Introduction

‘The eyes are the window to the soul.’ William Shakespeare. ⁽¹⁾  

“Our eyes reveal the depth of our emotions and connect us to the essence of life. The eye: the window to the soul; the center of the face’s beauty; the point where a person’s identity is concentrated; but at the same time, an optical instrument requiring constant washing, wetting, and maintenance by a special liquid dosed with salt. So the gaze, the greatest marvel man possesses, is regularly interrupted by a mechanical washing action.” ⁽²⁾   (Milan Kundera Identity, 1997.)

As life unfolds, numerous factors may threaten our visual contact with the world. Genetics, trauma, infections, inflammation, diabetic retinopathy, and oxidative stress (i.e., aging) all contribute to vision loss over time. Sometimes, the decline is simply due to the natural wear and tear on our eyes (aging). Sometimes, it is due to bad luck (trauma). And sometimes, it is grandma’s fault (genetics).

Nonetheless, the gradual deterioration of our eyesight constantly challenges this most precious sensory link to our surroundings. By understanding the underlying causes of this decline, we empower ourselves to proactively address and preserve our visual faculties for as long as possible.

Approximately 1/3 of all Americans over the age of 40 experience a form of vision-reducing eye disease. ⁽³⁾ The five most common eye disorders are: ⁽⁴⁾

1. Cataracts:
   • Cataracts are the most common chronic eye condition, affecting more than 24 million Americans aged 40 and older. The risk of developing cataracts increases with age, and by 65, approximately half of all Americans have cataracts.
     
2. Glaucoma
   • Glaucoma is the second most common chronic eye disease, affecting over 3 million Americans. It is particularly prevalent in individuals over 60, with African Americans, Hispanics, and those with a family history of glaucoma being at higher risk.
     
3. Diabetic Retinopathy
   •  Diabetic retinopathy, affecting about 7.7 million people in the U.S., is the leading cause of vision loss in working-age adults.

4. Age-related Macular Degeneration (AMD)
   • AMD affects over 2 million Americans aged 50 and older. It is a leading cause of vision loss in older adults, with the risk increasing significantly.
     
5. Dry-Eye Syndrome
   • Dry eye syndrome primarily affects women and older adults. It is often underdiagnosed and can significantly impact the quality of life.

While each entity deserves consideration, our focus today is on the ‘silent’ threat, the leading cause of irreversible blindness, glaucoma. Glaucoma stealthily narrows one’s vision, often striking without warning. Thoroughly understanding glaucoma allows us to take action preemptively to preserve our window to the soul.

Longevinex® and Complementary Therapies for Glaucoma

Longevinex® stands out as a scientifically backed, effective supplement that offers hope in the fight against glaucoma and other vision-related challenges. As you continue reading, you’ll discover more about how complementary therapies like trans-resveratrol can support those diagnosed with glaucoma.

What is Glaucoma? ⁽⁵⁾         

Glaucoma is a chronic eye condition that damages the optic nerve. It is typically caused by a buildup of fluid in the eye, resulting in increased intraocular pressure (IOP). This elevated pressure can harm the optic nerve, which is essential for transmitting visual information from the eye to the brain. Notably, glaucoma can develop even when eye pressure is within normal ranges.

Glaucoma is the second leading cause of blindness in the world. It results in vision loss if not caught and treated early. Symptoms develop slowly, and many patients do not notice them for years. Over 50% of glaucoma victims are unaware of their condition when diagnosed by appropriate medical personnel.

Symptoms of glaucoma include: ⁽⁶⁾

• Loss of side vision 
• Eye redness 
• Headaches 
• Blurry or foggy vision 
• Halos around lights 
• Dilated pupil 
• Nausea and vomiting 
• Severe throbbing eye pain 

Common Etiologies for Glaucoma Include: ⁽⁷⁾

1. Increased Intraocular Pressure (IOP):

• Aqueous Humor Dynamics: The eye constantly produces a clear fluid called aqueous humor, which fills the anterior chamber—the space between the cornea and the iris. This fluid supplies essential nutrients to the eye and helps maintain its shape. Under normal conditions, the eye drains aqueous humor through a complex system that includes the trabecular meshwork and the uveoscleral pathway. When the production of aqueous humor exceeds its drainage, or if there is resistance in the drainage channels, intraocular pressure increases. Left untreated, this elevated pressure, termed ocular hypertension, damages the optic nerve, resulting in glaucoma.
  

⁽⁸⁾

• Open-Angle Glaucoma: The most common form of glaucoma, accounting for about 90% of cases, is “open-angle glaucoma.”  Open-angle glaucoma develops when the trabecular meshwork becomes partially blocked over time. Though the drainage angle formed by the cornea and iris remains open, this blockage gradually increases, often without symptoms, until significant vision loss occurs. ^(9-10)
  

• Closed-Angle Glaucoma: Closed-angle glaucoma occurs when the eye’s drainage angle suddenly closes, rapidly increasing intraocular pressure. In closed-angle glaucoma, the space between the iris and the drainage canals is narrower than normal. As the pupil enlarges too much or too quickly, the outer edge of the iris bunches up over the drainage canals, obstructing fluid outflow. This condition is a medical emergency characterized by severe pain, nausea, vomiting, blurred vision, and visual disturbances such as rainbow-colored halos around lights. Immediate treatment is crucial to prevent permanent vision loss. ^(10-11)
  

2. Age: As we mature, increased rigidity of the trabecular meshwork and a decrease in the size of the anterior chamber result in increased intraocular pressure, which damages the optic nerve. ⁽¹²⁾

3. Genetics: A strong family history of glaucoma increases future generations’ risk of developing glaucoma. Mutations in the MYOC (myocilin) and OPTN (optineurin) genes are linked to primary open-angle glaucoma. Ongoing research continuously identifies new genetic markers that predispose individuals to glaucoma. ⁽¹³⁾

4. Ethnicity: Glaucoma affects different ethnic groups with varying degrees of severity. Persons of Asian descent are prone to angle-closure glaucoma, while African Americans are more likely to develop open-angle glaucoma at a younger age. Hispanic populations are at a higher risk after age 60 than their Caucasian-matched controls. ⁽¹⁴⁾

5. Medical Issues:

• Diabetes: Individuals with diabetes are at increased risk for glaucoma due to diabetic retinopathy. Diabetes leads to neovascularization (the growth of new, fragile blood vessels) that blocks the drainage angle. ⁽¹⁵⁾

• Hypertension: Chronic high blood pressure damages blood vessels in the eye, contributing to optic nerve damage and increasing the risk of glaucoma. ⁽¹⁶⁾

• Cardiovascular Diseases: Atherosclerosis increases the risk of glaucoma optic by diminished blood flow to the optic nerve. ⁽¹⁷⁾

6. Eye Conditions:

• High Myopia (Nearsightedness): Nearsightedness is associated with structural changes, including stretching and thinning of the retina and optic nerve head in the eye, increasing the risk of open-angle glaucoma. ⁽¹⁸⁾
• Eye Injuries: Eye trauma leads to secondary glaucoma by damaging the drainage structures or causing hyphema, bleeding, inside the eye, which can obstruct the drainage pathways. ⁽¹⁹⁾
• Prolonged Use of Corticosteroids: Corticosteroids elevate intraocular pressure (IOP) by decreasing the outflow of aqueous humor. This is especially pronounced in “steroid responders,” individuals whose IOP rises significantly in response to corticosteroid use. Whether administered as topical eye drops or taken systemically through oral or injectable forms, corticosteroids can lead to steroid-induced glaucoma. ⁽²⁰⁾

Diagnosis:

1. Tonometry:

• Goldmann Applanation Tonometry: Considered the gold standard of glaucoma diagnosis, Goldmann Applanation Tonometry involves flattening a small part of the cornea with a probe to measure the force required to flatten it, which correlates with the intraocular pressure. ⁽²¹⁾

• Non-contact tonometry uses a puff of air to flatten the cornea and measure the IOP.  It is less precise but eliminates the chance of contaminating the eye with the touch applanation technique. ⁽²²⁾
• Dynamic Contour Tonometry: This newer method measures intraocular pressure by assessing the corneal contour. Dynamic Contour Tonometry provides more accurate readings in cases where corneal thickness varies. ⁽²³⁾

2. Ophthalmoscopy:

• A slit-lamp biomicroscope examines the optic nerve head (optic disc) for signs of glaucoma. Key indicators include: ⁽²⁴⁾
• Cupping: An increased cup-to-disc ratio, where the central depression of the optic nerve head (the cup) becomes larger relative to the total size of the disc.
• Notching: Focal thinning or loss of the neuroretinal rim, particularly at the superior and inferior poles of the optic disc.
• Pallor: The optic disc appears pale, indicating nerve fiber loss.

3. Visual Field Test:⁽²⁵⁾

• Detecting Visual Field Loss: This test maps the patient’s visual field, detecting subtle losses of peripheral vision that are often the first sign of glaucoma. The patient focuses on a central point while lights of varying intensities are flashed in their peripheral vision. The patient presses a button each time they see a light, creating a visual field map.

4. Gonioscopy: ⁽²⁶⁾

• Assesses the Drainage Angle: Gonioscopy uses a special contact lens with mirrors to visualize the anterior chamber angle, where the iris meets the cornea. It helps differentiate between open-angle and angle-closure glaucoma. 
• Gonioscopy reveals abnormal blood vessels (neovascularization), synechiae (adhesions), and pigmentation indicating secondary glaucoma.

5. Pachymetry ⁽²⁷⁾

• Pachymetry measures corneal thickness.
  • A thick cornea may result in a falsely high IOP reading.
  • A thin cornea may give a correspondingly false low reading. 
  • Pachymetry is performed using a small probe that touches the cornea to measure its thickness.
    

Prevention ⁽²⁹⁾

• Regular Eye Exams:
  • Early Detection: Glaucoma is often known as the “silent thief of sight” because it progresses without symptoms until significant damage has occurred. Regular comprehensive eye exams, especially for individuals over 40 or those with risk factors, are critical for early detection. Examinations must include intraocular pressure measurement, optic nerve evaluation, and visual field testing.
    
• Lifestyle:
  • Diet and Nutrition:  A diet rich in fruits and vegetables, particularly those high in antioxidants like leafy greens and colorful fruits, protects the optic nerve from damage. Omega-3 fatty acids, lutein, and zeaxanthin (found in leafy greens) benefit eye health.
  • Exercise: Regular aerobic exercise lowers IOP. Exercise improves blood flow to the optic nerve and cardiovascular health, reducing glaucoma risk.
  • Don’t Smoke: Smoking increases oxidative stress while reducing blood flow to the optic nerve.
    
•  Protecting the Eyes: ⁽³⁰⁾
  • Preventing Eye Injuries:  Wearing protective eyewear during activities that could result in eye injuries (e.g., sports, using power tools) can prevent trauma-induced glaucoma. Avoid activities that might cause significant eye strain or pressure, such as rubbing the eyes excessively or prolonged exposure to bright computer screens.
  • UV Protection: Wearing sunglasses that block 100% of UVA and UVB rays protects the eyes from UV damage, which is a major contributor to cataracts and other eye conditions that increase the risk of glaucoma.
    

Treatment:

1. Medications:

• Prostaglandin Analogs: ⁽³¹⁾ 
  • Mechanism of Action: Prostaglandin analogs, latanoprost (Xalatan), bimatoprost (Lumigan), and travoprost (Travatan), are first-line treatments for most glaucoma patients. Prostaglandin analogs increase the outflow of aqueous humor through the uveoscleral path, reducing intraocular pressure, on average, by 25-33%.
  • Side Effects include ocular redness, darkening of the iris, and increased eyelash growth. Rarely, patients develop a cystoid macular edema or herpetic keratitis.
    
• Beta-Blockers: ⁽³²⁾
  • Mechanism of Action: Beta-blockers timolol (Timoptic) and betaxolol (Betoptic) decrease the production of aqueous humor by inhibiting beta-adrenergic receptors in the ciliary body. Beta-blockers lower intraocular pressure but are considered second-line due to potential systemic side effects bradycardia, hypotension, decreased myocardial contractility, respiratory and heart failure.  Beta-blockers are contraindicated in patients with congestive heart failure and chronic obstructive lung disease.
    
• Alpha Agonists: ⁽³³⁾
  • Mechanism of Action: Alpha agonists, typified by brimonidine (Alphagan), reduce aqueous humor production and increase uveoscleral outflow. They are used mainly as adjunctive therapy in combination with other IOP-lowering drugs.
  • Side Effects include dry mouth, fatigue, and a risk of allergic reactions manifesting as conjunctival redness and follicular conjunctivitis. Patients with a history of severe cardiovascular disease should use these medications with caution due to the risk of systemic hypotension.
    
• Carbonic Anhydrase Inhibitors ⁽³⁴⁾
  • Mechanism of Action: Carbonic anhydrase inhibitors (CAIs), acetazolamide (Diamox), and dorzolamide (Trusopt) inhibit the enzyme carbonic anhydrase, reducing aqueous humor production. Oral CAIs, such as acetazolamide, are used in acute settings, such as angle-closure glaucoma, while topical CAIs are used for chronic management.
  • Side Effects: Oral CAIs cause systemic side effects such as paresthesia (tingling in the fingers and toes), fatigue, gastrointestinal disturbances, and metabolic acidosis. Topical CAIs cause local stinging, burning, and a bitter taste.
    
• Rho Kinase Inhibitors  ⁽³⁵⁾
  • Mechanism of Action: Rho kinase inhibitors, exemplified by netarsudil (Rhopressa), a newer class of glaucoma medications, increase the drainage of aqueous humor through the trabecular meshwork. They also reduce episcleral venous pressure, contributing to their intraocular pressure-lowering effect.
  • Side Effects include hyperemia (eye redness), corneal verticillata (whorl-like deposits in the corneal epithelium), and conjunctival hemorrhage. Despite these side effects, Rho kinase inhibitors offer a novel mechanism of action that benefits previously treatment-resistant patients.

2. Surgery:

• Laser Trabeculoplasty ⁽³⁶⁾
  
  • Procedure: Laser trabeculoplasty is a minimally invasive instrument that creates small burns in the trabecular meshwork. The burns cause the tissue to contract, improving aqueous humor outflow and reducing intraocular pressure. There are two types of laser trabeculoplasty:
    • Argon Laser Trabeculoplasty (ALT): ALT uses a thermal laser to target the trabecular meshwork.
    • Selective Laser Trabeculoplasty (SLT):  SLT uses a laser with a lower energy than ALT.  SLT specifically targets pigmented cells in the trabecular meshwork, causing less damage to surrounding tissues.
  • Outcome: SLT effectively lowers intraocular pressure by approximately 20-30%. It is often used as an adjunct to medication or initial treatment in patients who prefer to avoid daily medications. The procedure may need to be repeated as the effect of SLT diminishes over time.
    
• Trabeculectomy: ⁽³⁷⁾
  
  • Procedure: Trabeculectomy requires creating a small flap in the sclera and removing a portion of the trabecular meshwork.  Trabeculectomy generates a new drainage pathway for aqueous humor. The fluid drains into a bleb (a small reservoir) formed under the conjunctiva, where it is absorbed into the bloodstream.
  • Outcomes: Trabeculectomy is considered the gold standard for surgical management of glaucoma and achieves significant reductions in intraocular pressure. Trabeculectomy carries risks such as infection, bleb leaks, and scarring, which can lead to procedure failure and the need for additional surgeries. Postoperative care includes antibiotics, anti-inflammatory eye drops, and antifibrotic agents like mitomycin C to reduce scarring.
    
• Glaucoma Drainage Devices: ⁽³⁸⁾
  
  • Procedure: Glaucoma drainage devices (shunts or tubes) are small implants that drain aqueous humor from the anterior chamber to a reservoir (bleb) created under the conjunctiva. Common devices include the Ahmed valve, Baerveldt tube, and Molteno implant.
  • Outcomes: Glaucoma drainage devices are used in patients with refractory glaucoma who do not respond to trabeculectomy or other less invasive procedures. They are helpful in complex cases, such as uveitic glaucoma or neovascular glaucoma, or in eyes with extensive scarring from previous surgeries. The main risks include tube erosion, blockage, and infection. Regular follow-up is essential to monitor the device’s function and the eye’s health.

3. Non-Prescription Adjuncts:

1. Special Considerations

• Trans-Resveratrol ^(39-40)
  • Source: Trans-resveratrol is a polyphenolic compound predominantly found in the skin of red grapes, red wine, peanuts, blueberries, and Japanese knotweed. It is an antioxidant, anti-inflammatory, and neuroprotective agent.For an in-depth look at fifty medical indications for trans-resveratrol, click this link and this link.
    
  • Mechanism of Action:
    • Antioxidant Properties: Trans-resveratrol is a potent scavenger of free radicals and unstable molecules that cause oxidative stress and damage cells. Retinal ganglion cells and the optic nerve in glaucoma patients are particularly vulnerable to oxidative stress. By neutralizing free radicals, trans-resveratrol protects cells from damage and slows glaucoma progression.
    • Neuroprotection: Trans-resveratrol exerts neuroprotective effects by modulating signaling pathways involved in cell survival, inflammation, and apoptosis (programmed cell death).  Trans-resveratrol upregulates the expression of anti-apoptotic proteins and downregulates pro-apoptotic factors, thus promoting the survival of retinal ganglion cells.
    • Anti-Inflammatory Effects: Chronic inflammation damages the optic nerve. Trans-resveratrol inhibits the NF-kB pathway, which is involved in the expression of pro-inflammatory cytokines. By reducing inflammation, trans-resveratrol preserves optic nerve function.
    • Improvement in Blood Flow: Trans-resveratrol improves ocular blood flow, particularly to the optic nerve. It enhances the vasodilating production of nitric oxide. Improved blood flow prevents ischemic damage to the optic nerve, contributing to glaucoma.
      
• Dosage: 
  • Trans-resveratrol for glaucoma ranges from 150 to 500 mg per day.

2. Progesterone ⁽⁴¹⁾

• Mechanism of Action: Progesterone is a steroid hormone produced during the second half of the female menstrual cycle and is more than a sex-related hormone. Progesterone a natural diuretic.  As such, it reduces IOP by enhancing the outflow of aqueous humor through the trabecular meshwork. Progesterone is mediated by the modulation of steroid-sensitive pathways within the eye. Progesterone primarily influences matrix metalloproteinases (MMPs), a group of enzymes that break down proteins, such as collagen, found in the spaces between cells in tissues. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis.  MMPs remodel the extracellular matrix of the trabecular meshwork, making it easier for fluid to drain.
• Clinical Implications:  While progesterone is not currently a standard treatment for glaucoma, its benefits include managing menopausal symptoms and reducing the risk of glaucoma progression.

3. Vitamins and Minerals

• Vitamins A, C, and E ⁽⁴²⁾
  • A, C, and E (ACE) vitamins are potent antioxidants that protect the optic nerve and retina cells from oxidative damage. Vitamin A plays a crucial role in maintaining the health of the cornea and the function of retinal cells. Vitamin C, found in high concentrations in the aqueous humor, helps preserve the structural integrity of the trabecular meshwork. Vitamin E protects cell membranes from oxidative damage.  When taken separately, Vitamins A, C, and E have little effect on glaucoma.  When all three are used in combination, there is a lessening of glaucoma symptoms.
    
  • Dietary Sources: Vitamin A is abundant in carrots, sweet potatoes, and dark leafy greens. Vitamin C is found in citrus fruits, strawberries, bell peppers, and broccoli. Vitamin E is present in nuts, seeds, spinach, and vegetable oils. A diet rich in these vitamins supports overall eye health and aids in the management of glaucoma.

4. Magnesium ⁽⁴³⁾

• Mechanism of Action: Magnesium is essential for dozens of physiological processes, including the regulation of blood pressure and vascular tone. It relaxes blood vessels, improving blood flow to the optic nerve and lowering intraocular pressure. Magnesium regulates glutamate, an excitatory neurotransmitter that can become neurotoxic at high levels and contribute to glaucoma optic nerve damage.
  
• Dietary Sources: Magnesium is found in green leafy vegetables, nuts, seeds, whole grains, and legumes.

5. Ginko Biloba ⁽⁴⁴⁾

• Mechanism of Action: Ginkgo biloba improves circulation and cognitive function. Ginkgo improves blood flow to the optic nerve in glaucoma and staves off oxidative stress. Ginko has a neuroprotective effect by reducing glutamate toxicity and supports mitochondrial function in retinal ganglion cells.
  
• Clinical Evidence Ginkgo supplementation improves visual field outcomes in glaucoma patients. The dose is 120-240 mg per day. Ginko is an antiplatelet agent, so use it cautiously with anticoagulants.

4. Homeopathic Remedies

• Phosphorus ⁽⁴⁵⁾
  • Homeopathic Use: Phosphorus treats inflammatory eye conditions, including glaucoma. It supports optic nerve health and improves circulation within the eye. Homeopathic phosphorus is used in highly diluted forms, often at 30C or 200C, depending on the individual case.
  • Mechanism of Action: Homeopathy operates on the principle of “like cures like.” Substances that cause symptoms in a healthy person are used in minute doses, analogous to vaccines, to treat similar symptoms in a sick person. Phosphorus in homeopathy addresses burning, redness, and visual disturbances, symptoms seen in glaucoma.
    
• Ruta Graveolens (“Rue”) ⁽⁴⁶⁾
  • Homeopathic Use: Ruta graveolens is used homeopathically to treat eye strain, fatigue, and inflammatory conditions of the sclera and cornea. Rue strengthens the eyes and improves visual acuity.
  • Mechanism of Action: Ruta is diluted to achieve the “like cures like” principle, as with all homeopathic remedies. Ruta aids in tissue regeneration and reduces scar formation. It contributes to the management of glaucoma by improving the structural integrity of the eye.

5. Chinese Herbs

• Gou Qi Zi (Lycium Bubrum, Goji Berries) ⁽⁴⁷⁾
  • Traditional Use: Gou Qi Zi is used in traditional Chinese medicine (TCM) to improve vision and overall eye health. It is valued for its ability to nourish the liver, which is believed in TCM to have a direct connection to the eye. 
  • Mechanism: Goji berries are rich in antioxidants, particularly zeaxanthin. Zeaxanthin is known as a nutrient that protects the retina from oxidative stress. Goji berries regulate blood sugar levels, improve circulation, enhance immune function, and protect against neurodegenerative diseases. 
    
• Ju Hua (Chrysanthemum): ⁽⁴⁸⁾
  • Traditional Use: Chrysanthemum flowers, or Ju Hua in TCM, are commonly used to treat inflammation-related conditions. Symptoms include red, dry, and or itchy eyes. In TCM, Ju Hua ‘dispels wind and clears heat,’ making it practical for eye conditions caused by internal or external inflammatory influences.
  • Mechanism: Ju Hua has anti-inflammatory properties and reduces oxidative stress in the eyes. Chrysanthemum tea is a popular and gentle way to consume this herb, offering therapeutic and preventative benefits.
    

Conclusion:

Glaucoma is a complex, multifaceted condition affecting over three million Americans.  Glaucoma is a leading cause of irreversible blindness.  While conventional therapies, both medications and surgery, are essential for controlling intraocular pressure and preventing vision loss, integrating healthy lifestyle changes, including a diet rich in antioxidants and regular aerobic exercise, improves blood flow to and helps protect the optic nerve from damage. 

Complementary therapies, such as trans-resveratrol, progesterone, vitamins, herbs, and homeopathic remedies, provide additional support in managing this disease. 

Longevinex’s trans-resveratrol, derived from Japanese knotweed and containing cyclodextrin, is a promising non-prescription method due to its neuroprotective and antioxidant effects. 

Trans-resveratrol is a potent anti-inflammatory, antioxidant, neuroprotective, and vasodilating agent. Cyclodextrin enhances the solubility and bioavailability of ocular hypotensive agents, improving Longevinex’s effectiveness.  

Progesterone offers potential benefits for lowering intraocular pressure, particularly in postmenopausal women. 

By integrating traditional treatments with preventive measures and emerging therapies, individuals with glaucoma can better navigate the challenges posed by this complex condition, ensuring a better quality of life and a sustained connection to the world around them.

Disclaimer

The information provided on this blog is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. The content presented here does not establish a doctor-patient relationship between you, the author, or any affiliated entities. Please consult with a qualified healthcare provider for personalized medical advice. Furthermore, the information shared on this blog may not be reviewed or approved by the FDA and should not be used as a basis for making medical decisions without proper professional consultation.

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