Glaucoma is the leading cause of blindness in the elderly. There are several types of this disease, all of which could cause damage to the optic nerve in the back of the eye. Peripheral vision examinations can detect glaucoma, even in cases where eye pressure is not necessarily elevated. Age and smoking are major causative factors in this disease, as is stress, because excess adrenaline (the fight-or-flight stress chemical) elevates eye pressure.

Most people develop the open-angle variety of glaucoma, also called primary open-angle, or chronic simple glaucoma. Other types of glaucoma are congenital, narrow-angle, secondary, and low tension; Many people with higher pressures or enlarged optic cups are put into the category of glaucoma suspect. The disease is characterized either by damage to the optic nerve through a mechanism of elevated pressure in the eye, poor blood supply in the optic nerve, or both. Conventional treatment options include eye drops, laser therapy (especially for the narrow angle variety) and surgery, and are required if the patient continues to lose peripheral vision (tested by visual field exams).

Poor circulation can contribute to glaucoma. If the eye tissues do not get enough circulation (mild ishcemia), then they weaken - which is one reason that, as people age, they develop hardness of hearing, lose hair, develop macular degeneration and glacuoma etc. Other factors that can contribute to ischemia are low blood pressure or low blood sugar, in which case the body restricts blood supply in response to conserve energy. Most ophthalmologists know that low blood sugar causes episodes of "spots before the eyes." Blood pressure also drops at night, and this can have a negative effect on the eye in people whose blood pressure runs low.

The body knows how to handle short term circulation problems. The normal immune system release of the cytokines in response to the mild ischemia then restores the blood flow to the optic nerve, often for many years, but the need to release inflammatory chemicals (to maintain that blood flow) thickens the aqueous humor (PEX syndrome) with increases in sticky proteins and also it uses up the antixodants to neutralize the inflammation (or lack of sufficient antioxidants allows this problem to develop).

PEX syndrome has been clearly linked to both glaucoma and cataracts. It appears that this pseudoexfoliative amyloidlike material moves into the aqueous humor and then gets deposited on the trabecular meshwork, causing oxidative damage and obstruction.  Obstruction of the trabecular meshwork then causes elevation of the intraocular pressure (IOP) and resultant glaucoma This background problem needs to be understood clearly to find natural medicine solutions to glaucoma.

To reiterate, the fluid pressure between the iris and the cornea builds up because the trabecular meshwork (the filter on the eye's drainpipe) becomes unable do its job properly. This is, however, a bit more complicated than it sounds. Recent evidence shows that there is a functional relationship between the ciliary body, which pulls, and the trabecular meshwork, which then distends and blocks fluid outflow. Originally thought to be a passive participant, it now seems that the trabecular meshwork itself has the ability to contract and open itself for fluid drainage (Wiederholt et al., 2000). The inflammatory changes noted above related to circulation can affect this process and damage the trabecula, but damage to the ciliary body cannot be discounted.

Many people mistakenly equate elevated eye pressures with glaucoma - this is a big mistake, because if eye pressures are lowered with eyedrops (that reduce fluid secretion) or surgery (which opens holes in the trabecular meshwork), the underlying disease process still exists. While lowering eye pressure is an important component of protecting vision in glaucoma, it is only one part.

The goal of internal herbal therapy is to preserve visual function and maintain the health of the optic nerve. The ideal medicine for glaucoma should improve microcirculation to the back of the eye, nourish and moisturize the intra-eye membranes, restore antioxidant status, reduce IOP (intra-ocular pressure), calm stress, and improve fluid drainage. Elevated eye pressures and regular eye examinations to check results should of course be handled by an ophthalmologist during herbal therapy. (see info on iFolia below, designed for this purpose)

It should be noted here that certain chemicals found in foods have been shown to relax the trabecular meshwork without tightening the ciliary muscle. Two of these chemicals are called tyrosine kinase inhibitors (TKI) and protein kinase C inhibitors (PKCI) (Wiederholt et al., 2000). According to Dr. Duke's database, these substances are found in high amounts in beans, including yellow split pea, black turtle beans, baby lima beans, large lima beans, anasazi beans, red kidney beans, red lentils, soybeans, black eyed peas, pinto beans, mung beans, azuki beans, etc. Quercetin is also a TKI, so also eat lots of yellow skinned onions, drink some green tea, and eat garlic and broccoli. The levels of specific chemicals gained by eating these foods is not extremely high (Janssen et al., 1998), but given the multiple benefits with regards to cancer prevention, cardiovascular disease etc., it makes good sense to include them in the diet.

With all of this in mind, we can begin to formulate. A good formula would choose herbs from the following groups, along with herbs for specific whole body problems, such as poor digestion, essential fatty acid deficiency etc.

• To directly reduce IOP (intra-ocular pressure) with internal medicines, use coleus (Coleus forscolii ), jaborandi (Pilocarpus jaborandi), gou teng twigs (Uncaria sinensis), abalone shell (shi jue ming or Haliotidis diversicolor), oyster shell (mu li or Ostrea gigas) and/or xie ku cao spike (Prunella vulgaris). Caution: a trained herbal practitioner or holistic physician must administer these. They can be especially useful if eye drops fail to control pressures.

• To improve blood flow to the eye and prevent destruction of the retinal neurons and ganglion cells, choose herbs from the moving blood group, such as ginkgo leaf, bala and dang gui root.

• To improve fluid drainage choose from punarnava root (Boerhavia difusa), water plantain rhizome (ze xie or Alisma plantago-aquatica), or cinnamon twigs. (As diuretics, this method makes sense in TCM and TAM, but does not have a strong basis in Western understanding.)

• To nourish and moisturize the intra-eye membranes choose from flaxseed oil, evening primrose oil, cooked rehmannia root, and especially DHA.

• To reduce nervous tension and calm the sympathetic nervous system, choose herbs from the nervine group, such as ashwagandha root.

• The phytochemical apigenin competes with chemicals which over-stimulate PKC activity, and so we find potential glaucoma benefit with apigenin-rich parsley, chamomile flowers, feverfew and chrysanthemum flowers (Williams et al., 1999), the last of which has long been used by TCM doctors for eye inflammation. In a similar fashion, curcumin from turmeric root is also able to reduce PKC activity (Lin JK et al., 1997). Both apigenin and curcumin also have anti-cancer activity(Trochon et al., 2000).

• Pharmacological studies have shown that certain ginseng root glycosides reduce activation of PKC (Byun et al., 1997). In patients with weak digestion this would be a perfect choice.

Complex Formulations

The Shanghai research hospital developed the following formula based upon the TCM treatment principles ofmoving the blood to remove stagnation and warming the Yang to reduce fluids: raw rehmannia root, 12 (parts), red peony root 9 , dang gui 12, achyranthes root (huan niu xi or A. bidentata) 15, poria mushroom 12, grifola mushroom (zhu ling or G. umbellata) 12, water plantain rhizome 12, cinnamon twig 6 (reported in Hu, 1991). The dose would translate into about 9-12 grams per day of concentrated 4:1 granuled Chinese herbs. This should be prescribed only by a qualified TCM doctor, as individual variations are needed for maximum effectiveness.

Develpments at the Chrysalis Natural Medicine Clinic, Delaware Opthalmology consultants and Westmont University

In 1996 Dr. Abel and I went to Nepal to investigate possible glaucoma treatments, and studied the Ayurvedic methods used by Dr. Mana. After that, working at our clinic with complex formulations of herbal extracts taken internally, based upon our technical understanding of the glaucoma disease process, and partially based upon the original tonic formula used in Nepal, we gradually made advances in understanding as we developed a basic formula called  iFolia capsules. Working with Dr. Abel's group, we have used this formula to preserve visual field in numerous patients since 1998, including some patients unable to take glaucoma eye drops. Our formulation was tested with the help of researcher Dr. George Ayoub (currently at UCSB) and found to have direct and immediate retinal protective action on animals, one of its important key benefits (unpublished research). That is, while most of the formula is designed to slowly work at resolving the underlying causes of glaucoma, the immediate protective effects seen in the animal studies, if true for humans (our clinical results so far imply this), gives a great advantage - the patients vision is protected as we work to improve it.

Note: Since I posted this article, I have received a lot of requests on how to obtain iFolia. Because of the complexity of the problem, and the individual needs of each patient, it is best to have expert guidance on how to use the herbs and what to expect. For more information on how to use and obtain the iFolia herbal treatment by becoming a patient, click here.

Lifestyle and Additional Information

If you are using eyedrops to control your glaucoma, you can improve results and decrease side effects by watching this brilliant instructional video by glaucoma expert Dr Robert Rich  of New york

http://www.youtube.com/watch?v=FhkRAaIbIuE&feature=player_embedded#!

Lifestyle and other adjunct treatment options that may aid in the management and/or prevention of glaucoma include:

• Good nutrition, especially reduced consumption of alcohol and
caffeine, and increased intake of foods high in vitamin C such as bell peppers, broccoli, citrus fruit, brussel sprouts, guava, kale, parsley and strawberries (Duke, 1997)

• Daily exercise for 30 to 40 minutes

• Smoking cessation

• Deep breathing exercises to reduce stress.

• Increased intake of spring water, up to six glasses per day

• If the patient is constipated, bowel regulation can be helpful. Both Eclectic and Ayurvedic physicians reported this.

• Dr. Foltz reports that massage of the eyeball appears to have a beneficial influence in some cases.

• Acupuncture can be used for eye pressure headaches.

• As with many diseases, individual patients are taking responsibility for their own learning and sharing with others on blogs. Here is a good blog about glaucoma and eye pressure (iop).