There is no cure for glaucoma, but the majority of people with the degenerative eye disease are able to manage the condition through a combination of prescribed eye drops, laser treatments and surgery. Eye drops are the most commonly prescribed treatment for glaucoma, however if there is further glaucoma progression then it may be necessary to have laser treatment (to help the fluid in the eye flow or drain better) or surgery. There are different types of glaucoma surgery and what is required will depend on the individual, the stage and progression of glaucoma.
The prospect of eye surgery or laser treatment may seem daunting, however is necessary to prevent further progression if indicated. There are some alternative therapies that have shown some promise as an adjunct to treatment, but as with all things, before trying anything new make sure to always consult with your Ophthalmologist or Optometrist first before adding any alternative therapy to current treatment regimes.
When considering any kind of alternative or supplemental treatment, remember that they should never take the place of conventional treatment. They are not replacement therapies but can be used together with conventional treatment prescribed by your Ophthalmologist.
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Cannabinoids and CBD Oil
Cannabis is a genus of flowering plant, commonly known for psychoactive properties when smoked or ingested. Although the number of species within the genus is under dispute, the three major species of cannabis are referred to as Sativa, Indica and Ruderalis.
All species of cannabis contain a number of naturally occurring compounds known as cannabinoids. The concentration of three of these compounds in a strain of cannabis (delta-9 TetraHydroCannabinol (THC), Cannabidiol (CBD) and Cannabinol (CBN)) determines the effects and use of the plant.
THC is the main psychoactive compound found in cannabis. When smoked or otherwise ingested, THC may lead to feelings of well-being or euphoria. Cannabis plants bred with an extremely low concentration of THC are often referred to as hemp and are used to make rope and fabrics. CBD is also psychoactive, but due to the way it binds with the endocannabinoid receptors in the brain, CBD does not cause the “high” of THC and instead appears to have an effect on depression, anxiety and seizures.
One of the major causes of optic nerve damage is higher than normal eye pressure (intraocular pressure or IOP). The ingestion of THC has been shown to decrease intraocular pressure by a significant amount (up to around 30%), but while this sounds promising as a treatment for glaucoma, there are some limitations that make cannabis a less than ideal treatment option.
THC has a relatively short, and dose dependent, effective period. The pressure lowering effect typically only lasts around three to four hours, therefore for effective management of IOP, multiple doses would be required around the clock to maintain a stable eye pressure. Abrupt changes in eye pressure like this may lead to glaucoma progression. Further, the use of multiple daily doses of THC would also potentially lead to significant cognitive impairment or reduction in normal function due to a near constant high. The cost of using marijuana every few hours would also be prohibitive for most people.
Studies suggest that direct ingestion of THC through smoking, pills or edibles is the only effective method of lowering intraocular pressure. THC containing eye drops and sublingual (under the tongue) compounds have been tested and found ineffective. Eye drops did not appear to cause any psychoactive reaction, but did cause irritation and burning in the eyes without any drop in IOP. There is a synthetic analogue of THC known as HU211 that has shown effectiveness in lowering IOP with minimal psychoactive effects but is still under investigation and more research is needed.
Another factor standing in the way of cannabis as a reliable glaucoma treatment is the fact that THC may lower blood pressure along with intraocular pressure. The lowered blood pressure may potentially have an impact on circulation and blood flow to the optic nerve.
In comparison to THC, although CBD oil has no euphoric psychoactive effects, it has not shown any effect on reducing eye pressure. In fact, there have been some studies which have shown an increase in IOP.
A recent clinical trial led by the Centre for Eye Research Australia (CERA) has indicated that high doses of vitamin B3 (Nicotinamide) may play an important role in protecting against or preventing the progression of the optic nerve damage that leads to blindness in glaucoma.
Professor Jonathan Crowston and Dr Flora Hui at the Centre for Eye Research Australia led the trial that included 57 glaucoma patients. The patients that received large doses of vitamin B3 (3g of vitamin B3 for 12 weeks) in addition to their usual prescribed glaucoma treatment had a significant improvement in visual function compared to those that received a placebo.While the initial trial was both small and relatively brief, the positive findings suggest that vitamin B3 may be useful in reducing the progression of glaucoma over a long period. A larger trial is being planned to help determine whether vitamin B3 should be added to glaucoma treatment to help slow the progression of the disease.
Other Alternative or Natural Remedies for Glaucoma
While research is inconclusive at the moment, there are a number of alternate or natural treatments for glaucoma that are currently under investigation. These include Ginkgo Biloba and Melatonin, as well as specific nutritional diets.
Ginkgo contains a number of antioxidants (cyanidins, flavonoids and lactones) which have shown to play a role in the preservation of mitochondria (structures within cells that produce energy), inhibit cell death and possibly increase blood flow.
Studies have been conducted into the role of Ginkgo Biloba in glaucoma and other conditions such as dementia, which have shown some slowing in progression, however they have not been robust enough studies. Further investigation is required.
Melatonin is a hormone that is responsible for a number of functions, including regulating both circadian and seasonal rhythms as well as aqueous humor production (the fluid in the eye). Recent animal studies of the efficacy of melatonin on the reduction of IOP have shown some promise, with reductions of IOP ranging from 19% to 28%, however it is uncertain if this would translate in human studies and different types of glaucoma.
A study into the effects of moderate exercise on IOP indicated that people that engage in daily moderate exercise exhibited a 14% decrease in IOP. Two trials indicated that people who engaged in moderate exercise for a period of three months exhibited a moderate decrease in IOP for a period of up to three weeks after exercise ended.While not a treatment for glaucoma, these trials appear to indicate that maintaining a moderate exercise regime may help in reducing IOP in the long term. It is uncertain whether this lowering of IOP translates into preventing visual field loss or glaucoma progression.
A number of studies have been conducted into the efficacy of acupuncture for lowering IOP. Some animal studies have reported a reduction in IOP following acupuncture, with one of the studies concluding that acupuncture may preserve retinal function. However, these animal studies frequently involve using destructive techniques to create glaucoma, and therefore similar results are very unlikely to be obtained in studies with human eyes.A study on human glaucoma patients reported that subjects experienced a mild lowering of IOP for up to four weeks following acupuncture, but that study has been criticised for lacking a control group. As it stands, due to problems with both quality and quantity of studies, acupuncture remains something of a wild card when it comes to glaucoma treatment.
While diet is not a treatment for glaucoma, eating a diet rich in antioxidants, lutein, zeaxanthin, omega-3 fatty acids, vitamins A, E and K as well as zinc can help safeguard your eyes and potentially slow glaucoma progression. Some diets such as the Mediterranean Diet contain a good amount of these antioxidants and fatty acids.