dave's blog

Marketing messages teach us to look for solutions in the form of a pill or an easy fix. Glaucoma taught me that this brand of alternative medicine is fundamentally equal to allopathic medicine. In fact, the business model is identical and many of the same pharmaceutical companies are behind the "natural" supplements and the allopathic drugs. (The mindset is also nearly identical -- it is the mindset of looking for a solution without fundamentally changing ourselves.)

I carefully tested high levels of vitamin C over a number of years. Vitamin C was actually the first thing I focused on after being diagnosed with glaucoma. I used it before beginning self-tonometry and I continued for several years after starting self-tonometry.

In those first two years (before self-tonometry) the vitamin C did not prevent my glaucoma from progressing. And I found out after I got a tonometer that it did not reduce my IOP.  I used 30 grams per day while testing its effect on my IOP. My IOP is lower today on zero vitamin C (as a result of the knowledge I gained from self-tonometry).

The reason it is important to focus on IOP is because it is the only treatable risk factor for glaucoma. And it is very important to have metrics. No matter what we are doing (vitamins, diet, etc.), we need to have some way to measure the results.

And the wisely empirical approach advocated by FitEyes does often involve testing one element at a time. That's the way we make discoveries and progress past ignorance. Unlike almost any other patient support group in the world, FitEyes has a track record of discovering new knowledge. (We discovered and documented white coat ocular hypertension, for example.) That's why this is a research community at its core.

surely its perfectly normal for eye pressure to go up under certain circumstances. Just like our bp goes up and down. anne

We now know that intraocular pressure does respond to events in our lives, to our state of mind and emotions and to stress. However, before FitEyes came along in 2006 (and for several years afterwards) these facts were not recognized.

See this FitEyes article from Feb 2007:

http://fiteyes.com/Does-Stress-Increase-Eye-Pressure-For-Everyone

The standard medical opinion is that stress does not affect eye pressure (intraocular pressure). For example, see "Glaucoma - Frequently Asked Questions" at The Eye Institute states:

"As far as we know, stress does not affect eye pressure or the health of the optic nerve."

Another example of the prevailing medical opinion can be found in a Wills Glaucoma chat transcript on Stress and Glaucoma from July 20, 2005:

Patient:  Does being nervous or stressed increase the IOP (intraocular pressure) as it does blood pressure?

Dr. Elliot Werner:  Not as far as we know.

Even today many ophthalmologists will deny that stress affects intraocular pressure. They will further deny that non-stressful events such as Bailey described could affect eye pressure.

I learned about emotions and eye pressure, in part, by watching my favorite sports and measuring my eye pressure over a period of years. See Watching Tour de France Raises IOP. 

Here is what I discovered after monitoring my eye pressure before, during and after watching sports over a period of several years.

• If you watch a sports event that you don't care about at all, it has almost no effect on your eye pressure.
• If you watch a sports event where your ego is caught up in the outcome of the event (i.e., you are attached to an outcome, such as your team should win) the excitement will raise your IOP.
• If you watch a sports event where you appreciate the action, enjoy the skill of the participants, etc. and are not attached to the outcome, your intraocular pressure will be largely unaffected.

 A Novel Nitric Oxide Releasing Prostaglandin Analog, NCX 125, Reduces Intraocular Pressure in Rabbit, Dog, and Primate Models of Glaucoma

Abstract

Purpose: Nitric oxide (NO) is involved in a variety of physiological processes including ocular aqueous humor dynamics by targeting mechanisms that are complementary to those of prostaglandins. Here, we have characterized a newly synthesized compound, NCX 125, comprising latanoprost acid and NO-donating moieties.

Methods: NCX 125 was synthesized and tested in vitro for its ability to release functionally active NO and then compared with core latanoprost for its intraocular pressure (IOP)-lowering effects in rabbit, dog, and nonhuman primate models of glaucoma.

Results: NCX 125 elicited cGMP formation (EC50 = 3.8 ± 1.0 μM) in PC12 cells and exerted NO-dependent iNOS inhibition (IC50 = 55 ± 11 μM) in RAW 264.7 macrophages. NCX 125 lowered IOP to a greater extent compared with equimolar latanoprost in: (a) rabbit model of transient ocular hypertension (0.030% latanoprost, not effective; 0.039% NCX 125, ∆max = −10.6 ± 2.3 mm Hg), (b) ocular hypertensive glaucomatous dogs (0.030% latanoprost, ∆max= −6.7 ± 1.2 mm Hg; 0.039% NCX 125, ∆max = −9.1 ± 3.1 mm Hg), and (c) laser-induced ocular hypertensive non-human primates (0.10% latanoprost, ∆max = −11.9 ± 3.7 mm Hg, 0.13% NCX 125, ∆max = −16.7 ± 2.2 mm Hg). In pharmacokinetic studies, NCX 125 and latanoprost resulted in similar latanoprost-free acid exposure in anterior segment ocular tissues.

Conclusions: NCX 125, a compound targeting 2 different mechanisms, is endowed with potent ocular hypotensive effects. This may lead to potential new perspectives in the treatment of patients at risk of glaucoma.

I'd like to ask everyone with a tonometer and good eye pressure data to contribute comments to this post. What factors have we identified that affect eye pressure? I'm going to start the list informally with things that come off the top of my head. I'll revise and refine this list based on feedback from people with tonometers and good data. Thank you!

Reduces Eye Pressure

My original expectation was that elevated intraocular pressure would respond to herbs (and vitamins) in the same way every other physical complaint I had encountered in my life responded.

My initial strategy for managing my IOP was a strategy built on herbs and supplements. That strategy was a complete 100% total failure.

The entire following blog post was intially written as a private email to a friend of mine. I decided to share it here.

I grew up doing fast things in a fast way. I raced motorcycles -- and I have always loved anything fast. But I also tried to accomplish the maximum possible number of things each day and I always pushed myself to do things quicker or more efficiently. Then I developed glaucoma.

As I have gotten to know myself more intimately (thanks in part to self-tonometry) I have realized that I actually like to take my time. I enjoy doing things in a non-rushed manner. You could even say that I enjoy being slow! (Something I never would have admitted to myself in my days of racing, even in my most private thoughts.) Even today, I still have a great admiration for people who do things quickly, as if this is an inherently superior way of being.

But I now know that I like to take my time doing things. I still enjoy efficiency. But sometimes it is more efficient to delay the next project's start and finish what was started rather than have to terminate it due to an artificial deadline and then pick it up again at a later time. I like going deep into things (whether discussions, research or building software) and having the time to do it well. And I have found that sometimes I even enjoy doing something in a completely inefficient manner (saying that still sounds sacrilegious). Sometimes I enjoy just plain being slow! (What have I just said! My gosh!)

PURPOSE. Several reports have demonstrated an association between glaucoma and obstructive sleep apnea (OSA), though the origin of this association remains unknown. In the present study, the influence of OSA and continuous positive airway pressure (CPAP) therapy on intraocular pressure (IOP) and ocular perfusion pressure (OPP) was examined.

METHODS. IOP, blood pressure, and pulse rate were measured every 2 hours during 24-hour sessions in 21 patients with newly diagnosed OSA. A first series of measurements was performed before CPAP therapy, and a second series was performed 1 month after the initiation of CPAP therapy. OPP was then calculated.

A lot of new people are joining our group for home eye pressure monitoring (self-tonometry). Please allow me to welcome all the new users and share a few thoughts about what to do when your new tonometer arrives.

It is always best to leave the job of making judgments about your eye pressure -- in the context of your health care -- to your doctor. This is not just a disclaimer!

Part of the skill of managing your eye pressure effectively is to not think about it the way a doctor would. If you think there is a medical emergency, by all means call your doctor. But in general the best thing you can do is measure as often as possible and do everything you can to avoid playing doctor.

Do not diagnose your own intraocular pressure. Don't think about what it may mean in terms of glaucoma. This is a powerful skill, not a cop out. This is a powerful skill because we have strong evidence that one's state of mind affects one's eye pressure. You will begin to see evidence of this when you start monitoring your eye pressure.

The effect of oral magnesium therapy on visual field and ocular blood flow in normotensive glaucoma

Note these conclusions! Also note that Josef FLAMMER, Professor and Head, Department of Ophthalmology, University Hospital Basel (Switzerland), recommends magnesium supplementation (so I am told).

Purpose. To evaluate the effect of oral magnesium therapy on ocular blood flow and visual field perimetry indices in patients with normotensive glaucoma (NTG).

My evaluation Icare ONE tonometer arrived today. I will compare it to:

    * Icare TA01i
    * Reichert 7CR Tonometer
    * Pascal Dynamic Contour Tonometer
    * Ocular Response Analyzer
    * Reichert AT555 Tonometer
    * maybe another one or two tonometers...

Look for a full review in the near future on FitEyes.com. UPDATE: I have decided not to publish my review of the Icare ONE at this time. Please read Are handheld or portable tonometers appropriate for home eye pressure monitoring?

Let me offer an analogy. If I were reviewing golf clubs, I would not include a review of a baseball bat. A baseball bat is not appropriate for playing golf. During the process of evaluating the Icare ONE, I came to a broader conclusion about all handheld tonometer and their appropriateness for self-tonometry (home eye pressure monitoring). Therefore, I feel it is better to have that general discussion first. You can read my thoughts here: Are handheld or portable tonometers appropriate for home eye pressure monitoring?

There is a related discussion on the Icare ONE here: New iCare ONE Tonometer Designed for Home Eye Pressure Monitoring

For now, here are some pictures of my evaluation Icare ONE tonometer.

Just arriving via FedEx (below). Some tonometers it will be evaluated against are shown in the background.

Cure for glaucoma soon, says new research
newkerala.com/nkfullnews-1-125456.html

October 6th, 2009 SindhToday
Toronto, Oct 6 (IANS) Cure for glaucoma which leads to blindness may be on its way.

Canadian researchers have discovered an unidentified form of circulation in the human eye which may provide important clues to glaucoma.

The human eye is considered to lack lymphatics – a circulation responsible for pumping fluid and waste out of tissues.

But now researchers at the Universityof Toronto and the local St Michael’s Hospital say the inability to clear that fluid from the eye is linked to glaucoma which currently affects over 66 million people worldwide.

A research study presented as a "poster" at ARVO 2010 indicated that the position of one's head (and body) during sleep can have an effect on intraocular pressure. For example, your eye pressure may be lower if you sleep on your back compared to sleeping on your side. (Furthermore, in my own experience, sleeping on your stomach may be the worst for IOP.)

Not discussed in this particular study was any difference in intraocular pressure between eyes. There is some evidence that if you sleep on your left side, intraocular pressure in the left eye could be higher.

It has come to my attention that a number of people are reading the headline from our discussion about eggplant and intraocular pressure and coming to a conclusion without actually reading the article. That's not a good idea in this case.

Please read the article and the comments. Here's the link: Eating eggplant reduces eye pressure

Here's what one well-respected ophthalmologist told his patient in response to her inquiry about starting home eye pressure monitoring.

I am reading this study now. I like the fact that they did investigate ocular perfusion pressure (OPP) while monitoring the intraocular pressure (IOP) during this study, and that they checked IOP in the sleeping position (rather than sitting the patient up). So, with a quick glance, the methodology looks acceptable to me.

Purpose: To determine whether a 30-degree head-up sleeping position decreases nocturnal intraocular pressure (IOP) compared with lying flat in patients with glaucoma.

Recently here on FitEyes, readers have asked about the relationship between intraocular pressure about meditation. That prompted me to write this post about some of the broader spiritual aspects of what I do as well as how I view intraocular pressure in my own life and in my work as a Serene Impulse teacher.