Glaucoma Supplements in Kennewick,  WA

Over the years the doctors at Grand Ridge Eye Clinic have been asked what supplements can be helpful in combating Glaucoma. What we have discovered is that there is not a catch all, easy answer to that question. You are an individual and any supplements regarding your health must be tailored to your specific needs and tolerances. To that end, we want to come along side of you and your primary care physician and help you to make the choice that best suits your lifestyle and health goals. The following is education and recommendations based upon current research. Grand Ridge Eye Clinic does not endorse any particular supplement. The following material is for information purposes so that you can make informed decisions.

The source material is linked

Definition of Terms

Glaucoma – A group of eye conditions that damage the optic nerve. The optic nerve sends visual information from your eye to your brain and is vital for good vision. Damage to the optic nerve is often related to high pressure in your eye. But glaucoma can happen even with normal eye pressure.

IOP – Intraocular pressure is the pressure, or force, inside of your eyes. Specifically, it’s a measurement of the fluid pressure in your aqueous humor.

Aqueous Humor – Aqueous humor is the clear liquid inside the front part of the eye. It nourishes the eye and keeps it inflated.

Optic Nerve – A nerve at the back of your eye that connects to your brain. The optic nerve sends light signals to your brain so you can see.

Trabecular Meshwork – A spongy tissue located near the cornea that is part of the drainage system of the eye.

Drainage Angle – The point in the eye where the colored part of the eye (iris) and the white covering of the eye (sclera) meet. This is where the aqueous humor flows out of the eye.

Vitamins – Naturally occurring nutrients that our bodies are unable to synthesize on their own but are necessary for the healthy functioning of our body. They are best found in the foods we eat but can also be taken in a pill, tablet, liquid, powder or capsule form. Vitamins should not be taken in excess. This is not a matter of, “If a little is good, a lot must be better!” There are recommended dosages that your body functions best with so that you do not have detrimental effects from taking vitamins.

Supplement – While all vitamins (organic in nature) can also be taken as supplements, not all supplements are vitamins. Supplements are often times comprised of multiple ingredients (occasionally to include herbs and/or multiple vitamins, hence the term multivitamin), are designed to complement our diet, even if we are already getting sufficient number of vitamins from the foods we eat. Supplements are meant to be added to, no replace, the benefits we get from the food we consume.

Link to The National Eye Institute's Explanation of Glaucoma Types

9 Important Bio cellular Mechanisms of Eye Aging that Contribute to Glaucoma

1. Oxidative Stress

2. Chronic Inflammation

3. Neuronal Transmission Failure

4. Impaired Glucose Metabolism

5. Mitochondrial Dysfunction

6. Vascular Dysregulation

7. High Homocysteine Levels

8. Stress-related Cellular Damage

9. Macular Pigment Deficiency

qd = once daily

bid = 2 times per day

tid = 3 times per day

qid = 4 times per day

Supplements that have been shown to help with glaucoma (next to each supplement is the # of the bio cellular mechanism that it addresses)

Dosage Recommended and Warnings
Mechanism of Action
Natural sources of the supplement

Acetyl L Carnitine “ALC” (#1)

200-500 mg/qd

Amino acid produced by the body, also found in food and supplements. It plays a crucial role in the production of energy by transporting fatty acids into your cell’s mitochondria. For your body to produce ALC out of lysine and methionine your body needs vitamin C. The main role involves mitochondrial function and energy production. It is mostly stored in your muscles, but also trace amounts are in your blood, liver, heart and kidneys. May increase mitochondrial function.

Meat and dairy products, or by supplement

Anti-Oxidants (#1)

A general term for any compound that can counteract unstable molecules called free radicals that damage DNA, cell membranes, and other parts of cells. Because free radicals lack a full complement of electrons, they steal electrons from other molecules and damage those molecules in the process. Antioxidants neutralize free radicals, by giving up some of their own electrons. This acts as a natural “off” switch for the free radicals. This helps break the chain reaction that can affect other molecules in the cell and other cells in the body. (The body generates free radicals in response to environmental insults, such as tobacco smoke, UV rays, and air pollution, but also is a natural byproduct or normal processes in cells. When the immune system fights intruders, the oxygen it uses spins off an army of free radicals that destroy viruses, bacteria, and damaged body cells in an oxidative burst. It can also occur during exercise.)

Carrots, coffee, fruits, leafy greens, nuts, peaches, veggies.

Bilberry Oil (#1)

Caution: Is a natural blood thinner

Contains antioxidants known as anthocyanins and polyphenols. Thought to curb inflammation and protect against diseases associated with oxidative stress.

Fruit closely related to blueberry, native to northern Europe, Asia, the northern US, and Canada. Often eaten fresh, in jam, juices, or pies. Also available in powder, or supplement form.

Billberry & grape seed (#1)

Reduce eye pressure, increase ocular blood flow, and improve visual function. Grape seed is a great natural source of proanthocyanidins, containing more antioxidants than maritime pine bark (95% vs. 80%). Historically used to treat diabetes, inflammation, and diarrhea.

Fruit closely related to blueberry, native to northern Europe, Asia, the northern US, and Canada. Often eaten fresh, in jam, juices, or pies. Also available in powder, or supplement form.

Bilberry-maritime pine bark combination (#1)

Reduces eye pressures

Carrots, coffee, fruits, leafy greens, nuts, peaches, veggies.

Black Current Seed Extract (#2)

50 mg/qd

Black currant contains: Anthocyanidin (a type of pigment), gama-linolenic acid (GLA), an omega-6 FA, Alpha-linolenic acid (an omega-3 FA) and other omega-6 fats. Believed to lessen inflammation. Taken to lower cholesterol, lessen fatigue, help symptoms of RA, improve poor circulation, and for glaucoma.

Extracted from the seeds of the black currant shrub, a plant with dark purple-black berries that grows in areas of Europe, Asia, New Zealand, and in the mid-western States in the US.

Chromium Polynicotinate (#4)

500/qd for eyes (other studies said 50-300 mcg/qd)

Helps to balance blood sugar levels, lose weight, and reduce cholesterol levels (this combines chromium with niacin). It helps to regulate insulin. It helps absorb and distribute nutrients from the foods you eat.

Dairy products, broccoli, potatoes, green beans, beef, poultry, apples, bananas. We tend to be more chromium deficient with age.

Citicoline (CDP-choline) (#3)

500 mg/qd

Naturally found in our brain, enhances communication between nerve cells, protects neural structures, and supports healthy brain activity. Neuroprotective effects.

Particularly present in organ meats, like brain or liver

Coleus Forskohlii extract (#2, #8) (the main bioactive ingredient in Coleus forskohlii is called forskolin (see below)

100/qd

Warning: Do not take if you are on blood thinners.

May increase testosterone, and protect against cancer and inflammation. It increases cellular levels of a molecule called cyclic adenosine monophosphate (cAMP). Elevated cAMP levels are associated with increased rates of fat loss.

Made from the root of a plant in the mint family. The plant grows in Nepal, India, and Thailand.

CoQ10 (#1, #3, #4)

00-200/qd

Warning: Don’t take if you have heart failure, liver problems, diabetes, are pregnant, take blood thinners, take thyroid meds or are receiving chemotherapy. There’s some evidence that it could reduce the effectiveness of blood thinners.

A vitamin-like compound found in every cell in the body. It plays a vital role in the production of energy within the mitochondria, which are the powerhousess of the cell. It also functions as an antioxidant and is neuroprotective. In glaucoma, coQ10 has been studied for neuroprotection and has been shown to reduce oxidative stress, improve mitochondrial function, and reduce inflammation. It is important to note that roughly 60% of older Americans are on statin therapy, which reduce levels of coQ10 in the body by as much as 40%, so patients may want to incorporate coQ10 in their regimen.

Found in organ meats, like heart and liver. It’s also found in fatty fish such as trout, salmon, mackerel, and sardines. It’s in all meat, but highest in organs. Soybean products like tofu, soy milk, and soy yogurt, vegetables especially broccoli, nuts and seeds especially pistachios, peanuts, and sesame seeds.

Forskolin (#2, #8)

See above Coleus Forskohlii

Herb that lowered IOP in rabbits, monkeys, and humans by reducing aqueous flow, but causes hyperemia and tachyphylaxis. It wasn’t a long-term fix though, IOP elevated over time. Also, it has downsides that include that forskolin is arrhythmogenic, and it can promote androgen activity on prostate cells in patients with prostate cancer.

See above Coleus Forskohlii

Gama Tocopherol (#1, #2)

200/qd

a major form of vitamin E in diets. Antioxidant and anti-inflammatory effects.

Soybean, corn, black walnuts, sesame seeds, pecans, pistachios, English walnuts, flaxseeds, and pumpkin seeds.

Gingko biloba leaf (oil) (#1,)

120 mg/qd for leaf (40 mg TID for oil)

Caution: There’s concern regarding bleeding with ginkgo biloba, but it doesn’t appear to increase bleeding risk in studies.

Antioxidant, helps increase blood flow specifically microcirculation, stabilize mitochondria and protects neurons from damage, and either improves pre-existing visual field loss or slows the progression of visual field damage in low pressure glaucoma. It contains a complex mixture of at least 37 phytochemicals in 2 main groups: flavonoids (which have antioxidant properties) and terpenoids (which reduce blood viscosity). One study found TID dosage after a month was able to improve pre-existing VF loss. Another study showed improved blood flow to the retina and ON. Inhibits glutamate cytotoxicity, which leads to ganglion cell death, and it’s shown to increase blood flow. (Don’t use if they’re already using a blood thinner). Ginkgo biloba is native to China. The leaf contains about 20 different types of flavonoids and has been studied for neuroprotection in glaucoma. Ginkgo has been shown to have antioxidant and vascular effects. In some studies, Ginkgo has been shown to slow visual field progression in normal tension glaucoma patients. However, not consistent in all studies. (F)

Tree/plant-based (supplement form only)

Green Coffee Extract (#1, #2)

200-400/TID

Caution: Contains caffeine, and therefore has the same side effects as caffeine (anxiety, sleep disturbances, increased blood pressure, may affect bone health negatively)

An abundant supply of chlorogenic acids, compounds with potent antioxidant and anti-inflammatory effects.

Coffee beans that have not been roasted and remain raw

Green Tea extract (#1, #2)

725-1450 in studies (but typically recommended for 250-500 on bottles)

Caution: Processed by the liver, don’t take in excess.

High in antioxidants, helps reduce oxidative stress and reduce inflammation, may improve cholesterol numbers,

The catechin most closely linked to the health benefits of green tea extract is EGCG, make sure the supplement you are taking contains it. Best to take with food.

Hot tea, daily, contain antioxidants (#1)

Daily

Caution: Different teas contain different amount of caffeins

Lower odds of developing glaucoma by 74%. Antioxidants in tea are associated with less risk of heart disease and cancer.

Hot tea, daily, contain antioxidants (#1)

Daily

Caution: Different teas contain different amount of caffeins

Lower odds of developing glaucoma by 74%. Antioxidants in tea are associated with less risk of heart disease and cancer.

Lipoic Acid (#1, #2, #4, #5, #8)

150 (has been studied up to 2,400 mg without serious side effects, but never in an eye study)

Essential for aerobic metabolism. Antioxidant. An organosulfur compound derived from octanoic acid. It’s crucial for digestion, absorption and the creation of energy, present within the mitochondria. It also has antioxidant properties. Helps with blood sugar regulation, inflammation, may reduce oxidative stress, helps cholesterol numbers.

Red meat (muscle of beef), spinach, kidney, heart, liver, broccoli, tomatoes, and to a lesser extent: brussels sprouts, peas, potatoes, yams, yeast, beets, carrots.

Lutein & Zeaxanthin (#1, #9)

10 mg/qd lutein, 2 mg qd zeaxanthin are what’s been studied for eyes.

Powerful antioxidants. Increase macular pigment optical density and contrast sensitivity in eyes with glaucoma. They help recycle glutathione, another antioxidant in the body. Help protect the eye from free radicals.

Kale, parsley, spinach, broccoli, peas, to a lesser extent orange juice, honeydew, kiwis, red peppers, squash, grapes, durum wheat, corn, egg yolk. Fats improve the absorption of lutein and zeaxanthin so having with olive oil salad dressing or butter on cooked greens, can help with uptake.

Magnesium elemental (#1, #3)

140-500 qd

May improve ocular blood flow. Neuroprotective by inhibiting the release of glutamate (which induces oxidative stress and can cause damage to the ON)

Avocado, almonds, dark chocolate, spinach, cashews, bananas, pumpkin seeds, leafy greens, dark chocolate, tofu

Melotonin (#1, #3)

3 mg/qd before bed only

Caution: Do not take if you are on blood thinners, anticonvulsants, blood pressure drugs, CNS depressants, seizure meds, obsessive compulsive drops or anti-depressants.

A hormone in your body, connected to the time of day, increasing when it’s dark and decreasing when it’s light. It’s production declines with age. May play a role as an antioxidant in ocular tissue and have neuroprotective effects. It provides anxiolysis, enhances analgesia, decreases IOP.

Supplements only

Mirtogenol (#1)

similar to gingko from billberry and French maritime pine. Improves ocular blood flow

Bilberry extract and French maritime pine bark (supplement form only)

Omega 3 PGE3 (#1, #8)

300-6000/qd

Caution: Over 3000mg/qd can cause excess bleeding, do so under a doctor’s care only.

Be aware of mercury amounts in source as mercury consumption may occur with low quality fish oil. Mercury toxicity can cause glaucoma

May decrease IOP by increasing aqueous outflow, works similar to the method of prostaglandin analog medication. Decreases eye pressure in 50% of people with glaucoma, up to 5 points after 6 weeks. Important components of cell membranes and are precursors to many other substances in the body such as those involved in regulating blood pressure and inflammatory responses. Anti-inflammatory effects.

Mackerel, salmon, sea bass, oysters, sardines, chia seeds, hemp seeds, walnuts, cod liver, herring

Omega 6 Fatty Acids (#1, #8)

May decrease IOP by increasing aqueous outflow, works similar to the method of prostaglandin analog medication. Decreases eye pressure in 50% of people with glaucoma, up to 5 points after 6 weeks. Important components of cell membranes and are precursors to many other substances in the body such as those involved in regulating blood pressure and inflammatory responses. Anti-inflammatory effects.

Meat, poultry, fish, eggs, sunflower oil, corn, soybeans, walnuts, safflower oil, tofu, hemp seed, peanut butter, avocado oil, almonds, cashews

Palmitoylethanolamide (PEA) (#2, #3)

300 mg/bid

Reduced eye pressure by an additional 16% in combination with timolol eye drops, and improved VF parameters in patients with low pressure glaucoma. An endocannabinoid (endogenous fatty acid amide), naturally produced throughout our body to reduce pain and inflammation in response to tissue damage and injury. Similar looking to delta-9-tetrahydrocannabinol, the main active ingredient in marijuana. Has a lot of the benefits of cannabis, but without the side effects, non-addictive. An endocannabinoid-like mediator, anti-inflammatory, analgesic, antimicrobial, immunomodulatory, and neuroprotective. A naturally occurring lipid ingredient contained in foods/dietary supplements.

Soybeans, peanuts, pistachios, almonds, walnuts, eggs, milk, cheese, chicken, beef, salmon, tuna, mackerel, sardines, anchovies, flaxseeds, chia seeds, hemp seeds, pumpkin seeds, sunflower seeds, avocado, olive oil, dark chocolate, lentils, kidney beans, chickpeas, black beans, soy products, quinoa, brown rice, oats, barley, buckwheat, turmeric, ginger, cinnamon, oregano, rosemary.

Pycnogenol/French Maritime pine bark (#1, #8)

Tested at 50-450 mg/qd

Antioxidant. Studies show it improves blood flow. It protects against oxidative stress. It protects against UV radiation induced erythema. In asthma patient’s symptom scores and circulating leukotrienes were reduced and lung function improved. Immunomodulation has been observed in both animal and humans with lupus. Dilation of the small blood vessels has been observed in patients with cardiovascular disease.

The plant grows in southwest France, and other countries on the mediterranian sea.

Pyrroloquinoline Quinone (aka methoxatin) (#1, #2, #5, #6, #8)

Not consistently listed, maybe as low as 5 mg/qd

More than an antioxidant, it’s a vitamin like accessory factor important in health and disease prevention. It’s associated with biological processes such as mitochondriogenesis, growth, and aging. It attenuates clinically relevant dysfunctions. It mediates mitochondrial functions.

Spinach, kiwi, soybeans, parsley, carrots, oranges, tomatoes, bananas, dark chocolate, green tea.

Pyruvate (#5)

5 g/qd

Helps support mitochondria, tested in conjunction with B3 for multiplied benefit.

Red apples, cheese, dark beer, red wine.

Resveratrol (#1, #2, #3, #5, #8)

Strong antioxidant and anti-inflammatory properties, neuroprotective and anti-aging, antitumor effects. May also improve mitochondrial dysfunction. May slow apoptotic process, helping to maintain normal mitochondrial membrane potential and enhancing cell survival.

Peanuts, pistachios, dark chocolate, grapes, white and red wine, blueberries, cranberries, cocoa

Saffron (extract) (#1)

30 mg/qd

Modulates the stress response of the body, and decreases eye pressure in stable glaucoma patients.

Spice

Selenium (#1, #8)

200-500 mg/qd

Antioxidant that protects cells from damage caused by things like aging, lifestyle choices, and environmental pollution. Reduces oxidative stress. Antiviral effects, supports fertility, may reduce the risk of some cancer, autoimmune diseases, and thyroid disorders. May reduce side effects from cancer chemotherapy and radiation.

Brazil nuts, fish, ham, pork, beef, turkey, chicken, cottage cheese, eggs, brown rice, sunflower seeds, baked beans, mushrooms, oatmeal, spinach, milk and yogurt, lentils, cashews, bananas.

Taurine (#1, #8)

500 mg/qd

An amino acid that promotes heart health, brain health, and longevity. Found to prevent weight gain, reduce fasting blood glucose and markers of liver damage, increase bone density in the spine and legs, and improve the health of the immune system. It is involved in regulating water status in our cells, preventing oxidation in the body, and supporting calcium signaling in key organs. Protects against oxidative damage. Low taurine levels are associated with cataracts.

Meat, seafood, and dairy products. Highest concentration in shellfish: muscles, oysters, scallops, and clams, and dark meat in chicken, turkey, and pork. Also, in peanuts.

Tumeric/Curcumin (#2)

400-800 mg/qd

Helps to reduce inflammation, may ease osteoarthritis symptoms and RA. In lab tests, curcumin blocked the growth of certain kinds of tumors, in some cases it stabilized colorectal cancer that wasn’t helped by other treatments. Other lab studies suggest that it might help protect against types of colitis, stomach ulcers, and high cholesterol. It may help upset stomach, diabetes, depression, HIV, uveitis, and viral infections. Most of these studies were done in a lab and not in vivo.

Spice

Vitamin A (#1)

5000 mg/qd

Antioxidant, appears to protect photoreceptors in ARMD patients, but no benefit observed for glaucoma. Retinol can have SE of hair loss, fatigue, increased intracranial pressure and cirrhosis. (After the first AREDS 2 study, they found that former smokers had an increase in lung cancer with vitamin A supplements)

Yellow, orange and red vegetables, such as carrots, sweet potatoes, red peppers. Beef liver, lamb liver, liverwurst, cod liver oil, king mackerel, salmon, bluefin tuna, goose liver pate, goat cheese, butter, limburger cheese, cheddar cheese, camembert cheese, Roquefort cheese, eggs, trout, clams, cream cheese, oysters, whole milk,

Vitamin B1 (thiamine) (#2,#8)

10 mg/qd

Mixed reviews-B1 deficiencies are associated with increased cortisol, which in turn increases IOP. But taking B1 didn’t significantly lower IOP. Required by the body to properly use carbohydrates and maintain proper nerve function.

Pork, green peas, tofu, brown rice, squash, asparagus, cauliflower, oranges, potatoes, kale, blackstrap molasses, fish, seeds, nuts, beans, seafood, liver, eggs, brewer’s yeast.

Vitamin B3 (Nicotinamide) (#3,#5)

500-3000 mg/qd

Low B3 linked with mitochondrial dysfunction, appears to be neuroprotective. B3 boosts NAD levels in mice (Combined with pyruvate increased benefit more than either nutrient alone). Supports cell metabolism, mitochondrial health and DNA repair. Study showed it improved the function of the ON ganglion cells over 6 weeks. . Combined with pyruvate 1500-3000 mg)significantly improved visual function when taken over 2 months, no adverse effects reported in the combo. The author uses 500 mg per day not 3000 the same with pyruvate

Beef liver, poultry, eggs, dairy products, fish, nuts, seeds, legumes, avocado, and whole grains

Vitamin B12 (methyl cobalamin) (#3)

Protects neural structures and supports healthy brain activity, a good alternative to Citicoline. 2 studies found VF improvement but not very long-term studies and no baseline B12 levels were measured prior to supplementation.

Animal liver and kidneys, clams, sardines, beef, tuna, trout, salmon, milk and other dairy products, eggs.

Vitamin C

500 (1000-2000) mg/qd

Mixed reviews-some studies showed reduced IOP, but it didn’t last long, high dosages of vitamin C can be linked with kidney stones and GI upset

Citrus fruits, tomatoes, tomato juice, potatoes, red/green peppers, kiwi, broccoli, strawberries, brussels sprouts, cantaloupe

Vitamin E (tocotrienol/tocopherol) (#1)

Alpha toco 100-400 mg/qd

Mixed opinions: antioxidant properties, lower peroxidation products in glaucoma patients.

Wheat germ oil, sunflower seeds, almonds, hazelnut oil, mamey sapote, sunflower oil, almond oil, hazelnuts, abalone, pine nuts, goose meat, peanuts, Atlantic salmon, avocado, rainbow trout, red sweet pepper, Brazil nuts, mango, turnip greens, kiwifruit

Zn Mono methionine (Not O) (#2, #3, #5, #8)

30 mg/qd

Zinc in general is an essential catalyst in many of the body’s innumerable biochemical reactions. It is a structural component of cell membranes and proteins. It plays a role in immune function. It also acts as an antioxidant and protects cells from free radical damage. Zinc Mono methionine is a combination of the mineral zinc and the amino acid methionine. Three studies have shown the combination helps the body absorb zinc better.

Shiitake mushrooms, green peas, spinach, lima beans, lentil sprouts, asparagus, beet greens, broccoli, okra, sweet corn, pumpkin seeds, garlic, peanuts, Brazil nuts, almonds, cashew, rice, lentils, avocados, blackberries, pomegranate, raspberries, guavas,

Avoid simulating foods (sugar and refined foods, alcohol, drugs, smoking, coffee, and salt.

Patients who ate 3 or more servings of fruit such as peaches or oranges, or fruit juices, per day were 79 percent less likely to have POAG. In addition, those who ate more than one serving of collard greens or kale, which are nitrate-rich, leafy green vegetables, per week decreased their odds of having POAG by 57 percent. The Nurses Health Study and Health Professionals Follow up Study found that a greater inteake of nitrate-rich foods and leafy green vegetables decreased the risk of POAG by 20-30%.

Blood pressure

Keep diastolic BP near 80 mmHg (low diastolic=increased risk)
Reduce systolic BP to under 130
High myopia 7.3x increased risk compared to emmatropic eye
Consider: Genetic home test, 23 & Me, for glaucoma risk.

https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342079/all/Glaucoma

Sources:

(a) American Heart Association

(b) Wm Bartlett MD, June 2009 lecture

(c) University of Illinois Eye & Ear Infirmary

(d) British Journal of Ophthalmology, Researchers from UCLI

(e) Wang, Assn of Dietary Fatty Acid Intake with Glaucoma JAMA Ophthal. 2018 Feb. 1

(f) Physicians Committee for Responsible Medicine. Nutrition guide for clinicians: glaucoma. Nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342079/all/Glaucoma. Updated December 15, 2020

(g) Ramdas WD, Wolfs RCW, Jong JCK, et al. Nutrient intake and risk of open-angle glaucoma: the Rotterdam Study. Eur J Epidemiol.2012;27(5):385-393

(h) Weinrab RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014;311(18):1901-1911.

(i) Heiting G. All About Vision. Ocular hypertension: 5 causes of high eye pressure. Www.allaboutvision.com/conditions/hypertension.htm. Published March 2019. Updated September 2021.

(j) Owaifeer AMA, Taisan AAA. The role of diet in glaucoma: a review of the current evidence. Ophthalmol Ther. 2018;7(1):19-31

(k) Kong GYX, Bergen MJV, Trounce IA, Crowston JG. Mitochondrial dysfunction and glaucoma. J Glaucoma. 2009;18(2):93-100

(l) Glaucoma Research Foundation. Glaucoma and nutrition: why what you eat matters. Www.glaucoma.org/news/blog/glaucoma-and-nutrition-why-what-you-eat-matters.php?gclid=CjwKCAjwkvWKBhB4EiwA-GHjFpmrxph_wVZYa0jMlo10vmSMux5zCjzJAFphywGaUnVbd9AZRsbjghoC7q4QAvD_BwE. Published June 16, 2021.

(m) Yuki K, Murat D, Kimura I, Ohtake Y, Tsubota K. Reduced-serum vitamin C and increased uric acid levels in normal-tension glaucoma. Graefes Arch Clin Exp Ophthalmol. 2010;248(2):243-248.

(n) Gamell LS. Supplements and glaucoma: advising your patients. Review of Ophthalmology. Www.reviewofophthalmology.com/article/supplements-and-glaucoma-advising-your-patients. Published February 9, 2018.

(o) Ekici F, Korkmaz S, Karaca EE, et al. The role of magnesium in the pathogenesis and treatment of glaucoma [published online ahead of print October 13, 2014]. Int Sch Res Notices.

(p) Rolle T, Dallorto L, Rossatto S, Curto D, Nuzzi R. Assessing the performance of daily intake of a homotaurine, carnosine, forskolin, vitamin B2, vitamin B6, and magnesium based food supplement for the maintenance of visual function in patients with primary open angle glaucoma. J Ophthalmol. 2020;2020:7879436.

(q) Jung KI, Kim YC, Park CK. Dietary niacin and open-angle glaucoma: the Korean National Health and Nutrition Examination Survey. Nutrients. 2018;10(4):387

(r) Nzoughet JK, Chao de la Barca JM, Guehlouz K, et al. Nicotinamide deficiency in primary open-angle glaucoma. Invest Ophthalmol Vis Sci. 2019;60(7):2509-2514

(s) Cimaglia G, Votruba M, Morgan JE, Andre H, Williams PA. Potential therapeutic benefit of NAD+ supplementation for glaucoma and age-related macular degeneration. Nutrients. 2020;12(9):2871.

(t) Tribble JR, Otmani A, Sun S. Nicotinamide provides neuroprotection in glaucoma by protecting against mitochondrial and metabolic dysfunction. Redox Biol. 2021;43:101988

(u) Pasquale LR, Kang JH. Lifestyle, nutrition and glaucoma. J Glaucoma. 2009;18(6):423-428

(v) Ren H, Magulike N, Ghebremeskel K, Crawford M. Primary open-angle glaucoma patients have reduced levels of blood docosahexaenoic and eicosapentaenoic acids. Prostaglandins Leukot Essent Fatty Acids. 2006;74(3):157-163.

(w) Downie LE, Vingrys AJ. Oral omega-3 supplementation lowers intraocular pressure in normotensive adults. TranslVis Sci Technol. 2018;7(3):1.

(x) Huang W, Fan Q, Zhang X. Cod liver oil: a potential protective supplement for human glaucoma. Int J Ophthalmol. 2011;4(6):648-651

(y) Cybulska-Heinrich AK, Mozaffarieh M, Flammer J. Ginkgo biloba: An adjuvant therapy for progressive normal and high tension glaucoma. Mol Vis. 2012;18:290-402.

(z) Patel S, Mathan JJ, Vaghefi E, Braakhuis AJ. The effect of flavonoids on visual function in patients with glaucoma or ocular hypertension: a systematic review and meta-analysis. Graefes Arch ClinExp Ophthalmol. 2015;253(11):1841-1850.

(A) Harris A, Gross J, Moore N, et al. The effects of antioxidants on ocular blood flow in patients with glaucoma. Acta Ophthalmol. 2018;96(2):e237-e241.

(B) Quaranta L, Bettelli S, Uva MG, Semeraro F, Turano R, Gandolfo E. Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma.Ophthalmology. 2003;110(2):359-362, discussion 362-354.

(C) Park JW, Kwon HJ, Chung WS, Kim CY, Seong GJ. Short-term effects of Ginkgo biloba extract on peripapillary retinal blood flow in normal tension glaucoma. Korean J Ophthalmol. 2011;25(5):323-328

(D) Steigerwalt RD, Belcaro G, Marazzoni P, Bombardelli E, Burki C, Schonlau F. Mirtogenol potentiates latanoprost in lowering intraocular pressure and improves ocular blood flow in asymptomatic subjects. Clin Ophthal. 2010;4:471-476.

(E) Steigerwalt RD, Belcaro G, Morazzoni P, Bombardelli E, Burki C, Schonlau F. Effects of Mirtogenol on ocular blood flow and intraocular hypertension in asymptomatic subjects. Mol Vis. 2008;14:1288-1292.

(F) Abu-Amero KK, Kondkar AA, Chalam KV. Resveratrol and ophthalmic diseases. Nutrients. 2016;8(4):200.

(G) Can Nutrient Supplements Prevent Glaucoma January 31, 2022. http://www.cuimc.columbia.edu/news/can-nutrient-supplements-prevent-glaucoma/

(H) Age-Related Eye Disease Study Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol 2001;119:10:1417-1436.

(I) Asregadoo ER. Blood levels of thiamine and ascorbic acid in chronic open-angle glaucoma. Ann Ophthalmol 1979;11:1095-1100

(J) Virno M, Bucci MG, et al. Intravenous glycerol-vitamin C (sodium salt) as an osmotic agent to reduce intraocular pressure. Am J Ophthalmol 1966;62:824-833.

(K) Linner E. The pressure lowering effect of ascorbic acid in ocular hypertension. Acta Ophthalmol (Copenh) 1969;47:685-689.

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