What Doctors Don\'t Tell You: Glaucoma and Arimidex

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Q Some years ago, I was diagnosed with glaucoma and prescribed Teoptic eyedrops. For a few years, I was sent for eye tests, and my eye pressures were checked twice a year. When all that ceased, I thought the specialist had decided I was managing okay.

Meanwhile, I was becoming steadily more and more exhausted. My GP took my pulse and said it was a bit low. My slow pulse gradually but steadily worsened. I was most exhausted at around 52-54 beats per minute. I returned to my GP.

This time, he referred me to a heart specialist - and I was finally told I was taking a beta-blocker. I asked my GP to refer me to the eye man who had recently operated on my 91-year-old mother’s cataracts. He changed my drops to one that didn’t contain a beta-blocker, but this caused reddening of my eyelids. He then changed it again to Travatan, which still causes reddening, but is more convenient, being used only in the evening, though I wake up feeling as if someone has put sand in my eyes. When the new specialist sent me for eye tests, they showed a small loss of field but, after a year on Travatan, this had largely been repaired.

At the end of last year, my pressures were well down into the normal range, and the fields almost perfect. I was also feeling very well in other ways too, having greatly improved my nutritional status.

I asked if I could try a short break from the drops to see if the pressure would rise again. I have just been retested, and my pressures are dangerously high in both eyes. This is very disappointing, and I have had to return to Travatan.

Is there any natural way of reducing eye pressure? I have so enjoyed the break from drops - fewer headaches, no gritty eyes, no Dracula-looking red eyelids. I used Travatan last night for the first time since my break, and have a very severe headache today. No doubt that will settle down after a while, but is there any chance of doing without these unpleasant side-effects? - JA, Cumbria

A Yes. Glaucoma, a leading cause of blindness in the UK, is where eye pressure, due to an obstruction in the outflow of aqueous humor (the liquid inside the eyeball), becomes elevated and eventually damages the optic nerve.

Teoptic (carteolol) is one of a number of beta-blocker-containing eyedrops that has formed the mainstay of glaucoma treatment for most of the last 20 years. They work by stopping the production of the fluid in the eye. Travatan (travoprost) is a prostaglandin and one of the newer glaucoma drugs. Indeed, these standard treatments, which also include corticosteroids, adrenaline and the enzyme inhibitor acetazolamide, can have dangerous and unpleasant side-effects (Proof! vol 3, no 4; Cover Story).

According to our resident homoeopath Dr Harald Gaier, there are several alternatives to relieve your condition. In Ayurvedic medicine, the root of Coleus forskohlii, which contains forskolin, has proved helpful. A double-blind study concluded that a 1-per-cent forskolin solution reduced intraocular (eyeball) pressure when used hourly for six hours as well as after just a single application (S Afr Med, 1987; 71: 570-1).

A Japanese study also found the solution effective, but concluded that more than one application was needed (Jpn J Ophthalmol, 1986; 30: 238-44). A further study of humans and animals showed a 70 per cent reduction in pressure (Lancet, 1983; i: 958-60).

In traditional Chinese herbal medicine, Salvia miltiorrhiza has improved visual acuity in 44 per cent of cases (Chin Med J, 1983; 96: 445-7). What’s more, the effects of treatment (a daily intramuscular injection for 30 days) were were still evident up to 30 months later.

Ginkgo biloba may also be helpful, though the results of available studies are less conclusive (J Klin Monarsbl Augenheilkd, 1980; 177: 577-83).

Perhaps the most controversial herbal remedy for glaucoma is Cannabis (marijuana). Two studies have shown the effectiveness of Cannabis. One found that oral or smoked marijuana reduced intraocular pressure for about four or five hours with 'no . . . deleterious effects . . . on visual function or ocular structure' (JAMA, 1971; 217: 1392). The other found that, in patients who smoked Cannabis for months at a time, intraocular pressure stayed constant, with no deterioration of vision (Braude MC, Szara A, eds, The Pharmacology of Marijuana, 1976: 815-24).

Clearly, the medicinal use of Cannabis is controversial, and smoking it or taking it orally may also bring unwanted tranquillising effects. There has been talk, however, that Cannabis-containing eyedrops could be developed.

Since the eye is mainly made of collagen - the substance which gives strength to body tissues - increasing vitamin C intake may be helpful. Several studies show that vitamin C can both enhance collagen metabolism as well as lower intraocular pressure (Ann Ophthalmol, 1983; 61: 737-41; Acta Ophthalmol, 1969; 47: 685-9; Chin Med J, 1975; 1: 64-8; Eye Ear Nose Throat Monthly, 1967; 46: 1502-8). Additional supplementation with bioflavonoids helps prevent the breakdown of vitamin C and free-radical damage to collagen fibres.

Vaccinium myrtillus (bilberry) extract is particularly rich in flavonoids and can reduce nearsightedness, improve night vision and reverse diabetic blindness (Angiologica, 1972: 9: 355-74; J Biol Chem, 1981; 250: 4494-7; Quart J Crude Drug Res, 1979; 17: 139-96).

Glaucoma is often the result of a nutritional deficiency. Long-term alcohol ingestion, for example, not only destroys vitamin A and other nutrients vital to eye health, but eventually destroys the liver, the storehouse of vitamin A.

An increased protein intake has been found to help eye problems, particularly glaucoma. So, you need to assess your diet for its nutritional content and adjust it and/or take supplements so that your daily intake of protein is at least 60 g/day (if you are a woman) and 70 g/day (if you are a man), plus 10 mg/day of glucose.

You should also increase your daily intake of the following vitamins to: Vitamin A 25,000 IU Vitamin E 500 mg Vitamin C 3 g Vitamin B1 15 mg Vitamin B2 12 mg Vitamin B6 12 mg.

As other nutrients may be necessary, it may be wise to consult a specialist in nutritional medicine, particularly an ophthalmic practitioner who has knowledge of ophthalmic nutritional therapy.

You may also wish to have the ophthalmic practitioner monitor your eyeball pressure since improving your nutritional status may enable you to reduce, if not eliminate, the use of drugs (Proof! vol 2, no 3; Special Report). The normal range of intraocular pressure is 16-22 mmHg, with variations of 3-5 mmHg over the course of a day.