Good morning! I’m Dr. David Richardson, a cataract and glaucoma
surgeon in Southern California. And right now I’m discussing a series of videos
on the holistic approach to treating glaucoma. So, looking at things other than just intraocular
pressure, also known as IOP… Today I’d like to talk about diet and nutrition
and some of the research that’s available on that. Alright let’s get going. So, it will come as no surprise to those who
have watched the first few of my videos that I’m going to state that anything that’s good
for your cardiovascular health is also good for your optic nerve and potentially for either
preventing or helping to treat glaucoma. So what’s the available research that suggests
that that’s the case and not just my opinion. Most of the research that’s available is,
unfortunately, just observational research. Now, what that means is that there’s a group
of people that were followed, often these are nurses in many of the studies, and associations
are made. So pretty much everything they do is looked
at from diet, exercise, and then correlations are discovered. So one of the larger studies that looked at
diet and the development of glaucoma… or this is one of the things that’s looked
at. Generally these studies have multiple reports
that come from them, each one breaking down a certain association with a particular disease,
but in this particular study that looked at diet in black women… in this study and the
association with development of glaucoma, there was a protective benefit associated
with vegetables and fruits. Now the study broke that down a bit. What the overall suggestion laws was that
those who had at least three servings vegetables and fruits had a decreased risk of developing
glaucoma but of course you’d like to know which fruits and which vegetables. And so they did break that down a bit those
who had at least three servings of oranges or peaches had a decreased risk of developing
glaucoma. Now whether or not orange juice or canned
fruits provide the same benefit is not as certain. And there was some suggestion in the study
that it had to be the whole fresh fruit. What else? Kale. Kale and collard greens—I mentioned that
in an earlier video for the lutein zeaxanthin content but kale and collard greens also provided
a benefit. Now interestingly you only needed two servings
of kale or collard greens a week in order to have the protective benefit. Now there are other vegetables that are worth
considering in terms of trying to prevent glaucoma. So in general the green leafy vegetables,
which once again are also just good for general retinal health seem to provide some benefits
and protection for glaucoma with the optic nerve. In particular, those vegetables that are high
in order called nitrates, not to be confused with nitrites which you find in salami and
processed meats, deli meats things like that. The nitrates are actually converted by the
body into nitric oxide. Now nitric oxide has a beneficial effect on
blood flow perfusion to the optic nerve. and indeed there’s a recently FDA-approved medication:
Vyzulta, which is a combination of a prostaglandin analog which tends to be a very effective
class of intraocular pressure lowering medications plus a nitric oxide releaser. So essentially, it’s prostagladin analog plus
a source of nitric oxide and that both provides an additional intraocular pressure lowering
effect if it may actually also have a neuroprotective effect and in that it may improve the blood
supply to the optic nerve. So what else? There are a class of molecules called anthocyanin
that are found in black currants. And black currants have been shown in at least
one study to stabilize visual fields and since in the treatment of glaucoma what we are trying
to do is maintain good vision, anything that can stabilize visual fields is worth considering. Then another source of the Anthocyanins is
eggplant. It turns out that as little as 10 grams per
day. I don’t know how many servings that is, can
provide some benefit. Eggplant is also a good source of Vitamin
C. you do, of note is, is that you do need the purple skin of the eggplant so it’s not
just the meat the skin is important in order to get this benefit. Omega-3 fatty acids, which I generally recommend
for my patients with a type of dry eye (they don’t help all types of dry eye but dry associated
with my bohmian gland dysfunction can benefit from omega-3 fatty acids. And the Omega 3 fatty acids seem to provide
some benefit in terms of blood flow to the optic nerve. Now, there may also be some pressure lowering
benefit and in order to get a source of omega-3 fatty acids in the diet you really need to
eat fatty fish at least 3 times a week so what types of fish are fatty fish? Wild-caught salmon, sardines, mackerel, tuna… Did I say Herring? So, not something that usually comes to mind
(not to me anyway). So if you’re not getting a fatty fish in your
diet at least three times a week then you really should consider supplementing with
a high-quality omega-3 fatty acid. Generally I just recommend you stay away from
the store brands. There are some high quality brand names such
as Nordic Naturals. There are supplements that are formulated
specifically for eye diseases. And those are available as either an eye doctor’s
office or online. Let’s see, what else…Oh! Interestingly enough, there is another chemical,
the flavonoids. Flavonoids are naturally occurring antioxidants
and these are found in such things as cocoa—so, in chocolate and tea. Now, if you’re thinking about chocolate, I
recommend that you stick to dark chocolate, so you limit the number of carbohydrates because
what you don’t want to do (of course) is, take something to improve your glaucoma, but
end up making your blood sugar higher or cardiovascular issues worse. So dark chocolate and a very small amount:
one or two squares a day, not one or two bars. One or two squares. Other things that are relatively high in flavonoids:
Tea. Now green tea gets all the credit but black
tea also has a high flavonoid content and benefit there. And the interesting thing about flavonoids
is that they may actually help protect the optic nerve and decrease the progression of
visual field loss. So if you’re not already a tea drinker, there
are all kinds of great flavor and tasting teas out there. I highly recommend that you have 1 to 2 cups
of tea a day. It’s actually probably reasonable for most
of us to cut down on our coffee and swap over to tea which has lower caffeine content. And the last thing that I’m going to mention
here is something that you’re probably not getting in your diet but is really exciting
(at least in animal studies). There’s no human studies that I’m aware of
yet that look at this protective benefit (at least not high quality study). But the Goji Berry extract was fed to rats
and these rats were essentially modified so that their pressures went up really high. And the Goji berry extract protected the retinal
ganglion cells—those are the cells that are actually damaged in glaucoma, protected
them from the damage that would normally occur with elevated intraocular pressure. So that’s really an exciting, early laboratory
research but it needs to be replicated in humans. Of course, without actually actively increasing
the pressure in humans…that would not be an ethical study. So anyway, this has been a long video but
I know it’s a video that has information that’s of interest to many of those who have followed
my written work online so I felt like it was worth the extra time and detail today. Anyway, I hope you agree and I look forward
to my next commute with you. All right… Take care.