Eyeworld

EW GLAUCOMA 86 October 2016 part of the therapy when indicated," Dr. Burgos said. Yet there are some risk factors to consider, as described below. Recommendations to patients When patients ask their eye doctors about the role of non-drug thera- pies, the responses they get will vary. Dr. Iwach encourages patients to ask him questions about non-drug ther- apies they've read about instead of trying something without consult- ing him first. Dr. Ritch extrapolates from the research to give his recommenda- tions on the use of ginkgo biloba, citicoline, omega-3 fatty acids, cur- cumin, and regular exercise. Dr. Panarelli emphasizes to pa- tients that lowering IOP is the only proven method to prevent addition- al vision loss, but he does support regular exercise for both physical and emotional benefits. "Chronic disease such as glaucoma can be difficult to deal with, and exercise is often an outlet for many patients, even those afflicted with limited acuity and peripheral vision," he said. He also tells patients there is no compelling evidence to suggest a relationship between dietary supple- mentation with vitamins A or E and glaucoma in large population-based studies. "As for ginkgo biloba and curcumin, I let patients know that they do not affect IOP, but they may improve blood flow to the optic nerve and have a neuroprotective effect," he said. Yet he still favors additional research before recom- mending their use regularly. Dr. Burgos is a proponent of vi- tamin C, omega-3 fatty acids, and a good multivitamin. He recommends ginkgo biloba in patients not at risk for bleeding or patients who are not taking anticoagulants. Many of his patients are older, and many do hap- pen to be on anticoagulants. When discussing non-drug therapies, glaucoma specialists will naturally consider any relevant risk factors. For instance, despite the benefits of exercise, patients with pigment dispersion syndrome or pigmentary glaucoma should proba- bly not run or jog regularly, to avoid an increase in the release of pigment in the eye, Dr. Burgos said. Patients with diabetes on oral medications or insulin must monitor their glucose levels during or after they exercise. Glaucoma patients should avoid the long-term use of certain inverted exercise positions in yoga such as downward dog or any headstand, Dr. Burgos said. These have been associated with a two-fold increase in IOP that can remain above base- line even after returning to a normal position. Ultimately, Dr. Iwach would like the interest in non-drug therapies to concurrently prompt an interest in earlier screening for glaucoma—if dis- ease is detected early, interventions are usually simpler. When explaining it to patients, Dr. Iwach likens it to getting oil changes for their cars on a regular basis—yet he also notices that patients are usually better about getting oil changes than getting their eyes examined regularly. EW Editors' note: The sources have no financial interests related to their comments. Contact information Burgos: fburgos@katzeneye.com Iwach: ai@glaucomasf.com Panarelli: ilana.nikravesh@mountsinai.org Ritch: ritchmd@earthlink.net Exploring continued from page 84

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