Robert Ritch, MD, FACS Glaucoma pearls from the world’s expert. 10.28.17
It used to be said the one of the biggest fears of many is public speaking. But now as humanity is living longer than ever, the hugest terrors are the fear of going blind.
Glaucoma is a leading cause of irreversible blindness worldwide. But it is greatly misunderstood. It is actually a large number of illnesses, some of the of the eye, and some of them systemic.
Dr. Robert Ritch is a leading glaucoma expert. Dr. Ritch has developed many procedures now in place by glaucoma specialists around the world. He has also defined exfoliation syndrome, which he says many eye doctors are not adequately trained to identify.
Dr. Ritch says that any cogent physician, reading and understanding the literature, must embrace nutritional intervention as much as procedures and medications.
There are diverse forms of glaucoma. Some are eye diseases and some are brain diseases. Some affect mostly the eye site, others affect vulnerability to other diseases.
High-pressure glaucoma is an “eye disease” that makes the internal eye pressure of the eye elevate (intraocular pressure) causing optic nerve damage.
Normal or low-pressure glaucoma is more often a “systemic disease”. It occurs more frequently in thinner women with various attributes: astute sense of smell, tendency to low blood pressure, cold extremities, driven personalities, and tendency to various cardiovascular disease issues that do not necessarily shorten their life span.
Exfoliation syndrome is when pigment comes off (exfoliates) from the iris. The iris gives your eye its color. Blue eyes come from an iris with bluish pigment.
Your iris helps control the diameter and size of the pupil and thus the amount of light reaching your retina. When pigment sloughs off from the iris, it can clog the ability of the eye to drain. Fluid builds up. This increases the inner eye pressure and ultimate can start to damage the optic nerve.
The optic nerve is part of the brain. As it damages, you can loose vision. This is called visual field damage.
· High-pressure glaucoma is an eye disease secondary to elevated eye pressure.
· Normal or low-pressure glaucoma are diseases of the optic nerve that can’t withstand pressure variations or elevations, and often involve brain and whole body health.
Transforming growth factor beta1 (TGFB1) is a protein, called a cytokine, that when elevated, can promote dangerous inflammatory changes, especially within the eye. There are a large body of peer review published data linking elevated TFGB1 to open angle normal pressure glaucoma.
TGFB1 is elevated in both normal pressure glaucoma and exfoliation syndrome patients. It is not often elevated in high-pressure glaucoma. Specific nutrients and herbs have been shown, in peer review science, to normalize TGFB1 levels.When is eye damage the worse? The worst window for eye damage is potentially during the night. Blood pressure tends to lower slightly in all health people as we sleep. But if blood pressure goes too low, or there is sleep apnea present, the eye pressure moves in the opposite direction and dangerously elevates. If this happens, eye damage can be relentless while you sleep.
If you have normal or low tension glaucoma, to avoid nocturnal eye damage, raising the head of the bed by 20% (you can buy sleeping wedges at Bed Bath & Beyond), salt loading before bed with a glass of tomato juice, improve sleep apnea with machines, all which can reduce eye damage while you sleep.
Nocturnal eye damage can be to the optic nerve or to other structures of the eye. It is not limited to the optic nerve. Not many doctors, even eye or sleep doctors, are aware of the huge link between sleeping and eye health.
Sleeping on one side may enhance optic nerve damage in the eye on that side, in glaucoma patients. It’s a good idea for glaucoma patients or high risk patients, to train themselves to sleep on their back.
Nutrients are a must. Dr. Ritch recommends many nutrients such as pigments from flowers that help preserve eye structure thickness, Meriva turmeric, Gingko Biloba, specific minerals like zinc and magnesium, citicholine oil (Italian studies on humans with eye drops with this show reversal of visual field damage but only supplements of this are available in the US), fish oils, and much more.
Nutritional shocking back copy. Dr. Ritch explains how nutrition originally got vilified in medicine (Morris Fishbein was head of the AMA and editor of NEJM for years, and based on greed changed the course of medical history) and it’s a fascinating and sad story.
Dr. Berkson wrote this up in depth in her blog on how health care lost its way. Check it out here: https://drlindseyberkson.com/losing-care-healthcare-medicine-lost-way-especially-regarding-natural-answers-diseases/
Micro-stents. When a glaucoma patient gets cataract surgery, the FDA has approved the placement of micro-stents to stabilize the damaging ups and downs of pressure in the eye. This procedure is reimbursable by Medicare. When a stent is placed at the same time as getting a new lens, then you cannot get corrective laser eye procedures.
This show is a rare opportunity to hear about eye health with a focus on glaucoma from a physician that treats kings and presidents all around the world.
Dr. Robert Ritch holds the Shelley and Steven Einhorn Distinguished Chair in Ophthalmology and is Surgeon Director Emeritus and Chief of Glaucoma Services at the New York Eye & Ear Infirmary of Mount Sinai, New York City and Professor of Ophthalmology. When still a fellow in 1978, he performed the first laser iridotomy in New York and initiated the first course on laser treatment of glaucoma at the American Academy of Ophthalmology. He is a world leader in exfoliation syndrome, which affects 80 million people, and has started a global consortium to work on preventing, reversing, and even curing this disease.
Dr. Ritch has co-authored or edited nine textbooks and over 1800 medical and scientific papers, book chapters, articles and abstracts. He has presented over 750 lectures worldwide, including 50 named lectures and has received over 60 national and international awards and medals.
In 1985, he founded the Glaucoma Foundation and has served as Secretary, Medical Director, and Chairman of the Scientific Advisory Board. In 1994, he initiated the annual Optic Nerve Rescue and Regeneration Think Tank, which has attracted numerous successful researchers from other fields into glaucoma research.