Proactive glaucoma care: Steps to protect your optic nerve

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Glaucoma Melbourne

If you are at risk for glaucoma, what steps can you take to protect your optic nerve from being damaged?

Proactive glaucoma care Melbourne

What is proactive glaucoma care?

“Proactive glaucoma care” is a term I came up with to describe the concept of proactively managing your glaucoma risk.

Similar to proactively managing dental issues, where dentists give patients strategies to prevent further damage to their teeth, it’s my job as an ophthalmologist and glaucoma specialist to provide advice on how best to look after your vision and eye health.

First, I will explain what neuroprotection is and why it is important.

What is neuroprotection in glaucoma?

Glaucoma occurs when high eye pressure causes progressive damage to your optic nerve, resulting in irreversible vision loss. Medical and surgical management of glaucoma focuses on lowering your eye pressure to reduce the risk of vision loss from glaucoma.

Neuroprotection, which literally means ‘nerve protection’, focuses on the steps you can take to protect your optic nerve from being damaged, independent of your existing treatments to control eye pressure.

“Protection for your optic nerve is at the heart of what proactive glaucoma care is all about. In other words, managing your glaucoma risk through diet and lifestyle changes, in addition to any existing treatments.”

Let’s take the example of age-related macular degeneration (AMD). When we see patients with early signs of AMD, we proactively tell them to wear UV-protection sunglasses, stop smoking, and eat a healthy diet.

However, the current practice when we see glaucoma suspect patients is to ask them to come back in a year to re-evaluate and see if their condition has progressed.

“This is a reactive approach, where we only act when there is progression. We can do better than that. If you are a glaucoma suspect, it means you are at higher risk. We should proactively manage this risk to reduce the likelihood of progression to glaucoma.”

Similar to AMD, when we suspect glaucoma, we need to tell people to cut down on smoking, eat a healthy and balanced diet, and do more exercise and meditation.

Who is at higher risk for glaucoma?

It is important to be aware of your risk of glaucoma. When there is a family history of glaucoma, you are at a higher risk than others who don’t have glaucoma in their family. Other risk factors include
  • Previous ocular trauma
  • Prolonged use of steroid medication
  • Known high eye pressure
The higher your risk, the earlier you should start having annual eye checks. For example, if you have a strong family history of glaucoma and you are taking steroid medications for another health condition, your risk is quite high and you may want to start annual checks from the age of 40. On the other hand, if your risk is low because you only have low myopia or nearsightedness as a risk factor, then it is probably reasonable to start annual checks from age 60 onwards.
proactive glaucoma melbourne

Natural remedy glaucoma

We don’t have to wait until progression occurs

Many patients have asked me if glaucoma can be cured or reversed. Unfortunately, there is no cure for glaucoma nor can it be reversed. However, there are proactive steps you can take now to prevent and reduce your risk of glaucoma.

Studies confirm that

  • Smoking is associated with higher eye pressure and increased risk of glaucoma,
  • The intake of vegetables and fruit significantly reduces the odds of glaucoma risk by 47% to 79%,
  • Increased moderate physical activity lowers eye pressure and slows down the rate of glaucomatous field loss,
  • Mindfulness meditation reduces eye pressure and improves the quality of life

“My personal observation is that the overwhelming majority of patients want information on natural ways to reduce their glaucoma risk. That is why we should discuss these lifestyle and diet changes with them given that there are more upsides than downsides.”

It is clear that stopping smoking, eating a healthy diet, performing more exercise, and meditating all contribute towards reducing glaucoma risk.

Quit smoking and avoid cigarette smoke

We all know that smoking is bad for us and the images we see on cigarette packages often refer to lung disease. But smoking is also really bad for your eye health. Smoking increases eye pressure, and increases the risk of glaucoma by nearly twofold. For macular degeneration, the risk is increased by up to threefold. Quitting smoking is the singular most important thing you can do to support your eye health and reduce glaucoma risk.

Eat a healthy and balanced diet

A healthy diet is important for your general health and definitely for maintaining overall eye health. Make sure to include foods that contain plenty of antioxidants such as vitamin C, vitamin E, vitamin A and zinc. Here are some examples of foods that I recommend eating more of:

  • Vitamin C: berries, citrus fruits, tomatoes
  • Vitamin E: avocados, leafy greens, fish
  • Vitamin A: carrots, apricots, papayas
  • Zinc: whole bran, eggs, peanuts

Equally important are foods to avoid. These are:

  • Highly processed and packaged foods containing artificial chemicals and additives that cause inflammation and have little nutritional value.
  • Foods that are high in carbohydrates, especially those with a lot of added sugar.

Exercise regularly

Research suggests that aerobic exercise 3 times a week for at least 30 to 45 minutes each time is able to reduce eye pressure by around 20% on average. Going out walking and aiming for an additional 5,000 steps per day, or performing an extra two to three hours of non-sedentary activity daily, could reduce the rate of vision loss from glaucoma by around 10%.

Meditate to reduce eye pressure

A randomised clinical trial from India has confirmed that mindfulness meditation practised for 1 hour every day for 3 weeks* significantly reduced eye pressure, decreased stress levels, and improved quality of life. Whilst many of us don’t have the luxury (or patience) to meditate for that long, 15-20 mins daily meditation is better than none.

*At the same time continuing with the prescribed glaucoma medications

Glaucoma supplements

Nutraceutical supplements for glaucoma

There is increasing evidence for nutraceutical supplements for glaucoma neuroprotection, in addition to the standard medical treatment to reduce eye pressure. This is because glaucoma can still occur despite low eye pressures.

Among supplements for neuroprotection that have been researched, ginkgo biloba extract and nicotinamide are probably the two that stand out the most. Other supplements that have been evaluated in clinical trials include bilberry, saffron, and methylcobalamin.

The concept of taking supplements for neuroprotection makes sense to both glaucoma and glaucoma suspect patients, particularly those who are at higher risk. Additionally, most of the supplements are already available over the counter in dosages that have been clinically found to be safe.

Having said that, it is always a good idea to discuss with your healthcare professional first prior to taking any supplements. This is especially relevant if you have any existing health conditions or are taking medications.

“We should proactively discuss supplements with our patients if they are open to it. Arm them with clear, unbiased information about the potential risks and benefits, and empower them to make their own decision based on their health circumstances.”

Critics will say there is no evidence to support this proactive glaucoma care approach. However, there is already enough evidence to warrant open two-way discussions with patients. We do not have to wait for the perfect evidence to be published first before we educate patients about proactively managing their glaucoma risk.

Acting in the best interests of our patients should be at the core of our clinical practice. In my opinion as a glaucoma suspect myself, just waiting passively for glaucoma progression to occur is not good practice – proactive glaucoma care management is.

Glaucoma Melbourne cost

Another reason to promote proactive glaucoma care management: cost

The burden of glaucoma in Australia is rising, affecting almost 200,000 non-indigenous Australians over age 50 and over 2,000 indigenous Australians over age 40.

Glaucoma is estimated to cost Australia $4.3 billion every year by 2025, as a result of an ageing population. Approximately 10% of Australians over the age of 40 are considered to be at risk of glaucoma. Of these, around 12.5% will go on to develop glaucoma within the standard two-year interval for routine eye examinations.

If we are able to prevent or delay the development of glaucoma through proactive glaucoma care management, this could potentially lead to substantial cost savings for the government and also for the affected patients too.

It is difficult to be able to calculate the exact cost savings for the government and health system without detailed financial and economic modelling.

For the patient, the cost savings of not having glaucoma come from reduced need for medications, visits to the eye specialist, time taken off work, potential risk of undergoing surgery, and progressive vision loss (affecting ability to work, drive, earn income, and live independently).

It is very clear: nothing can be more expensive than losing your vision.

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I operate at multiple locations in and around Melbourne.

  • Royal Victorian Eye & Ear Hospital, East Melbourne
  • St Vincent’s Hospital, Fitzroy
  • Sunshine Private Day Surgery, St Albans
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  • Footscray Day Surgery

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What patients appreciate about Dr Brian Ang

Patients like the fact that my explanations are clear, concise, and easy to understand. I make sure that I provide enough relevant information so that patients can make the best informed decisions based on their own circumstances. What I will not do is to pressure patients into making decisions that they are not comfortable with. Instead I will respect and support your decisions as we work together to achieve the best clinical outcomes for your eyes.