Consider this menu when managing glaucoma patients

A 54-year-old male returned for his IOP check and optic nerve evaluation following successful SLT OU, and asked, “Are there any nutritional treatments for glaucoma?”

Let’s take a bite into the re-search related to three areas: protection, perfusion, and pressure.

PROTECTION

Niacin (vitamin B3), a precursor to nicotinamide, has a possible protective effect in reducing the risk of developing glaucoma.¹ In addition to this protective effect, and when combined with pyruvate, nicotinamide was shown to provide a statistically significant improvement in visual function among open-angle glaucoma (OAG) patients.²

Related to this possible repair and protective process, a combination of vitamin D3, gastrodin, lycopene, vitamin C, and blackcurrant (VGLCR) exerted “a synergistic effect” on retinal ganglion cells to slow the degenerative process in glaucoma.³ The study’s conclusion: “All these results have confirmed the active role of VGLCR in the repair of eye damage caused by glaucoma for the first time; VGLCR, therefore, appears to have greater beneficial effects if used preventively, becoming an important element in the fight against glaucoma.”³

Furthermore, dietary natural plant products (DPNPs) — such as flavonoids (berries, tea, ginkgo biloba, red wine and dark chocolate [cocoa]), carotenoids (green, leafy vegetables, papaya, corn, egg yolk, carrots, pumpkin, peaches, apricots, and dark green vegetables) and omega-3/omega-6 fatty acids (flaxseed oil, fish oil, and walnuts) — have antioxidant, anti-inflammatory, and anti-angiogenic properties^4-8 that may help combat the suggested inflammatory and oxidative stress in glaucoma pathogenesis.⁹

Other menu items to consider: OAG patients should consume glutathione and nitric oxide-rich foods (e.g., dark green, leafy vegetables) vs. selenium and iron (e.g., red meat).¹⁰ Also, the Rotterdam Study reveals that diets low in vitamin B1 and high in magnesium were linked with an increased risk of OAG when compared with control subjects.¹¹

Savor this final bite: “…there is sufficient evidence from preclinical studies to support the synergistic neuroprotective benefits of carotenoid supplementation as an adjunctive nutraceutical approach to the management of glaucoma. However, the available results from clinical trials are largely controversial and insufficient at present, thereby warranting further prospective controlled studies. Thus, it remains to be seen if this adjunctive nutraceutical approach, in combination with IOP-lowering therapy, can provide additional protective benefits to glaucomatous eyes.”¹²

PERFUSION AND PRESSURE

In addition to ginkgo biloboa’s possible antioxidant and anti-inflammatory effect, it has been shown to increase ocular perfusion.^13,14

Also, supplements that contain either forskolin or black currant anthocyanins may create a “beneficial decrease” in IOP levels in healthy subjects, as well as in glaucoma patients.¹⁵ Further, these supplements are shown to reduce IOP beyond the levels achieved with therapy alone.^9,14

TO-GO BOX...

“…although further investigations are needed to determine their efficacy and safety, nutritional supplementation may represent an important coadjuvant in the therapeutic management of glaucoma.”⁷ These are exciting times as, “…already available [nutritional] therapy could rapidly usher in a new era that goes beyond IOP lowering.”¹⁶ In short, lets tell our patients, “If it’s good for the body, then it’s good for the eye…and eat your fruits and veggies!” OM

REFERENCES
1. Taechameekietichai T, Chansangpetch S, Peerawaranun P, Lin SC. Association between Daily Niacin Intake and Glaucoma: National Health and Nutrition Examination Survey. Nutrients. 2021;13(12):4263. doi: 10.3390/nu13124263
2. De Moraes CG, John SWM, Williams PA, Blumberg DM, Cioffi GA, Liebmann JM. Nicotinamide and Pyruvate for Neuroenhancement in Open-Angle Glaucoma: A Phase 2 Randomized Clinical Trial. JAMA Ophthalmol. 2022;140(1):11–18. doi: 10.1001/jamaophthalmol.2021.4576.
3. Molinari C, Ruga S, Farghali M, Galla R, Fernandez-Godino R, Clemente N, Uberti F. Effects of a New Combination of Natural Extracts on Glaucoma-Related Retinal Degeneration. Foods. 2021;10(8):1885. doi: 10.3390/foods10081885.
4. Ikonne EU, Ikpeazu VO, Ugbogu EA. Corrigendum to "The potential health benefits of dietary natural plant products in age related eye diseases" [Heliyon 6 (7) (2020) e04408] 2021;7(5):e07069. doi: 10.1016/j.heliyon.2021.e07069.
5. Ige M, Liu J. Herbal Medicines in Glaucoma Treatment. Yale J Biol Med. 2020;93(2):347-353. Published 2020 Jun 29.
6. Tribble JR, Hui F, Jöe M, et al. Targeting Diet and Exercise for Neuroprotection and Neurorecovery in Glaucoma. Cells. 2021;10(2):295. doi: 10.3390/cells10020295.
 7. Kang JH, Pasquale LR, Willett W, et al. Antioxidant intake and primary open-angle glaucoma: a prospective study. Am J Epidemiol. 2003;158(4):337-46. doi: 10.1093/aje/kwg167.
8. Ramdas WD, Schouten JSAG, Webers CAB. The Effect of Vitamins on Glaucoma: A Systematic Review and Meta-Analysis. Nutrients. 2018;10(3):359. doi: 10.3390/nu10030359.
9. Adornetto A, Rombolà L, Morrone LA, et al. Natural Products: Evidence for Neuroprotection to Be Exploited in Glaucoma. Nutrients. 2020;12(10):3158. doi: 10.3390/nu12103158.
10. Ramdas WD. The relation between dietary intake and glaucoma: a systematic review. Acta Ophthalmol. 2018;96(6):550-556. doi: 10.1111/aos.13662.
11. Ramdas WD, Wolfs RC, Kiefte-de Jong JC, et al. Nutrient intake and risk of open-angle glaucoma: the Rotterdam Study. Eur J Epidemiol. 2012;27(5):385-93. doi: 10.1007/s10654-012-9672-z. 
12. Lem DW, Gierhart DL, Davey PG. Carotenoids in the Management of Glaucoma: A Systematic Review of the Evidence. Nutrients. 2021;13(6):1949. doi: 10.3390/nu13061949.
13. Kang JM, Lin S. Ginkgo biloba and its potential role in glaucoma. Curr Opin Ophthalmol. 2018;29(2):116-120. 2018;29(2):116-120.
14. Loskutova E, O'Brien C, Loskutov I, Loughman J. Nutritional supplementation in the treatment of glaucoma: A systematic review. Surv Ophthalmol. 2019;64(2):195-216. doi: 10.1016/j.survophthal.2018.09.005.
15. Ohguro H, Ohguro I, Yagi S. Effects of black currant anthocyanins on intraocular pressure in healthy volunteers and patients with glaucoma. J Ocul Pharmacol Ther. 2013;29(1):61-7. doi: 10.1089/jop.2012.0071. 
16. Ramulu PY. Neuroprotective Therapies for Patients With Worsening Glaucoma Despite Adequate Intraocular Pressure Lowering—Short-term Neurorecovery, Long-term Neuroprotection? JAMA Ophthalmol. 2022;140(1):18–19. doi: 10.1001/jamaophthalmol.2021.4573.
 

DR. LIFFERTH practices at Center for Sight. He is a member of the Optometric Glaucoma Society and a Glaucoma Diplomate of the American Academy of Optometry. For additional glaucoma cases, you can also follow Dr. Lifferth on his Instagram account: glaucomaqd. Email him at glaucomaqd@yahoo.com.