, and look her directly in the eyes and spell this out. I
know if you do it like this, it will really register with her. I was a child
with eye problems. She just wants to fit in and not seem different wearing
her goggles. Sit her down and explain just how difficult all this was and
how easily it could have been prevented. She's old enough to face the fact
that she made a huge mistake not wearing protection. She has to accept she
is different in this, but it's not a bad thing. She can be more responsible.
It could make this the last time you all have to go through so much trouble.
I'm praying for you and yours. God bless. Joan Williamson
We finally got through to Children's yesterday. I hit the doctors only button to finally connect with someone other than a machine that says the power is out and all lines are closed until further notice. Had to drive by to that dreaded DC at the beginning of rush hour. Only got lost once. We saw the glaucoma doc, Dr Jaafar. The inflammation is already starting to subside (Yeah!) and he took her off the atropine. She has to stay on the higher dosage of prednisone and we go to Rockville tomorrow to see her PO for another check. We may go to Duke next week.
I didn't get lost getting out of DC during the height of rush hour, but I missed my turn and I couldn't get back to it. When I was at the right street there were " No Left Turn" signs flashing because it was rush hour. They don't have square blocks around there, so I wound up driving for 45 minutes before I was finally able to get on Constitution Ave to get out of town. I wish they would move Children's Hospital to the suburbs.
I finally got home and got some sleep. The lack of sleep (stress) is causing my rheumatoid arthritis to flare and I can barely walk this morning. Both knees and both hips are really hurting. I had to resort to my cane again. I hate that thing, but it sure comes in handy.
Ruth
Hi -
I am a patient of Dr. Robert Ritch in New York City... also of Dr. Frank Mares here in New Mexico -- where my wife and I live most of the year.
I have had glaucoma for about 8 years. Visual Fields have not changed much...but I do have a superior area loss. If you like I could scan in regular visual field test results if you like...and send them to you... let me know.
I had both cataract and trab surgeries this year ...left eye in April and Right eye in August...left eye went well... right eye is having some difficulty right now my eye pressure in my right eye is higher than ever before.
I will go to the website and take the test.
Bernie Linnartz
empower@...
I am not endorsing this, but I am passing it on from a usenet group:
Mr Carl Groenewald and I are consultant eye surgeons in England. In
our spare time, we have developed a visual field test for the
internet, which allows anyone to perform self-examination, using a
personal computer and at their own convenience, free of charge.
Our test may enable people to become aware of visual loss and perhaps
to check whether they are improving or getting worse. Some might
become detect new defects so that they can obtain medical advice or
take special precautions, for example if they drive a car.
Conditions causing visual field loss include glaucoma, retinal
detachment, macular degeneration, pituitary tumours, other brain
tumours, strokes, Sturge Weber syndrome, von Hippel Lindau disease,
and many others. Not all visual field defects indicate serious disease
and false positive and negative results can occur (with any test).
I would be grateful if anyone could participate in our research
project and help us evaluate our test. We urgently need persons with
visual field defects to visit our website and send us feedback so that
we can make improvements. Hopefully the test will be found
interesting, a little like a computer game. It is quite different from
conventional tests so please read the instructions, see the demo and
do a rehearsal before trying the test. If you could perform the
sensitive version of the test, this would be ideal.
Our website is at http://www.testvision.org/
Please remember to e-mail us the results with your email address if we
may reply to you (but note that we are only able to comment on your
result and not on any ocular or medical problem you might have).
It would be helpful if you let us know what you like or don't like
about our test.
Yours faithfully,
(Professor) Bertil Damato PhD FRCOphth
St Paul's Eye Unit
Royal Liverpool University Hospital
Prescot St
Liverpool L7 8XP
Tel: +44 (0)151 706 3973
Fax: +44 (0) 151 706 5436
Hi, Ruth.
Just wanted to tell you that I'm following the saga and praying for Rebecca
down here in Florida. Please keep us posted.
Sarah J. Blake
Personal mail to: myhouse@...
http://www.growingstrong.org
Sarah Blake offers technology training, life skills training, information
and referral services, peer support, and presentations tailored to the needs
of various groups. For more information, please visit:
http://www.growingstrong.org/sarah/services.html
Rebekah was playing dodge ball tonight before church and got hit in the eye with the Baerveldt. She was supposed to be wearing her goggles but she wasn't. They put ice on it and when she came up to see me she said she had gotten hit and it was still stinging. The white of the eye was blue compared to her other eye so I tried calling her doctor in Potomac but couldn't get through. Cell phone towers are still iffy since hurricane, So I called Duke and they said bring her to the ER. So we are on our way to Children's in DC. 2 hours away is better than 6 to Duke. I had to come home and get my husband because I don't see well enough to drive DC at night. He was sleeping because he works nights. I mainly want to make sure the Baerveldt wasn't dislodged or something because I don't like the way the eye has a blue cast to it. Will let you know how things are tomorrow.
Ruth
Hi Ruth, glad you are all well. I just got power a few minutes ago! Thought of people w/ Rx which need refrigeration. Hope Rebekah not on those. Regards, Lilian
Well, Isabel was noisy, but didn't cause a lot of damage to us. We lost 1 small tree and our rain gutter. Not bad. We have our electricity back, with no spoiled food. So we came out okay. I saw the Potomac River today. It was at flood stage (it looked quite a ways over flood stage to me) and tomorrow it is supposed to be more than twice as high as today. Many, many trees were floating down the river. I kept thinking what happens if they all get jammed up somewhere. Tomorrow I will see what the Shenandoah looks like. I know a house down by the river, (we see it driving to school every day) that has to be under water if the Shenandoah is as high as the Potomac. Debbie, Janet, how are you? (Moot question if you don't have electricity).I know both Anne Arundel and Virginia Beach got hit harder than us. I've been thinking and praying for you. Fairfax County, where my husband works is under a boil water order because the electricity knocked out the water treatment plant. A lot of
unhappy hotel guests because there is no morning coffee-just bottled water, canned soda and OJ.
Gotta fix dinner. Turkey Sandwiches. We celebrated the end of the hurricane by BBQ'ing a turkey. Our neighbors think we are crazy. They don't know I had planned to BBQ the turkey the day the hurricane hit. I had taken it out of the freezer last Sunday. I thought I'd better wait for the wind to die down a little first:)
Oh! Yes! The soccer ball did come down. A big gust of wind shook the whole house just after midnight, so I got up to look how things were going and I saw the ball in the front yard. So I ran out quick and got it. Next time I try being Mia I'll face the other direction first :)
Ruth
Cool article! Wish they would have focused more on the eye problems..... I
wonder how many eye problems in children are missed because of lack of knowledge
about them?
Sherry
Well, they left all the stuff about symptoms of cataracts and glaucoma in kids and just focused on the fundraising for Ronald McDonald House :( but here is the article on Rebekah.
http://www.zwire.com/site/tab1.cfm?newsid=10175678&BRD=2553&PAG=461&dept_id=506037&rfi=6
Ruth
I would have called imediatly!!!FHS Brittney 16
hi all,
I had trab surgery to both eyes 7 months ago. All has been reasonably ok but
this past weekend I suffered from stabbing pains to both eyes. Is this
relatively normal? I did have a very tiring week involving alot of computer
work so was wondering if this contributed? The pains have gone now so I'm
wondering whether I should bother getting in touch with my opthalmologist or
not? thanks, karen.
Beta blockers are actually commonly used to treat glaucoma. You may find
that it has a nice effect on your pressure as well.
Sarah J. Blake
Personal mail to: myhouse@...
http://www.growingstrong.org
Sarah Blake offers technology training, life skills training, information
and referral services, peer support, and presentations tailored to the needs
of various groups. For more information, please visit:
http://www.growingstrong.org/sarah/services.html
Because of an irregular heartbeat I am now on an oral Beta Blocker.
The opthamologist has no problem with it. I want to know if anyone
with Glaucoma is on an oral Beta Blocker and what has been their
experience with it. I am using Xalatan once a day and the beta
blocker, Toprol-XL once a day.
Super, Nao! Glad the surgeries went well. You recovered really quickly! I'm
still struggling with the astigmatism from my surgery - I wonder if it ever will
go away (as the glauc doc is hoping).
Latest round of eye events - we were out of state at a museum on Sunday and all
of a sudden I got some horrendous floaters. I called the ophth and talked with
the doc on call. He felt that there was low risk that I was having retinal
detachment (no flashes of light) and moderate risk of retinal tear and to be
seen on Tuesday after we got back from vacation. I had the most grueling eye
exam yet - no tear noticed but the ophth I saw still wasn't comfortable with it,
so he wanted me to come back in a few days. I go back in this afternoon (a bit
earlier than he said, but it's a transportation issue) I *think* I have new
floaters - hopefully it's just the ones from Sunday getting back in my vision.
I'm a -11 in that eye and the ophth said the risk of retinal tear or detachment
is great with that high of myopia.
Sherry
Well, I had my second follow-up today - no signs of a tear, but he wants to keep
a close eye on the eye (gads!) for the next couple of months. He said the
vitreous is pulling away from the retina, causing the floaters and possibly a
tear is in the making. He did see where a hemorrhage occurred near the optic
nerve.
I've had floaters to some extent for nearly 40 years.
Sherry
Hi.
Had my first trab in my left eye on May 12. This eye has returned to
pre-surgery vision (20/25) and is not blurry. However, the bleb is
quite high & hence bothering me a great deal. Started on flax seed (1
T. per day) to see if this helps moisten my eyes. Am also using OTC
Genteal gel plus a prescription gel 2 times per day, which seems to be
making the eye much more comfortable.
Trab on my right eye was July 30. Altho recovery was much faster with
this eye, vision is still blurry (I assume that this is bcuz the
stitches are still in the eye and they cause astigmatism). However,
vision in this eye has also returned to 20/25.
Pressures are fabulous! Went from 4 drops presurgery & pressure at
mid-20's to pressure at 8 or 10. :)
Nao
I have never heard of either before and so know nothing about them but a
google search revealed (among other things) the comment below about dosage
(see http://illness.altmedangel.com/eyes.htm):
"A dose of three to nine A-C Carbamide and three Iplex daily is usually
powerful therapy for people with glaucoma." He says to "allow eight to 18
months for full effects. After four to six months, you can usually go back
to your doctor and discuss weaning off eye drops."
Dear Friends,
I recently read an advertisement for a health newsletter published
by a doctor who mentioned that taking two supplements (Iplex and
A-C Carbamide) could reduce the need for prescription eyedrops in
people with glaucoma after taking these supplements for 4-6
months. Does anyone have any experience with these
supplements and what are the recommended dosages?
Thanks!
John
In a message dated 8/31/03 5:45:53 PM Eastern Daylight Time,
jjjdad2003@... writes:
Hang out on the Net long enough and you'll hear everything! I have heard
similar accounts in a few cases. There is an excellent one written by such a
patient named Jean (a nurse) at the top of Page 2 of my message board (see URL
below) It's entitled: "Summary of my Experience with NTG". Her history included
migraines, LASIK within the prior 2 years, (which could have perturbed IOP
measurements), a normal VF at that time, a short course of steroids before that,
and some occasional thyroid problems. Her IOPs were always about 14.
Regards,
Hank
Site Admin.
Glaucoma and Ocular Hypertension
Patient Advocacy Center
(GLOHPAC)
<A HREF="http://glohpac.proboards7.com"
Is anyone aware of any situation whereby a patient with recent onset
of glaucoma developec extremely rapid optic nerve degeneration over a
very short period of time? This is not someone who had acute angle
closure glaucoma but had just had a vitrectomy. For ophthalmologists
the cup/disc ratio went from .4 to .8 in a little over a month with
eye pressures in the 20's. Thanks
Note: forwarded message attached.
I asked Dr. Rick Wilson about this once and he suggested waiting at least 10
minutes after instilling the drops.
Regards,
Hank
In a message dated 8/27/03 12:04:00 PM Eastern Daylight Time,
turgutkarapinar@... writes:
I survived this week. Actually it was wonderful. We don't have much family-both my hubby and I only had 1 sibling and they have both passed away. My parents died in the early 90's, so all we have is DH parents who live 1000 miles away. We have not had 1 night alone since my oldest was born 17 1/2 years ago. Sometimes I get jealous reading about everyone leaving the kids with relatives and taking off for a few days. We never had that option. Anyway this week was bliss. ALL 3 kids were at camp. My oldest was a counselor, my middle had his last time at Junior camp and Rebekah went for the first time. She wanted to go last year, but I couldn't let her, because she didn't know how to put her eye drops in. As it turned out, that was the week we found out her pressures were sky high, which started our whirlwind tour of doctors from Boston to Durham. Rebekah LOVED camp. Everything went smoothly except-the eyedrops. Rebekah has been doing really good at home with them. But when she
got to camp and had to put them in with 12 other girls staring at her, she (in her words) had a "bad" day. The camp nurse finally put them in and did so the rest of the camp. Meanwhile, back at home, hehehehe-my DH and I had some uninhibited fun. I looking into winter camp-maybe fall and spring too!
Ruth
Hi Emary,
I was on a trip home and I made a mental note two answer both of your messages, particularly the one about snake oil. Is it really true that ingredients from drops like Xalatan are really making up my IOP control regime? When I was at home I actually was lokking for snake oil, but to use it externally in a massage potion to combat lower back pains and pain in the legs. I never heard of it being used in glaucoma treatment of any kind.Maybe you have some more news that I might learn from.
Weed makes me terribly high & I have used it for many, many years but not since 1996. Hope to hear from you
Ps. Sorry for coming around so late, greetings Harry
Emary van Merlin <emary@...
Did you know that Cannabis was the #2 prescribed medicine before the
drug industry took over medicine? Why is it illegal for us to use even
homeopathic doses that have no delta-9-THC? And why is synthetic
delta-9-THC a legal drug, when it is illegal when produced by a plant
that God created?
Dr. Ritch pointed out this resource to me. It looks very useful!
http://www.glaucomafoundation.org/vision/index.html
http://tinyurl.com/jh7z
<a href="http://www.glaucomafoundation.org/vision/index.html"
aids</a
Hi, I started with Xalatan resulting in about 35% reduction in IOP. Later, I switched to Lumigan leading to an additional 5-10% reduction.
Here, as in general, the only way really to know how the
meds may affect you is to try. Personally, I had
intolerable problems with lumigan--severe gastro symptoms,
facial flushing and rashes, joint and back pain,
eye pain and enlargement.
I understand a large percentage of patients are not
able to tolerate lumigan for one reason or other, probably
about the same percentage as for travatan. I had
less severe problems with Xalatan, and use a custom-componded
half strength version which works almost as well for me
as the full strength (dropping iop about 30%).
All of these medications are still new--Lumigan and Travatan
especially--so we really don't yet know the extent of adverse
reactions. Needless to say, it is important to consult with
your doc if about any such responses.
Best to all.
to the party in regards to lumigan I am on this and it is at tier level 3 which means a higher cost and does not count towards my drug benefit deductible. I am also on Cosopt
fancy 678
I'm interested in anyone's experience with this as well. Or in Lumigan. I just received a letter from my insurance company. They will continue covering Xalatan (what I take now), but at a much higher cost to me and have suggested I switch to a formulary; Lumigan or Travastan.
I don't seem to have any side affects from Xalatan and don't like the idea of switching.
Hello - 2 slightly different questions:
1/ Has anyone had any experience with Chinese medicinal herbs or Chinese acupuncture for the treatment of glaucoma?
2/ I just switched meds from Xalatan to Travatan - is anyone familiar with TRAVATAN? any side-effects?
thanks,
Eleanor