Glaucoma

Glaucoma

Political opponents were fond of saying that President George Bush lacked “vision” for America’s future. They were almost right.

In April 1990, White House doctors discovered that the 65-year-old president had a budding case of glaucoma in his left eye. Although he had not lost any vision, he immediately began using eyedrops twice a day to prevent future loss of sight.

“I haven’t felt a thing,” Bush told the press at the time.

Like Bush, many people afflicted with this insidious disease aren’t aware that they have it. In fact, glaucoma is often called the silent thief of sight because it usually strikes slowly, painlessly, and without warning. Yet it afflicts more than three million Americans—most of them over age 60. Each year, it affects another 50,000 people worldwide and causes blindness in more than 1,000.

“You should never take your eyesight for granted, particularly because of diseases like glaucoma. Most people don’t realize that they have had visual losses from glaucoma until the losses are very advanced. Your vision may be 20/20 right up to the end—and then it’s snuffed out. And unfortunately, those losses are irreversible,” says Anne Sumers, M.D., ophthalmologist in Ridgewood, New Jersey, and a spokeswoman for the American Academy of Ophthalmology.

But if glaucoma is detected and treated early, the progress of the disease can be halted and most of your vision can be saved with a regimen of eyedrops once or twice a day, Dr. Sumers says. Years after his diagnosis, for instance, Bush’s vision was still in tip-top shape.

To understand how glaucoma robs vision, imagine that your eye is like a small sink, says Robert Ritch, M.D., medical director of the Glaucoma Foundation in New York City. The faucet is a gland behind the iris that constantly produces fluid that bathes the eye. The drain is a 1/50-inch-wide opening called the trabecular meshwork. As you age, this drain tends to clog and the fluid meets more resistance in flowing out of the eye. Since the eye is a closed compartment, fluid buildup results in raised pressure, or intraocular pressure (IOP), inside the eye, putting excessive pressure on the optic nerve. As the IOP increases, the nerve slowly begins to die and your peripheral (side) vision fades. Untreated, it eventually leads to almost total blindness. Once it is detected, the first line of treatment is to lower IOP. You’ll need to regularly take medication to control it.

If you’ve been diagnosed with low-pressure glaucoma, in addition to taking medication, there are several things you can do to help keep it under control.

Try This First

Go for ginkgo. In addition to any prescription medications, ask your doctor about using ginkgo biloba, an over-the-counter herbal remedy that Dr. Ritch believes helps preserve vision. “Ginkgo appears to increase blood flow to the eye and prevent the death of cells in the optic nerve,” he says.

Look for ginkgo extracts containing 6 to 7 percent terpenes, a component of the herb that Dr. Ritch suspects plays a key role in stopping optic nerve damage. He suggests taking 120 milligrams of the herbal remedy twice a day for two months, then cutting back to 60 milligrams twice a day. Doses of ginkgo biloba higher than 240 milligrams of concentrated extract can cause skin rash, diarrhea, and vomiting. Don’t use ginkgo if you’re taking monoamine oxidase (MAO) inhibitor drugs like phenelzine sulfate (Nardil) or tranylcypromine (Parnate), aspirin or nonsteroidal anti-inflammatory medications, or blood-thinning medications like warfarin (Coumadin).

Other Wise Ways

Set your sights on antioxidants. Studies strongly suggest that antioxidant vitamins C and E can relieve low eye pressure and slow the development of glaucoma, Dr. Ritch says. He recommends taking 2,000 milligrams of vitamin C and 800 international units (IU) of vitamin E daily. (Vitamin C in amounts above 1,200 milligrams may cause diarrhea in some people. Also, although vitamin E is generally sold in doses of 400 IU, one small study showed a possible risk of stroke in dosages higher than 200 IU. Consult with your doctor if you are at high risk for stroke.)

Walk away from it. Regular aerobic exercise like walking can help lower pressure in the eye, increase blood flow to the optic nerve, and slow the progression of the disease, Dr. Ritch says.

In fact, research conducted at Oregon Health Sciences University in Portland on a group of sedentary people who began a program of brisk walking for 40 minutes three times a week found that those with glaucoma reduced their eye pressure by 20 percent. And those people who did not have glaucoma saw a 9 percent reduction in eye pressure.

Stick to your schedule. Timing is critical when using glaucoma medications, Dr. Sumers says. To get 24-hour coverage from your medication, you have to properly space out your doses.

“Some people think that three doses a day means at breakfast, lunch, and supper. That’s not going to work, because the last dose of medication is going to wear off before you get another one the next day,” she says. “So if you’re supposed to use eyedrops three times a day, allow a full eight hours between treatments.”

Don’t skimp. If you don’t think you got enough medication into your eye, try again, Dr. Sumers suggests. “You can’t overdose on eyedrops. It’s better to use an extra drop than to not get enough in.”

Try the squeeze play. After you insert your eyedrops, press a finger against the tear duct in the inner corner of your eye for about one minute, Dr. Ritch says. It will help keep medication in your eye, where it is needed, rather than allowing it to run down your face. Keep your eyes shut while doing this, so the drug can be properly absorbed, he suggests. It is particularly important to leave about 10 minutes between medications if you’re using two different eyedrop medications. If you don’t wait long enough, the second drop will wash the first drop out of the eye before it has chance to do its job.