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Chapter 2

There's Light at the End of the Tunnel: Treating Glaucoma Holistically

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Glaucoma (chronic open angle) is an insidious disease that can be difficult to detect until a significant amount of vision is lost. And the reason it is so dangerous is that most glaucoma patients have no symptoms. Many feel no pain at all, and most have 20/20 vision if only straight ahead. But, left untreated, glaucoma can slowly steal your peripheral vision until you think you're peering through a tunnel (at best) or until you go blind (at worst). Even more frightening is the fact that 70 percent of the vision lost to glaucoma occurs before the patient is diagnosed.

As many as 15 million Americans may have chronic glaucoma. (Only about half of glaucoma patients are ever diagnosed with the disease. 1 ) Of those, almost 2 million already suffer some loss of vision, and more than a quarter of a million are blind in at least one eye. Glaucoma costs $2.5 billion each year to treat, and, of course, those numbers will increase as the baby boomer generation ages.

What is Glaucoma?

Technically, glaucoma is due to damage to the optic nerve, sometimes as a result of increased pressure of the aqueous humor, the clear, watery fluid that circulates in the chamber of the eye between the cornea and the lens. To understand the disease fully, let's first discuss what happens inside the eye in glaucoma.

Aqueous humor is one of the components of the eyeball that helps transmit light rays to the retina. In the healthy eye, aqueous humor is produced and drained from the eye into the bloodstream at a constant rate so that you always have a fresh supply and always the right amount. The drainage occurs through a little canal between the iris and the cornea.

Sometimes, in some people, too much aqueous humor is produced, and the eye can't get rid of it fast enough to maintain what is called normal intraocular pressure. In other patients, the drainage mechanism is faulty; fluid can't escape fast enough to keep pressure down to normal levels. Either way, the abnormally high pressure that results is called intraocular hypertension. This increased pressure can damage the optic nerve, first affecting side or peripheral vision, leaving central or straight-ahead vision perfectly normal. If untreated, this central vision is affected as well, and can eventually result in blindness.

Another type of glaucoma is narrow-angle glaucoma. This occurs when there is a sudden increase in the intraocular pressure of the fluid (aqueous humor) in-

Page 35 side the eye due to a lack of drainage. The pupil dilates and the iris blocks the normal route of fluid drainage.

Narrow-angle glaucoma is usually more common between the ages of 40 and 60, in people who suffer from hyperopia (farsightedness), and is slightly more common in women.

Narrow-angle glaucoma symptoms are serious and usually include the following: Severe pain is felt in or behind the eyes.

Vision is blurred.

The whites of the eyes become red. Possible nausea or vomiting.

However, just as suddenly and severely as the symptoms appear, they can disappear. Even if the symptoms subside, this form of glaucoma should be treated immediately. Eyedrops will reduce the intraocular pressure, and surgery may need to be performed in order to enlarge the drainage area for the aqueous humor. Treating this type of glaucoma, as well as other rarer forms, such as pigmentary glaucoma, congenital glaucoma and inflammatory glaucoma is not the focus of our holistic approach in this book.

Who Gets Glaucoma?

About 1 in 50 Americans over the age of 40 have chronic open-angle glaucoma, and your risk increases with age. Demographics also play a part: Hispanic-Americans have 20 times the risk of developing glaucoma as white Americans. African-Americans have four times the risk until they reach the age of 45, when their risk increases to almost 17 times more than that of whites.

Health problems, such as obesity and arthritis, can also increase one's risk. Although high blood pressure is not a direct risk factor for glaucoma, many studies have found high blood pressure to be statistically related to glaucoma. This is probably because one factor that can cause high blood pressure is poor circulation. Poor circulation could also prohibit proper eye drainage, possibly causing an increase in ocular pressure, as well as a reduced supply of critical nutrients to

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the optic nerve. Perhaps this is why glaucoma can result in vision loss at any level of eye pressure if the optic nerve is weak.

How Do I Know if I Have Glaucoma?

The tests for glaucoma are simple and painless. First, your doctor will check for increased intraocular pressure with a tonometer. There are two types. The first, called an applanation tonometer, measures the pressure with a touch to the cornea. The second type, called an air puff tonometer, blows a puff of air at your eyes.

The doctor also will look into your eyes with a biomicroscope to evaluate the health of the anterior chamber of the eye. If the chamber is shallow, drainage may not be as efficient as in a normal or deep chamber.

As the doctor looks into your eyes, he or she also will examine the optic nerve for damage, specifically, for a condition called cupping. Cupping indicates that the optic nerve has been pushed out of shape by too much pressure from the aqueous humor, or that nerve cells have been lost, leaving empty space behind.

Finally, the doctor will check your peripheral vision with a machine called a visual field tester. This machine detects blind spots in your vision, which determines if there's been any damage from the glaucoma.

Although most physicians believe that intraocular pressure is the only diagnostic indicator of glaucoma, only a complete eye exam that includes evaluation of the pressure, optic nerve, peripheral vision and drainage angle can accurately determine if you are free of glaucoma.

Conventional Treatments

In the past few years, there have been new drugs on the market to help lower intraocular pressure. The most common are: Timolol (Timoptic, a beta-blocker), Carteolol (Ocupress), Betaxol (Betoptic), Latanoprost (Xalatan), Brimonidine (Alphagan) and Apraclonidine (Iopidine).

Doctors treating glaucoma try to use the smallest concentration of only one drug and add another drug only if the first isn't working. The beta-blockers are