Meeting News

Speaker: Lowering IOP only proven glaucoma treatment

Shan Lin, MD
Shan Lin

ORLANDO, Fla. – As patients learn more about alternative therapies, one glaucoma specialist still recommends medication first, then elevating low systemic blood pressure – and then supplements.

“The only proven glaucoma treatment is lowering IOP,” Shan Lin, MD, said here at the Optometric Glaucoma Society meeting, held prior to the American Academy of Optometry meeting.

When patients inquire about alternative therapies, “it’s important to set up the right expectations,” he said.

Lin explained that while marijuana use lowers eye pressure, the duration of action is only 3 hours and has the downsides of lowered perfusion pressure, neurologic side effects and potential for addiction. The American Academy of Ophthalmology does not recommend marijuana as primary treatment for glaucoma, as, “better treatments are available,” he said.

One study showed significant improvement in preexisting visual field damage among patients with normal tension glaucoma after treatment with ginkgo biloba (Quaranta et al.). However, “the jury is still out,” Lin said, as other studies have shown no effect.

Another study involving a series of acupuncture comprising 12 sessions of either eye-related or non eye-related points (Law et al.) showed no overall effect on diurnal IOP or best-corrected visual acuity but demonstrated temporary improvement in IOP immediately after a treatment session, he said. It was important to note that the non eye-point sessions led to lowered blood pressure.

Perfusion pressure is “the most significant factor outside of IOP that affects glaucoma,” Lin said. The new paradigm is that low blood pressure and ocular perfusion pressure correlate with a higher risk for glaucoma, he said, referencing the Barbados Eye Study (Leske et al.) and Early Manifest Glaucoma Trial (Leske et al.). A recommendation for patients with low blood pressure is to use more salt in their diet to increase blood pressure and decrease IOP.

One overall beneficial alternative is meditation. A randomized control study (Dada et al.) showed that 1 hour of daily meditation led to a decrease in IOP of 4 points and improved quality of life. Meditation also normalized stress biomarkers, Lin said.

Another potentially useful supplement is black currant, which increased blood flow, slowed visual field progression and lowered IOP in healthy study participants (Ohguro et al.). Mirtogenol, which is bilberry and pine bark extract, lowered IOP and increased blood flow in patients with ocular hypertension (Steigerwalt et al., Steigerwalt et al.).

Palmitoylethanolamide, a fatty acid found in the body that augments cannabinoid receptors, led to lower IOP and improved visual fields (Costagliola et al., Gagliano et al.). – by Talitha Bennett

Reference:

Costagliola C, et al. J Med Food. 2014;doi:10.1089/jmf.2013.0165.

Dada T, et al. J Glaucoma. 2018;doi:10.1097/IJG.0000000000001088.

Gagliano C, et al. Invest Ophthalmol Vis Sci. 2011;doi.org/10.1167/iovs.10-7057.

Law SK, et al. Am J Ophthalmol. 2015;doi:10.1016/j.ajo.2015.04.033.

Lee J, et al. J Glaucoma. 2013;doi:10.1097/IJG.0b013e3182595075.

Leske MC, et al. Arch Ophthalmol. 1994;doi:10.1001/archopht.1994.01090180121046.

Leske MC, et al. Ophthalmology. 1999;doi:10.1016/s0161-6420(99)90497-9.

Lin S. Alternative therapies in glaucoma treatment. Presented at: Optometric Glaucoma Society meeting; Orlando, Fla.; October 22, 2019.

Ohguro H, et al. Ophthalmologica. 2012;doi:10.1159/000335961.

Quaranta L, et al. Ophthalmology. 2003;doi:10.1016/S0161-6420(02)01745-1.

Steigerwalt RD, et al. Clin Ophthalmol. 2010;doi:10.2147/opth.s9899.

Steigerwalt RD, et al. Mol Vis. 2008;14:1288–1292.

Yoshida K, et al. J Ocul Pharmacol Ther. 2013;doi:10.1089/jop.2012.0198.

Disclosure: Lin reports no relevant financial disclosures.

Shan Lin, MD
Shan Lin

ORLANDO, Fla. – As patients learn more about alternative therapies, one glaucoma specialist still recommends medication first, then elevating low systemic blood pressure – and then supplements.

“The only proven glaucoma treatment is lowering IOP,” Shan Lin, MD, said here at the Optometric Glaucoma Society meeting, held prior to the American Academy of Optometry meeting.

When patients inquire about alternative therapies, “it’s important to set up the right expectations,” he said.

Lin explained that while marijuana use lowers eye pressure, the duration of action is only 3 hours and has the downsides of lowered perfusion pressure, neurologic side effects and potential for addiction. The American Academy of Ophthalmology does not recommend marijuana as primary treatment for glaucoma, as, “better treatments are available,” he said.

One study showed significant improvement in preexisting visual field damage among patients with normal tension glaucoma after treatment with ginkgo biloba (Quaranta et al.). However, “the jury is still out,” Lin said, as other studies have shown no effect.

Another study involving a series of acupuncture comprising 12 sessions of either eye-related or non eye-related points (Law et al.) showed no overall effect on diurnal IOP or best-corrected visual acuity but demonstrated temporary improvement in IOP immediately after a treatment session, he said. It was important to note that the non eye-point sessions led to lowered blood pressure.

Perfusion pressure is “the most significant factor outside of IOP that affects glaucoma,” Lin said. The new paradigm is that low blood pressure and ocular perfusion pressure correlate with a higher risk for glaucoma, he said, referencing the Barbados Eye Study (Leske et al.) and Early Manifest Glaucoma Trial (Leske et al.). A recommendation for patients with low blood pressure is to use more salt in their diet to increase blood pressure and decrease IOP.

One overall beneficial alternative is meditation. A randomized control study (Dada et al.) showed that 1 hour of daily meditation led to a decrease in IOP of 4 points and improved quality of life. Meditation also normalized stress biomarkers, Lin said.

Another potentially useful supplement is black currant, which increased blood flow, slowed visual field progression and lowered IOP in healthy study participants (Ohguro et al.). Mirtogenol, which is bilberry and pine bark extract, lowered IOP and increased blood flow in patients with ocular hypertension (Steigerwalt et al., Steigerwalt et al.).

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Palmitoylethanolamide, a fatty acid found in the body that augments cannabinoid receptors, led to lower IOP and improved visual fields (Costagliola et al., Gagliano et al.). – by Talitha Bennett

Reference:

Costagliola C, et al. J Med Food. 2014;doi:10.1089/jmf.2013.0165.

Dada T, et al. J Glaucoma. 2018;doi:10.1097/IJG.0000000000001088.

Gagliano C, et al. Invest Ophthalmol Vis Sci. 2011;doi.org/10.1167/iovs.10-7057.

Law SK, et al. Am J Ophthalmol. 2015;doi:10.1016/j.ajo.2015.04.033.

Lee J, et al. J Glaucoma. 2013;doi:10.1097/IJG.0b013e3182595075.

Leske MC, et al. Arch Ophthalmol. 1994;doi:10.1001/archopht.1994.01090180121046.

Leske MC, et al. Ophthalmology. 1999;doi:10.1016/s0161-6420(99)90497-9.

Lin S. Alternative therapies in glaucoma treatment. Presented at: Optometric Glaucoma Society meeting; Orlando, Fla.; October 22, 2019.

Ohguro H, et al. Ophthalmologica. 2012;doi:10.1159/000335961.

Quaranta L, et al. Ophthalmology. 2003;doi:10.1016/S0161-6420(02)01745-1.

Steigerwalt RD, et al. Clin Ophthalmol. 2010;doi:10.2147/opth.s9899.

Steigerwalt RD, et al. Mol Vis. 2008;14:1288–1292.

Yoshida K, et al. J Ocul Pharmacol Ther. 2013;doi:10.1089/jop.2012.0198.

Disclosure: Lin reports no relevant financial disclosures.