Glaucoma Abstracts 9

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Relief for retinal neurons under pressure.
            (Crowston and Trounce, 2017) Download
On page 756 of this issue (Science 2017), Williams et al. (1) report substantial advances toward filling these gaps by identifying nicotinamide adenine dinucleotide (NAD+) decline as a key age-dependent risk factor and showing that restoration with long-term dietary supplementation or gene therapy robustly protects against neuronal degeneration.

Improvement in Vision Parameters for Participants Treated With Alternative Therapies in a 3-day Program.
            (Kondrot, 2015) Download
CONTEXT:  Eye conditions that are considered progressive and degenerative and for which the causation is generally poorly understood or not understood within conventional medicine can respond to natural therapeutic interventions that result in arrest and/or improvement of morbidity, with enhanced functional results. Because many of the treated conditions are age related, a delay of disease progression for 5 or even 10 y can mean an additional decade of independence for seniors. The 11 included ocular conditions are ordinarily considered incurable by any method except surgery and, even with surgery, the outcomes can be variable and/or transient. OBJECTIVE:  The research intended to demonstrate the effectiveness of alternative modalities-intravenous (IV) nutrition, oxidative therapy, microcurrent stimulation, and syntonic light therapy-in improving vision in chronic eye conditions, even when administered for a short period. DESIGN:  The study was a retrospective, open-label, single-group design. All participants in the 3-d conference during the period covered were selected. SETTING:  The setting was ophthalmologist Edward Kondrot's Healing the Eye and Wellness Center near Tampa, FL, USA. PARTICIPANTS:  The participants in this study were all patients attending 1 of 11 CAM treatment events at the author's center within 2 y. Each session lasted 3 d and the number of participants in each session ranged from 5-15 (mean = 13). The cohort numbered 152 patients who were diagnosed with ≥1 of 11 types of eye disease. Seventy-eight percent of the patients had either age-related macular degeneration (ARMD) or glaucoma, which, taken together, are the leading cause of blindness in persons >65 y. INTERVENTION:  Each of 4 alternative modalities was provided at least once to each participant: (1) IV nutrition, (2) oxidative therapy, (3) microcurrent stimulation, and (4) syntonic light therapy. On the first day, a detailed treatment plan for each participant was developed. Each day consisted of 2 therapeutic eye programs, a stress reduction program, and a detoxification program. Also included were daily lectures and instructions on the methods and use of the equipment. OUTCOME MEASURES:  To measure outcomes, changes from baseline were documented through comparison with postprogram results. Pre- and postprogram testing included the following measures: (1) Early Treatment Diabetic Retinopathy Study (ETDRS) eye chart; (2) Lighthouse Letter Contrast Sensitivity test; (3) campimetry; (4) pursuits, saccade, and fixation tests; (5) pupillary examination; (6) external examination; (7) examination of the anterior segment; (8) intraocular-pressure test; and (9) dilated examination. Additional tests, if necessary, included (1) ocular coherence tomography, (2) infrared thermography, (3) 6-hour urine collection for heavy-metal toxicity, and (4) nocturnal oximetry. RESULTS:  All participants remained in the study for the duration of the program. Following the administration of the protocol, significant improvement in acuity, contrast, and visual field resulted in the majority of participants. None of the interventions was toxic or painful, and all likely contributed to an improved, overall health status for participants. CONCLUSIONS:  These treatment protocols should be considered part of a treatment program for all ocular disease processes. Eye health needs to be repositioned within an assessment of general health with the understanding that, with the exception of congenital disorders or accidents, vision decline represents a general diminishment in overall health and results directly from toxicity from both external sources such as air and water, and the internal accumulation of toxic metals; poor nutrition; and other life exposures and habits. Long-term follow-up studies are now in process.

Insulin resistance in retinal vein occlusion and glaucoma
            (Lockwood and Clearkin, 1992) Download
Three groups of subjects were studied: 15 patients who had had a central retinal vein occlusion, 15 patients with open-angle glaucoma, and 21controls. Although these results should be interpreted cautiously, they suggest an association between insulin resistance and both open-angle glaucoma and central retinal vein occlusion, which might explain the frequent association of these conditions.


 

Cytidine 5'-Diphosphocholine (Citicoline) in Glaucoma: Rationale of Its Use, Current Evidence and Future Perspectives.
            (Roberti et al., 2015) Download
Cytidine 5'-diphosphocholine or citicoline is an endogenous compound that acts in the biosynthetic pathway of phospholipids of cell membranes, particularly phosphatidylcholine, and it is able to increase neurotrasmitters levels in the central nervous system. Citicoline has shown positive effects in Parkinson's disease and Alzheimer's disease, as well as in amblyopia. Glaucoma is a neurodegenerative disease currently considered a disease involving ocular and visual brain structures. Neuroprotection has been proposed as a valid therapeutic option for those patients progressing despite a well-controlled intraocular pressure, the main risk factor for the progression of the disease. The aim of this review is to critically summarize the current evidence about the effect of citicoline in glaucoma.

Increased plasma free cortisol in ocular hypertension and open angle glaucoma
            (Schwartz et al., 1987) Download
Values of plasma free cortisol (not bound to plasma proteins), total plasma cortisol, and percent free cortisol were determined in normal, ocular hypertensive, and open angle glaucomatous subjects. Median total plasma, plasma free, and percent free cortisol levels were higher in ocular hypertensive and glaucomatous individuals. The most significant differences occurred with percent free cortisol values between normal and glaucomatous subjects. There was a significant positive correlation between percent free cortisol and total cortisol levels in normal subjects only. For subjects with glaucoma and hypertension, the percent free cortisol values were independent of the total cortisol values. Multilinear regression analysis also indicated that besides diagnosis and level of total plasma cortisol, male sex, blood sampling late in the day, and increased diastolic blood pressure were the only variables significantly related to increased values of plasma free cortisol and percent free cortisol. Ocular medication for glaucoma and use of beta-blockers were not found to be significant independent variables in the regression models for either plasma free cortisol or percent free cortisol. These observations further suggest that a disorder of the pituitary adrenal axis and/or a binding of plasma cortisol is associated with ocular hypertension and open angle glaucoma.


 

Insulin resistance and autoregulatory dysfunction in glaucoma and retinal vein occlusion
            (Stewart and Clearkin, 2008) Download
Systemic abnormalities associated with both ocular hypertension and open-angle glaucoma include essential hypertension, diabetes, hyperlipidemia, cardiovascular disease, and obesity.  Similarly, retinal vein occlusion is associated with hyper- tension, hyperlipidemia, and diabetes; again, the extent has yet to be established formally. In the light of the above, we may gain further insights into the association between open-angle glaucoma and retinal vein occlusion. So rather than being (as is frequently and implausibly supposed) one of cause and effect, the relationship may be simply, or at least in part, the manifestation of common underlying mechanisms, linked by insulin resistance.

Vitamin B3 modulates mitochondrial vulnerability and prevents glaucoma in aged mice.
            (Williams et al., 2017) Download
Glaucomas are neurodegenerative diseases that cause vision loss, especially in the elderly. The mechanisms initiating glaucoma and driving neuronal vulnerability during normal aging are unknown. Studying glaucoma-prone mice, we show that mitochondrial abnormalities are an early driver of neuronal dysfunction, occurring before detectable degeneration. Retinal levels of nicotinamide adenine dinucleotide (NAD(+), a key molecule in energy and redox metabolism) decrease with age and render aging neurons vulnerable to disease-related insults. Oral administration of the NAD(+) precursor nicotinamide (vitamin B3), and/or gene therapy (driving expression of Nmnat1, a key NAD(+)-producing enzyme), was protective both prophylactically and as an intervention. At the highest dose tested, 93% of eyes did not develop glaucoma. This supports therapeutic use of vitamin B3 in glaucoma and potentially other age-related neurodegenerations.

 


References

Crowston, J and I Trounce (2017), ‘Relief for retinal neurons under pressure.’, Science, 355 (6326), 688-89. PubMed: 28209856
Kondrot, EC (2015), ‘Improvement in Vision Parameters for Participants Treated With Alternative Therapies in a 3-day Program.’, Altern Ther Health Med, 21 (6), 22-35. PubMed: 26567447
Lockwood, A. and L. G. Clearkin (1992), ‘Insulin resistance in retinal vein occlusion and glaucoma’, Lancet, 340 (8827), 1100-1. PubMed: 1357490
Roberti, G, et al. (2015), ‘Cytidine 5’-Diphosphocholine (Citicoline) in Glaucoma: Rationale of Its Use, Current Evidence and Future Perspectives.’, Int J Mol Sci, 16 (12), 28401-17. PubMed: 26633368
Schwartz, B., G. McCarty, and B. Rosner (1987), ‘Increased plasma free cortisol in ocular hypertension and open angle glaucoma’, Arch Ophthalmol, 105 (8), 1060-65. PubMed: 2888454
Stewart, R. M. and L. G. Clearkin (2008), ‘Insulin resistance and autoregulatory dysfunction in glaucoma and retinal vein occlusion’, Am J Ophthalmol, 145 (3), 394-96. PubMed: 18282489
Williams, PA, et al. (2017), ‘Vitamin B3 modulates mitochondrial vulnerability and prevents glaucoma in aged mice.’, Science, 355 (6326), 756-60. PubMed: 28209901