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Dx Glaucoma


The Merck Manual Home Edition
states :
"Glaucoma is progressive optic nerve damage (often, but not always, associated with increased eye pressure) that leads to irreversible loss of vision.

Damage to the optic nerve can occur when pressure within the eye increases.Usually, the vision loss occurs so slowly that it may not be noticed for a long time.People at risk should have a complete eye examination, including measurement of eye pressures and testing of side (peripheral) vision.

Eye pressure needs to be controlled throughout life, usually with eye drops but sometimes with eye surgery.

Almost 3 million people in the United States and 14 million people worldwide have glaucoma. Glaucoma is the second most common cause of blindness worldwide and the second most common cause of blindness in the United States, where it is the leading cause of blindness among blacks and Hispanics. Only half of the people who have glaucoma know they do. Glaucoma can occur at any age but is 6 times more common among people over age 60.

People at highest risk are those with any of the following:
*Age older than 40
*African-American race
*Family members who have (or had) the disease
*Nearsightedness (in open-angle glaucoma) or farsightedness (in closed-angle glaucoma)
*High blood pressure
*Long-term use of corticosteroids
*Previous eye injury or surgery

Medications Used in Treatment
1. Prostaglandins: Xalatan®/latanoprost, Lumigan®/bimatoprost, Travatan®Z/travoprost, Zioptan®/tafluprost
2. Beta Blockers: Timoptic® Timoptic®XE/timolol, Betagan®/levobunolol, Betoptic®S/betaxolol, carteolol, /Optipranol®/metipranolol, Istalol®/timolol
3. Alpha Agonists: Iopidine®/apraclonidine, Alphagan®P/brimonidine
4. Carbonic Anhydrase Inhibitor/Beta Blocker: Cosopt®/dorzolamide/timolol, Azopt®/brinzolamide, Diamox®/acetazolamide, Cosopt®PF/dorzolamide-timolol, Simbrinza®/brimonidine-brinzolamide, Trusopt®/dorzolamide
5. Cholinergic Agonists: Isopto Carpine® Pilopine®HS/ pilocarpine
6. Cholinesterase Inhibitor: Phospholine Iodide/echothiophate
7. Adrenergic Agonists: Propine®/dipivefrin
8. Alpha Agonist/ Beta Blocker: Combigan®/brimonidine-brinzolamide

Suggested Links:
The Medscape Article gives specific recommendations and should be reviewed and discussed with your physician
*Medscape: on Primary Open-Angle Glaucoma
*N.H.S. Choices
*Glaucoma Research Foundation

*[Editor] A medical article documents that taking ginkgo biloba extract and anthocyanins (bilberry) significantly improved best-corrected visual acuity in a study of individuals with normal tension glaucoma; the study lasted up to 6 years. Another study reported that high dose vitamin C lowered intraocular pressure stating "Vitamin C in high doses has been found to lower IOP via its osmotic effect. Other nutrients holding some potential benefit for glaucoma include lipoic acid, vitamin B12, magnesium, and melatonin. Botanicals may offer some therapeutic potential. Ginkgo biloba increases circulation to the optic nerve; forskolin (an extract from Coleus forskohlii) has been used successfully as a topical agent to lower IOP; and intramuscular injections of Salvia miltiorrhiza have shown benefit in improving visual acuity and peripheral vision in people with glaucoma". Others do not agree.

Mercola suggests diet to lower insulin levels; which the Editor has shown can be best accomplished with mixed androgens as well as the diet.

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