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Editors Selection IGR 19-2

Medical Therapy: Natural therapies for glaucoma

Comment by Robert Ritch on:

19391 A novel perspective on natural therapeutic approaches in glaucoma therapy, Mozaffarieh M; Flammer J, Expert Opinion on Emerging Drugs, 2007; 12: 195-198

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Non-pharmaceutical medicine, a more appropriate term than complimentary or alternative medicine, has been in existence since pre-human times. Dogs eat grass for gastrointestinal problems. Chimpanzees use various plants for reasons ranging from parasitic disease to stimulating uterine contraction in pregnancy. Ayurvedic medicine and Chinese traditional medicine have been with us for 5,000 years. Nevertheless the twentieth century became the era of pharmaceutical medicine, or monotherapy. With time, traditional medical systems became regarded as unproven and ineffective and were looked on with derision, derogation, and contempt. However, in the past decade, the bandwagon is turning around once again and polytherapy is in. Monotherapy is ideal for acute disorders, such as asthmatic attacks, acute infections, myocardial infarction, etc. However, for chronic diseases, non-pharmaceutical medicine medical systems offer prophylaxis and preventive medical approaches. Another advantage of non-pharmaceutical extracts is that they produce a number of actions and have a balance in reducing side effects, which are more common with monotherapy. In addition, an increasing number of good quality controlled studies and molecular biological investigations have produced a great deal of new information published in very reputable journals in the past few years.

With respect to glaucoma, non-pharmaceutical medicine does nothing that we know of for intraocular pressure nor would it be expected to, since the pathophysiology of glaucoma was not even recognized until the early twentieth century. However, we now recognize that important factors in the etiology of many glaucomas are cardiovascular abnormalities, oxidative damage, ischemic injury, and probably autoimmune phenomena and inflammatory phenomena. The major role of non-pharmaceutical and traditional medical systems is in modulating the immune system, providing neuroprotection, and improving cardiovascular function. This is where these agents will come into play in the treatment of glaucoma.

Mozaffarieh and Flammer (1098) have written an excellent brief review of non-pharmaceutical approaches to glaucoma therapy. Among their approaches, they mention Ginkgo biloba extract, omega-3 fatty acids, and a variety of foods including tea, chocolate, and red wine. The most powerful polyphenolic antioxidant in red wine is resveratrol, which activates the sirtuin enzyme system. Resveratrol increased the lifespan in several animal models from yeast to mice by activating sirtuin-2, a conserved deacetylase enzyme which has also been linked to the benefits of caloric restriction, which has long been known to extend the lifespan. Several studies have demonstrated that resveratrol is an effective antioxidant.¹ A single infusion of resveratrol can elicit neuroprotective effects on cerebral ischemia-induced neuron damage through free radical scavenging and cerebral blood elevation due to nitric oxide release.² Its antiapoptotic activity has led to the suggestion that resveratrol may make a useful dietary supplement for minimizing oxidative injury in immune-perturbed states and human chronic degenerative diseases.³ The hot molecule of 2007 is curcumin, a component of turmeric, the yellow spice in curry and an element in Ayurvedic medicine for 5000 years. Curcumin has antioxidant, anti-inflammatory, anti-infectious, and anticancer activity and is potentially applicable to treatment of malignancies, diabetes, allergies, arthritis, Alzheimer's disease (AD), and other chronic diseases.⁴ Its effects are mediated through the regulation of various transcription factors, growth factors, inflammatory cytokines, protein kinases, and other enzymes. Curcumin inhibits such mediators of inflammation as NFkappaB, cyclooxygenase-2 (COX-2), lipooxygenase (LOX), and inducible nitric oxide synthase (iNOS).⁵ Curcumin has at least 10 known neuroprotective actions and targets multiple AD pathogenic cascades, making it a strong candidate for use in the prevention or treatment of major disabling age-related neurodegenerative diseases like AD, Parkinson's, and stroke.⁶ It affects many aspects of angiogenesis, downregulating such proangiogenic proteins as VEGF and BFGF and inhibiting signal transduction pathways.⁷ AD, macular degeneration, and glaucoma share many characteristics, making curcumin worth studying further for its potential uses in ophthalmology.

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