Best New Treatment Advances for Glaucoma
One of my patients, Carol, came to see me, after a visit to the ophthalmologist, with great fear that she was going to go blind. She was told she had glaucoma in both eyes and needed to use drops to lower the pressure in the eyes. The doctor explained that if the pressure didn’t come down with the drops, she would need surgery to prevent permanent blindness. She was not looking forward to putting drops in her eyes for the rest of her life, and for sure didn’t want surgery. Of course, she came to me for help.
Glaucoma is a degeneration of the optic nerve. The nerve gradually loses neurons and gets smaller, leading to a steady loss of vision. This generally starts from the outside peripheral vision where there are fewer nerves. Then it progressively goes into the center of the eye. The loss of nerves is happening all over, but since there are fewer nerves in the peripheral vision, it is first noticed there. Most people who have mild glaucoma don’t even notice that they have a loss of vision. At some point they may have difficulty reading, or driving at night, and go to the eye doctor only to find that glasses won’t fix their sight. It’s too late – the nerve isn’t working.
Glaucoma is often thought of as high pressure in the eyes. It used to be thought that excessive pressure caused a lack of blood flow in the retina and optic nerve causing damage. Some doctors still believe this because is what was taught in medical school and it seems to make sense. However, there are a few problems with this hypothesis.
High Pressure without Glaucoma
A 20-year study of sixteen hundred people with high eye pressure showed 75% never develop glaucoma. High eye pressure is common. By 40 years of age about 5% of people have high pressure in the eyes, but without glaucoma, or damage to the optic nerve. Around 75 years of age that increases to 8%. Their eye pressure measures high, but they don’t have any vision changes or signs of optic nerve damage. (Interestingly, high eye pressure is associated with low systemic blood pressure.)
Normal Pressure Glaucoma
The other confounding factor in the theory of high eye pressure causing glaucoma is that there are many people with glaucoma, who lose their vision, but have normal pressure. In the United States up to 48% of those with glaucoma have normal eye pressure. In Japan it is up to 66%! This is called “Low-Tension Glaucoma.” In other words, these people are showing damage to the optic nerve, and losing their vision, but they don’t have high pressure in the eyes.
Pressure is NOT the Cause
If half of people with glaucoma have normal pressure, and only a fourth of those with high pressure in the eyes get glaucoma, why are we still saying high eye pressure causes glaucoma? It takes a LONG time for knowledge gained by research to reach the doctors providing care in the “trenches.” (This is a good reason to have a functional doctor on your side. 😊 ) Glaucoma, or damage to the optic nerve, is NOT caused by high pressure in the eyes. The pressure in the eyes is just a symptom of inflammation, which is sometimes associated with glaucoma, but not a cause.
Focusing on eye pressure to prevent loss of vision is like trying to prevent damage to your car’s engine with a blown gasket and the oil light on by filling it with more oil. That may turn the oil light off for a time, but the engine with an oil leak will still be more likely to get overheated and seize up. Stopping every few miles to add more oil may help a little, but you must fix the problem to prevent destruction of your engine.
In the same way, the current treatments for glaucoma that all revolve around lowering pressure in the eyeballs is misguided at best. Most people are having surgeries, injections, and putting drops in their eyes to lower the pressure unnecessarily because, despite high pressure, they will not get glaucoma. Moreover, treating high pressure only drops the risk of blindness by about half. When you consider that 75% of those treated would never have developed glaucoma, it becomes obvious the current treatments are not adequate! We need something that really works so nobody goes blind.
Low Energy is the Cause
The first step in finding a good treatment is to know the cause. Since there are so many with glaucoma who don’t have high pressure, we may be able to determine a cause by looking at these people. The most consistent risk factors for low-tension glaucoma are:
- People with a family history of normal-tension glaucoma, such as people of Japanese ancestry
- People with a history of systemic heart disease such as irregular heart rhythm.
There seems to be one or more genetic defects, in some people that makes them more susceptible to glaucoma, probably due to a loss of mitochondria, which make energy for cells. The optic nerve requires a huge amount of energy compared to other cells, so it is especially susceptible to a lack of mitochondria. The other risk factor, heart disease with irregular rhythm, is also caused by a lack of energy, but in the heart. This gives us some important information about what the real cause of glaucoma may be.
Inflammation doesn’t seem to be the cause; it is often associated with glaucoma because those who have low energy are often deficient in antioxidants. However, those who have low pressure glaucoma may have good levels of antioxidants so, they don’t get high pressure in the eyes, but they still lose mitochondria.
Thus, the problem is energy. Since human beings are visual, the optic nerve is in constant use, making it more susceptible to a loss of power. In mice used as a model for glaucoma, it was found that mitochondrial deficits account for the loss of nerve cells. This is also the relationship of glaucoma and heart disease. People with arrhythmias lack mitochondria in the heart so they don’t have enough energy.
How to Increase Energy and Decrease Pressure
Thus, a program for rebuilding mitochondria should help most people with glaucoma. We already know how to improve mitochondrial function – it’s simple: