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Diet, Exercise and Nutrition

Is there a way to reduce the side effects of medications, such as by a special diet?

A: According to some of my patients, oral carbonic anhydrase inhibitors are better tolerated if taken with a glass of milk about 20 minutes before meals or bedtime. A number of years ago, sodium bicarbonate was reported also to reduce the side effects of oral carbonic anhydease inhibitors. Side effect of eye drops can be reduced by appropriate nasolacrimal occlusion (finger pressure over the tear duct after taking the drops). I do not know of any other means of reducing this column has any suggestions, I would be happy to hear them.

Are there any water restrictions for patients with glaucoma?

Q: Are there any water restrictions for patients with glaucoma? One doctor told me I may only drink 1 cups of water in any three hour period; another told me there were no water restrictions. Please advice me as to which is correct.
A: It was formerly believed that too much liquid could raise intraocular pressure. This is only true of your drink a quart in about 15 minutes or less. Otherwise, don't worry about it. Drink and be happy!

Do nutrition and exercise affect glaucoma?

A: A healthy diet coupled with a daily routine of exercise is a good prescription for everyone interested in good health. But remember, every patient is different. Before making any drastic change in your diet, it is wise to communicate that intention to your doctor and discuss the pros and cons. The same advice is true for embarking on a new exercise program. While studies show that aerobic exercise can lower intraocular pressure, other forms of exercise can increase pressure. So, if you're a glaucoma patient, it's especially important to check with your doctor before making any lifestyle changes. Such changes could have an impact on the test results your doctor relies on to evaluate the success of your treatment plan. You can find a helpful discussion of diet and glaucoma in "Coping with Glaucoma," by Edith S. Marks (Avery-Putnam-Penguin, 1997).

Can caffeine affect intraocular pressure (IOP)?

A: For years it was thought that caffeine had no affect on IOP, except in rare instances. Now, with the concept of non-pressure dependant factors such as constriction of the veins or arteries and ocular blood flow), the question is being debated again, since caffeine can affect blood flow. There is no conclusive answer, but too much caffeine is not recommended - especially if you have cardiovascular problems or migraines.As always, only a doctor who examines your eyes can determine the most appropriate treatment for you or answer questions about your specific condition. If you remain unsure or uncomfortable with your options, we recommend seeking a second opinion.

I take 2250 mg of niacin a day. Does niacin raise intraocular pressure?

A: No.

Does exercise lower intraocular pressure?

A: Aerobic exercise can lower intraocular pressure for a time. However, other forms of exercise can increase the pressure. You should check with your eye doctor before starting any exercise program.

Besides taking your medication and keeping yourself as healthy as possible, is there anything significant a person with glaucoma could be doing?

Q: Besides taking your medication and keeping yourself as healthy as possible, is there anything significant a person with glaucoma could be doing? Emotionally this medical condition is very draining. Not really knowing what the future may hold can be hard to deal with at certain times. Can you offer any hope of future medications, treatments and maybe even a cure in the not-so-distant future? Anything you could suggest as far as handling this medical condition would be help.
A: Until recently, my answer would have been that taking your anti-glaucoma medications rigorously is really the only way to slow down or prevent worsening of the visual damage. However, some very interesting facts have been coming to light and I believe our knowledge of these other factors is going to increase markedly in the next few years.
  Back in 1981, a study by Dr. Ivan Goldberg, now of Sydney, Australia, and his colleagues showed that patients with normal tension glaucoma who were sedentary had more rapid progression of their disease than patients who exercised. Aerobic conditioning appears to increase blood flow to the eye (as do calcium channel blockers). Researchers in Portland, Oregon have shown that aerobic conditioning can lower your baseline intraocular pressure and a further, transient lowering occurs on an acute basis with exercise. A study in Japan has shown that obesity is a very important factor in the progression of glaucomatous damage, parallel to what we already know in association with diabetes and hypertension. Some patients with glaucoma may be worsened by smoking. There is increasing evidence, although as yet no proof, that high dose antioxidants may also be of some benefit in at least some patients with glaucoma. How significant all of these factors are and how much their impact is compared to medications remains to be established.
  New medications and treatments are under development all the time. Glaucoma is not one single disease but really is an end stage. It is a particular pattern of optic nerve damage and visual field damage caused by a number of different diseases which affect the eye. Most of these diseases, but not all of them, are associated with elevated intraocular pressure which is the most important risk factor, but still only a risk factor, for glaucomatous damage. Intraocular pressure is not the disease itself. Some of these diseases are hereditary and some are acquired. We have a great deal to learn about the causes of most of these diseases, but the more we learn, the more specifically they can be treated and the sooner a cure can be developed. Certainly today, the outlook is far, far better for patients with glaucoma than it was even a few years ago.


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Glaucoma Associates
of New York

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