Glaucoma is a disease of the optic nerve involving loss of retinal ganglion resulting in death of the optic nerve cells, which is known as optic neuropathy.
Raised intraoccular pressure is a significant risk factor for developing glaucoma. One person may develop nerve damage at a relatively low pressure, while another person may have high eye pressure for years and yet never develop damage. Untreated glaucoma leads to permanent damage of the optic nerve and resultant visual field loss, which can progress to blindness. From a naturopathic perspective there is a plethora of dietary, lifestyle and supplement and herbal medicine advice that will address the causes of glaucoma, alleviate the symptoms and halt the progression of the disease
Glaucoma is the second leading cause of blindness in the world. Glaucoma affects one in two hundred people aged fifty and younger, and one in ten over the age of eighty. If the condition is detected early enough it is possible to arrest the development or slow the progression with medical and surgical means. In its early stages, glaucoma may produce no symptoms at all, and it's estimated that half of the more than 4 million Americans with glaucoma do not even realise they have it.
Because the vision loss caused by glaucoma comes on so gradually, it is sometimes called the "sneak thief of sight." Often, it's not until the disease is at an advanced stage that the related vision loss becomes apparent and by then damage to sight may be permanent. Symptoms may include pain in or behind the eyeball, headache and sensitivity to pressure. Patchy peripheral vision is sometimes noticed as the nerve cell layer is affected and there is often a loss of contrast sensitivity.
It is important to have regular eye checks to diagnose the disease, as glaucoma is often asymptomatic. A contrast sensitivity test should be performed along with a field test to measure visual loss. A field test has to be performed by an ophthalmologist or optometrist. If any loss of contrast sensitivity is detected an eye specialist consultation is recommended.
The major risk factor for most glaucoma is increased intraocular pressure Intraocular pressure is a function of production of liquid aqueous humor, (the watery fluid) by the ciliary body of the eye and its drainage through the trabecular meshwork. In a healthy eye, the fluid is regularly drained, however in those with glaucoma the drainage system doesn't work properly, so the fluid gradually builds up in your eye, causing increased pressure. Over time, the increased pressure causes the optic nerve fibres to die.
In the most common type of glaucoma, open-angle (chronic) glaucoma, side (peripheral) vision is usually affected first. In the later stages, glaucoma can lead to "tunnel vision," where you can only see straight ahead, and can eventually lead to blindness. The symptoms are gradual and come on very slowly, so you may not realise your vision is being impacted until much later stages.
About 10 percent of those with glaucoma have what's called angle-closure (acute) glaucoma, and in these cases a sudden rise in eye pressure can cause:
- Severe eye pain
- Blurred vision
- Sudden visual disturbances
- Halos around lights
- Reddening of the eye
- Nausea and vomiting
This latter form usually requires immediate treatment.
In open angle glaucoma there is reduced flow through the trabecular meshwork, in angle closure glaucoma, the iris is pushed forward against the trabecular meshwork, blocking fluid from escaping. This increased pressure results in damage to the optic nerve.
Western medical causes of glaucoma
The underlying causes of glaucoma are not completely understood, but typically the damage it does to your optic nerve is related to increased pressure in your eye. The pressure typically comes from a build-up of pressure from the aqueous humour, the watery fluid that is naturally present in your eyeball.
Ocular hypertension (increased pressure within the eye) is the largest risk factor in most glaucomas, but in some populations only 50% of patients with primary open angle glaucoma actually have elevated ocular pressure. 
Though less common, glaucoma can also occur when eye pressure is normal. It appears some people's optic nerves may be sensitive to normal levels of eye pressure, or the glaucoma may be related to problems with blood flow to your eye, which may be caused by atherosclerosis, the accumulation of plaques in your arteries or arteriosclerosis, the decrease in the elasticity of the arteries nourishing the eyes.
Risk factors for glaucoma
Anyone can get glaucoma, but there are factors that increase your risk:
Those of African descent are three times more likely to develop primary open angle glaucoma. People who are older, have thinner corneal thickness, and myopia also are at higher risk for primary open angle glaucoma. People with a family history of glaucoma have about a six percent chance of developing glaucoma. Many Asian groups, such as Mongolian, Chinese, Japanese, and Vietnamese, are prone to developing angle closure glaucoma due to their shallower anterior chamber depth, with the majority of cases of glaucoma in this population consisting of some form of angle closure. Inuit also have a twenty to forty times higher risk than Caucasians of developing primary angle closure glaucoma. Women are three times more likely than men to develop acute angle-closure glaucoma due to their shallower anterior chambers.
Over 60 years old
The risk of glaucoma increases once you are over 60.
Diabetes, high blood pressure, heart disease and hypothyroidism all increase your risk. Conditions that severely restrict blood flow to the eye, such as severe diabetic retinopathy and central retinal vein occlusion (neovascular glaucoma); A number of studies also suggest that there is a correlation, not necessarily causal, between glaucoma and systemic hypertension (i.e. high blood pressure). In normal tension glaucoma, nocturnal hypotension (low blood pressure at night) may play a significant role.
If someone in your family has glaucoma, it may increase your risk.
Eye injury and nearsightedness
Eye injuries such as retinal detachment, eye tumours, eye inflammations and eye surgery, as well as nearsightedness, increase your risk.
Use of corticosteroids
Other factors can cause glaucoma, known as "secondary glaucomas," including prolonged use of steroids (steroid-induced glaucoma).
Ocular trauma (angle recession glaucoma); and uveitis (uveitic glaucoma).
Vitamin Deficiencies A, betacarotene, lutein, EFAs for eyes, Zinc, Chromium, Magnesium, B vitamins to prevent diabetes.
Alpha lipoic acid also improves insulin sensitivity. The herbs cinnamon and gymnema sylvestra have also been shown to improve insulin sensitivity.
Western medical treatment of glaucoma
Conventional medicine's solution to glaucoma is typically drugs or surgery, or a combination of them. Often eye drops are given to glaucoma patients to use for life in an attempt to lower pressure inside of their eyes, but they come with an array of side effects including:
- Blurred vision
- Respiratory problems
- Lowered heart rate
- Burning or stinging in the eyes
Surgery also carries with it serious risks, among them an increased risk of cataracts.
Commonly used medications
- Medicinal Marijuana
- Prostaglandin analogs like latanoprost (Xalatan), bimatoprost (Lumigan) and travoprost (Travatan) increase uveoscleral outflow of aqueous humor. Bimatoprost also increases trabecular outflow
- Topical beta-adrenergic receptor antagonists such as timolol, levobunolol (Betagan), and betaxolol decrease aqueous humor production by the ciliary body.
- Alpha2-adrenergic agonists such as brimonidine (Alphagan) work by a dual mechanism, decreasing aqueous production and increasing uveo-scleral outflow.
- Less-selective sympathomimetics like epinephrine and dipivefrin (Propine) increase outflow of aqueous humor through trabecular meshwork and possibly through uveoscleral outflow pathway, probably by a beta2-agonist action.
- Miotic agents (parasympathomimetics) like pilocarpine work by contraction of the ciliary muscle, tightening the trabecular meshwork and allowing increased outflow of the aqueous humour.
- Carbonic anhydrase inhibitors like dorzolamide (Trusopt), brinzolamide (Azopt), acetazolamide (Diamox) lower secretion of aqueous humor by inhibiting carbonic anhydrase in the ciliary body.
- Physostigmine is also used to treat glaucoma and delayed gastric emptying.
Natural compounds for glaucoma
Natural compounds of research interest in glaucoma prevention or treatment include: fish oil and omega 3 fatty acids, bilberries, vitamin E, cannabinoids, carnitine, coenzyme Q10, curcurmin, Salvia miltiorrhiza, dark chocolate, erythropoietin, folic acid, Ginkgo biloba, Ginseng, L-glutathione, grape seed extract, green tea, magnesium, melatonin, methylcobalamin, N-acetyl-L cysteine, pycnogenols, resveratrol, Quercetin and salt .    Magnesium, ginkgo, salt and fludrocortisone, are already used by some physicians.
Cannabis for glaucoma
Cannabis Studies in the 1970s showed that marijuana, when smoked, effectively lowers intraocular pressure.In an effort to determine whether marijuana, or drugs derived from marijuana, might be effective as a glaucoma treatment, the US National Eye Institute supported research studies from 1978 to 1984. These studies demonstrated that some derivatives of marijuana lowered intraocular pressure when administered orally, intravenously, or by smoking, but not when topically applied to the eye. Many of these studies demonstrated that marijuana - or any of its components - could safely and effectively lower intraocular pressure more than a variety of drugs then on the market. In 2003 the American Academy of Ophthalmology released a position statement which said that "studies demonstrated that some derivatives of marijuana did result in lowering of IOP when administered orally, intravenously, or by smoking, but not when topically applied to the eye. The duration of the pressure-lowering effect is reported to be in the range of 3 to 4 hours". 
Peripherally selective 5-HT2A agonists such as the indazole derivative AL-34662 are currently under development and show significant promise in the treatment of glaucoma.  Serotonin has an action on the veins and arteries to increase vasodilatation and thereby increase blood flow. These in an exciting an interesting theory whereby the causes of eye disease are actually the same as the causes of migraines, where they also have success in treatment using serotonin agonists. Certain foods are known to cause vasoconstriction resulting in rebound vasodilatation of the arteries. In the same way this can result in headaches, it can also cause damage to the tiny blood vessels feeding the eyes, resulting in many eye disease. There are natural ways to increase serotonin also including the administration of 5 hydroxy tryptophan (5HTP), zinc, mg and B6 and St John's Wort is a well know serotonin agonist which means it increases serotonin. A reduction in vasoactive amines mainly cheese, chocolate and red wine and oranges may also be implicated.
Naturopathic treatment of glaucoma
Natural ways to lower intraoccular pressure
The same lifestyle changes that lower blood pressure typically also work to lower your eye pressure, thereby helping to prevent and even treat glaucoma without a risk of side effects.
The treatment principals are:
Lower your insulin levels
As your insulin levels rise, it causes your blood pressure, and possibly also your eye pressure, to increase. In time this can cause your body to become insulin resistant, and studies show insulin resistance, which is common in people with diabetes, obesity and high blood pressure, is linked to elevated eye pressure. The solution is to avoid sugar and processed grains.
- Light weight breads
- White Rice
- Processed Breakfast Cereals
- Potatoes especially without the skins
One of the most effective ways to lower your insulin levels is through exercise. A regular, effective exercise program consisting of aerobics, sprint-burst type exercises, and strength training can go a long way toward reducing your insulin levels and protecting your vision.
Other Tips to Keep Your Vision Healthy
As part of your overall program to keep your eyesight clear and problem-free, even as you age, make sure you are doing the following:
Nutritional supplements for glaucoma
Omega-3 fat supplement
A type of omega-3 fat called docosahexaenoic acid (DHA) may help protect and promote healthy retinal function. DHA is concentrated in your eye's retina and has been found to be particularly useful in preventing macular degeneration, the leading cause of blindness. Omega-3 fat, including DHA, are found in tuna, herring, sardines, mackerel, flax oil and walnuts.
Lutein and zeaxanthin
These fat soluble antioxidnats are incredibly important for your eyesight. Lutein, which is a carotenoid found in particularly large quantities in green, leafy vegetables, acts as an antioxidant, protecting cells from free radical damage.
Some excellent sources include kale, tomatoes, spinach, broccoli, brussels sprouts and egg yolks, particularly raw egg yolks. Egg yolks also have zeaxanthin, another carotenoid, in an equal amount to lutein. Zeaxanthin is likely to be equally as effective as lutein in protecting eyesight. It is important to note that lutein is an oil-soluble nutrient, and if you merely consume the above vegetables without some oil or butter you can't absorb the lutein. So make sure you're eating some healthy fat along with your vegetables.
Avoiding trans fats
Trans fat may interfere with omega-3 fats in your body, which are extremely important for your eye health. A diet high in trans fat also appears to contribute to macular degeneration. Trans fat is found in many processed foods and baked goods, including margarine, shortening, fried foods like chips, fried chicken and doughnuts, cookies, pastries and crackers.
Eating dark-coloured berries
The European blueberry, bilberry, is known to prevent and even reverse macular degeneration, and bioflavonoids from other dark-coloured berries including blueberries, cranberries, raspberries and cherries will also be beneficial. They work by strengthening the capillaries that carry nutrients to eye muscles and nerves.However, because berries contain natural sugar they should be eaten with walnuts and porridge to keep insulin levels low.
Herbal medicine for glaucoma
This tincture contains a blend of herbs known as opthamlics that treat eye diseases. The herbs are specifically rich in Vitamin A, caretenoids and anthocyanidins. Anthocyanidins, are antioxidants that neutralise free radical damage to the collagen matrix of cells and tissues that can lead to cataracts, glaucoma, varicose veins, haemorrhoids, peptic ulcers, heart disease and cancer. The herbs have been shown in numerous studies to improve night time visual acuity and promote quicker adjustment to darkness and faster restoration of visual acuity after exposure to glare. Ideal for pilots!
Carina Harkin BHSc.Nat.BHSc.Hom.BHSc.Acu.
 Sommer A, Tielsch JM, Katz J, et al (August 1991). "Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. The Baltimore Eye Survey". Arch Ophthalmol. 109 (8): 1090-5.
 Wang N, Wu H, Fan Z (November 2002). "Primary angle closure glaucoma in Chinese and Western populations". Chin Med J. 115 (11): 1706-15. PMID 12609093.
 Ritch R (June 2007). "Natural compounds: evidence for a protective role in eye disease". Can J Ophthalmol. 42 (3): 425-38.
 Tsai JC, Song BJ, Wu L, Forbes M (September 2007). "Erythropoietin: a candidate neuroprotective agent in the treatment of glaucoma". J Glaucoma 16 (6): 567-71.
 Mozaffarieh M, Flammer J (November 2007). "Is there more to glaucoma treatment than lowering IOP?". Surv Ophthalmol 52 (Suppl 2): S174-9.
 American Academy of Ophthalmology. Complementary Therapy Assessment: Marijuana in the Treatment of Glaucoma.. Retrieved September 30, 2008.  Complementary Therapy Assessments : American Academy of Ophthalmology
 Irvin Rosenfeld and the Compassionate IND - Medical Marijuana Proof and Government Lies
 Sharif NA, Kelly CR, Crider JY, Davis TL (December 2006). "Serotonin-2 (5-HT2) receptor-mediated signal transduction in human ciliary muscle cells: role in ocular hypotension". J Ocul Pharmacol Ther 22 (6): 389-401.
 Sharif NA, McLaughlin MA, Kelly CR (February 2007). "AL-34662: a potent, selective, and efficacious ocular hypotensive serotonin-2 receptor agonist". J Ocul Pharmacol Ther 23 (1): 1-13.
 MayoClinic Glaucoma