Macular Degeneration & Glaucoma
Table of Contents
Glaucoma is actually a group of eye diseases that are often caused by increased pressure inside the eye. Unless the pressure is controlled, it can cause damage to the optic nerve and a loss of vision (macular degeneration). In the early stages, it’s difficult to determine whether you have glaucoma; it’s virtually symptom-free. As the condition progresses, side vision may begin to fade. If left untreated, the field of vision will continue to narrow and blindness results.
Glaucoma is the leading cause of blindness in the United States. Nearly three million people have some form of it. Fortunately, if detected early, glaucoma can usually be controlled.
DIAGNOSIS AND TYPES OF GLAUCOMA
During the past century, elevated intraocular pressure [IOP] has been the main marker for glaucoma diagnosis. Eyes may have an IOP within the normal range and still develop glaucoma. On the other hand, an elevated IOP may be present. This comes without detectable damage to the optic nerve, called ocular hypertension. Thus, the new thinking is that progressive retinal damage may not be directly correlated to the extent of the IOP level.
The best way to protect yourself is to be aware of your risk, and to make sure you have a comprehensive screening regularly. People with higher risk include those with a family history of glaucoma. Furthermore, black Americans over the age of 40, anyone with elevated eye pressure, and anyone over the age of 60. People at a higher risk for glaucoma should have their eyes examined through dilated pupils every two years.
Sophisticated diagnostic tests are used to diagnose and manage glaucoma. All patients will have visual field examinations using both computerized and manual tests. These include ophthalmic photography (photos of the optic nerve) and nerve fiber layer photography with a digital system. Delayed intervention is likely to result in more permanent and greater visual loss. So, early intervention would be the best strategy for anyone with increased intraocular pressure or early glaucoma.
There are many types of glaucoma: mainly Primary Open-angle (which makes up about 80% of all cases). Then, there is normal tension, narrow-angle, acute angle-closure, chronic angle-closure, childhood, congenital (Infantile). Furthermore, one can have juvenile, after cataract extraction, pigment dispersion and pseudoexfoliation from uveitis, and glaucoma following trauma (traumatic).
CAUSES
For reasons that doctors don’t fully understand, increased pressure within the eye (intraocular pressure) is usually, but not always, associated with the optic nerve damage that characterizes glaucoma. This pressure is due to a buildup of a fluid (aqueous humor) that flows in and out of your eye.
This fluid normally exits your eye through a drainage system at the angle where the iris and the cornea meet. When the drainage system doesn’t work properly, the fluid can’t filter out of the eye at its normal rate, and pressure builds within your eye.
PRIMARY OPEN-ANGLE GLAUCOMA
In primary open-angle glaucoma, the drainage angle formed by the cornea and the iris remains open. However, the drainage channels (trabecular meshwork) in the angle are partially blocked, causing the fluid to drain out of the eye too slowly. This causes fluid to back up in your eye, and pressure gradually increases within your eye. Damage to the optic nerve doesn’t cause symptoms or pain. It happens so slowly that you may lose an extensive amount of vision before you’re even aware of a problem. The exact cause of primary open-angle glaucoma remains unknown.
ANGLE-CLOSURE GLAUCOMA
Angle-closure glaucoma occurs when the iris bulges forward to narrow or block the drainage angle. This is typically formed by the cornea and the iris. As a result, fluid can’t adequately flow through and exit your eye. Your eye pressure may increase abruptly. Angle-closure glaucoma usually occurs suddenly (acute angle-closure glaucoma), but it can also occur gradually (chronic angle-closure glaucoma). Some people with an abnormally narrow drainage angle may be at risk of developing angle-closure glaucoma.
TYPICAL TREATMENT
While glaucoma can’t be cured, it can usually be treated. Glaucoma can produce a chronic, progressive deterioration of the optic nerve. The treatment of glaucoma is to lower IOP in order to prevent or to slow down the damage to the optic nerve. Glaucoma treatment usually begins with medications or laser techniques. However, when these have failed or are not tolerated, your ophthalmologist may suggest surgical procedures. Medications — in the form of eyedrops or pills — are the most common early treatment for glaucoma. Some cause the eye to create less fluid. Others lower pressure by helping fluid drain from the eye.
In addition, laser surgery helps fluid drain out of the eye. There are three types of laser treatment. Doctors will often use an argon laser for open angle glaucoma. Furthermore, they’ll use a YAG laser for angle closure glaucoma, and a diode laser for end-stage glaucoma.
Common surgical procedures include trabeculectomy or valve implants to relieve pressure on the eye. The delicate, microscopic incisional methods include trabeculectomy with or without microshunt implantation, tube shunt (glaucoma drainage device) implantation, cyclophotocoagulation and newer procedures called MIGS, or minimally invasive glaucoma surgery. Each has its own special uses, advantages and disadvantages.
There are risks with any type of surgery. It is important to note that glaucoma surgery is very successful at substantially slowing the progression of glaucoma. Moreover, it achieves the intended eye pressure. Glaucoma surgery can prevent further vision loss and on rare occasions improves vision. However, damage that has already occurred as a result of glaucoma is considered permanent and not yet reversible.
Sometimes, the surgery can lead to eye pressures that are too low, called hypotony. This is more common soon after the surgery. With low pressures, fluid may collect behind the retina causing choroidal detachment. This results in a shadow in your peripheral or side vision. Usually this is temporary as the pressure returns to the levels that were intended. Sometimes, however, hypotony persists and surgery must be performed in order to fix this problem. More common than low pressure complications, glaucoma surgeries may fail over time due to the natural healing or scarring tendencies of the eye, resulting in eye higher than desired pressures. Sometimes, scarring is so intense that the operation may fail to achieve a lowered pressure and you may need to restart your glaucoma medications or undergo repeat surgery.
ALTERNATIVE THERAPIES AND PEMFS
Because glaucoma treatments are not 100% risk-free, nor are they always successful, and require lifetime treatment with potential side effects, are there alternatives to managing glaucoma? As with any condition being managed with magnetic fields or PEMFs, typically, the sooner treatment is begun in the course of the condition, the better the results and the faster good results are obtained.
As with most of the updates I write, I prefer to support my recommendations with research evidence, and my experience and the experiences of others. The latest science and knowledge regarding the causes of glaucoma are pointing to the significant presence of inflammation blocking the flow of fluid out of the eye channels, way before the discovery of either the presence of IOP or changes in vision, and the induction of an undesirable form of nitric oxide. The 2nd aspect of a focus for intervention is the protection of the retina from progression of the condition and perhaps recovery of the retina of the eye, when damage is already present.
MUCH OF THE RESEARCH ON THE USE OF MAGNETIC FIELDS IN EYE DISORDERS HAS COME FROM EASTERN EUROPE.
In one study, courses of rotating PEMF therapy (MT) were given using a device of a 33 mT [330 Gauss] magnetic field, rotation frequency of 1.0 to 1.5 Hz, to 31 patients (43 eyes) for 10 min with primary open-angle glaucoma, over 10 sessions. Untreated eyes (n = 15) of the same patients were controls. The patients were examined before and 4 to 5 months after MT. Vision acuity improved by 0.16 diopters, on average, in 96.7% of the treated people who had vision acuity below 1.0 diopter before treatment. By way of comparison, mild myopia [shortsightedness] could have a loss 1.00 to 3.00 diopters, while over the counter reading glasses will be rated at +1.00 to +3.00 diopters.
MT brought about an improvement of spatial contrast sensitivity by at least 7 of a possible 12 levels in 85% of 26 eyes assessed. After PEMFs, visual field deficits decreased by at least 10% in 72% of 43 eyes versus controls and decreased by 22% vs. the initial value overall in those treated. After 4 to 5 months the treatment changes in the vision acuity and visual field deficit were negligible, in other words the results were stable even after 4 – 5 months. In controls the parameters showed no improvement over the entire follow-up period.
Bisvas Shutanto Kumar, Listopadova NA. Possibilities of magnetotherapy in stabilization of visual function in patients with glaucoma. Vestn Oftalmol. 1996 Jan-Mar;112(1):6-8.
In a different study, a different device, that is, a “traveling” magnetic field device, similar to the Almag, was used to treat primary open-angle glaucoma (POAG). In a traveling magnetic field device each coil is turned on sequentially in a series repeatedly. That creates a wave or stream -like action in the tissues, thought to be more activating. The PEMF was applied in patients to the cervical spine in the area of the sympathetic ganglia. Vascular flow and pressure parameters were analysed along with visual evoked potentials, visual fields, and visual acuity. They found that magnetic field therapy produces better clinical results in patients with stage I and II POAG compared with medication (using trental tablets).
Magnetotherapy designed to affect cervical sympathetic ganglia for the treatment of patients with primary open-angle glaucoma. Veselova EV, Kamenskikh TG, Raĭgorodkiĭ IuM, Kolbenev IO, Myshkina ES. Vopr Kurortol Fizioter Lech Fiz Kult. 2010 Sep-Oct;(5):21-4.
Another group studied the influence of PEMF on the flow of fluid of the eye in POAG. They used a rectangular pulse form at a frequency of 50 Hz, 8.0-8.5 mT (80-85 gauss) intensity. The duration of the procedure was 7 minutes for a total of 10 sessions. 150 patients (283 eyes) were evaluated. Latent, initial and advanced glaucoma all benefited from the use of PEMFs. There was an increase in the amount and flow of fluid through the outflow canals of the front part of the eye [anterior chamber]. In the latent stage of glaucoma, outflow became normal in 25% of cases. At the initial and advanced stages 17.8% and 16.0% of cases, respectively, became normal. The authors concluded that they could recommend this method of treatment of open-angle glaucoma.
Tsisel’skiĭ IuV. Oftalmol Zh. 1990;(2):89-92. The effect of a pulsed electromagnetic field on ocular hydrodynamics in open-angle glaucoma.
Research evaluated the possible mechanisms for improvement seen in retinal function. The effectiveness of PEMF therapy is not the same in all patients. The benefits from PEMF treatment for 15-30 min usually last only for 8-10 days, consistent with the time to renew rod pigments in the retina. In addition, visual examination of the back of the eye after electromagnetic treatment reveals dilation of the capillaries. Hence, one conclusion is that the favorable effect of PEMF therapy was from improvement of microcirculation.
They found that retinal circulation gradually increased from arterioles to capillaries and venules. It appears that the authors concluded that the conditions for retinal rod pigment restoration in the central area of the retina are less favorable than in its peripheral areas. Therefore, the therapeutic effect in patients with loss of vision in the central area of the retina will occur after a greater number of PEMF stimulation sessions.
A possible mechanism of retina dystrophy treatment by electromagnetic field. Shlygin, V. V.; Arnautov, L. N.; Maksimov, G. V. Biofizika 38(3):507-510, 1993.
A PEMF system was used in the treatment of 283 eyes (177 patients) with macular damage of the retina. The treatment had a positive influence on the pathologic process in the eye, with stability of the benefit after treatment. In 152 eyes, visual acuity remained unchanged, improved in 131 (46%). Stabilization of the process was confirmed by objectively measured improvement indices. In 72 eyes, the results of treatment were followed up for 6 yr, confirming the effectiveness of this method of treatment.
Long-term observations have found the need to repeat the course of treatment every 3-5 months (within a year) to prevent progression of the damage. Unfortunately we do not have information on the characteristics of the magnetic system used. Nevertheless, this study demonstrates the need for longer-term treatment to get sustainable results. When one considers the length of time it takes to regenerate neural tissues, this long-term personal, home use approach makes sense.
The impulse electromagnetic field in the treatment of dystrophic lesions of the retina. Skrinnik, A. V.; Kovalchuk, A. S. Oftalmol Zh(8):459-462, 1989.
Since the general circulation and pumping of the heart affects circulation through the whole body, it is important to balance and restore the overall circulation, not just the circulation of the eyes. Also, glaucoma tends to be more common in people as they age. So, central general circulation, diastolic and pumping functions of the heart, reactivity of the heart muscle, microcirculation and biological age of the cardiovascular system were studied in 66 elderly patients with hypertension and ischemic heart disease. The patients received systemic magnetic therapy which produced a protective effect against aging as shown by improved microcirculation, heart muscle function, and central circulation.
The characteristics of the geroprotective action of magnetotherapy in elderly patients with combined cardiovascular pathology. Abramovich SG, Fedotchenko AA, Koriakina AV, Pogodin KV, Smirnov SN. Vopr Kurortol Fizioter Lech Fiz Kult. 1999 Sep-Oct;(5):7-9.
Indirectly, other actions of PEMFs on the eye can be taken as demonstrating repair and reduction of inflammation in the eye in general as well as specifically in glaucoma. Fifteen patients with surface infections of the cornea due to a foreign body in one eye were treated with PEMF (50 gauss, 50 Hz) for 9 minutes and the topical antibiotic gentamycin before and after removal of the foreign bodies. This treatment promoted suppression of the inflammatory reaction of the eye and accelerated corneal tissue regeneration. This study establishes that PEMFs can accelerate healing of not only inflammation but also eye tissue damage.
Verzin AA. Action of gentamycin against a background of magnetotherapy of the anterior chamber in a traumatic infected erosion of the cornea. Antibiotiki. 1982 Oct;27(10):774-5.
While most of our emphasis has been on the use of PEMFs, based on the studies we found, I also reviewed a study on the effect of a constant magnetic field (about 200 Gauss) on the fluid flow parameters of the eye. This was in 20 healthy controls and 29 patients with glaucoma. The magnet (a ring with internal diameter of 2.2 cm and external diameter of 5.1 cm) was applied to the external corner of the orbit so that the optical axis of the eye within the center of the magnetic field.
Duration of exposure was 3, 5, or 10 minutes. Exposure to the magnetic field caused a decrease of the intraocular pressure and decrease of the rate of tear secretion. The changes were more pronounced after 5-min exposure, while 10-min exposure did not cause significant changes in the fluid flow properties of the eye. From this study we do not know how frequently these exposures should happen and what the long-term benefits would be expected to be. Nevertheless, there appears to be benefit from even using static magnets of the right circular configuration.
SUMMARY
PEMFs have been shown in several research studies to have a positive impact on the glaucoma process, from potential to initial to later stages. Greater benefits are expected to be seen in earlier stages. PEMFs affect the flow of fluids in the eyes and therefore the intraocular pressures by decreasing inflammation, inducing the right kind of nitric oxide, improving circulation, particularly to the retina, and by probably also helping to stimulate repair of the nerve damage in the retina.
While most of the studies were short term, they still showed significant benefits to improving the function of the eye and slowing retinal damage and visual loss. I would recommend that anybody using PEMFs to treat their pre—glaucoma, increased ocular pressure and vision loss related to glaucoma, should do so daily for extended periods of time until it can be established that the pressures and the visual changes are stable for at least 4 to 6 months before discontinuing or reducing the frequency of PEMF treatments.
While very weak PEMFs may produce a benefit, these have not been studied. Most of the magnetic field strengths studied ranged from 80 to 330 Gauss (8-33 milliTesla). It doesn’t appear to matter that much which frequencies are used. This is because there was a lot of variation within these as well.
I don’t see a reason why PEMFs cannot be used with medical therapies for glaucoma. Perhaps reducing the need for laser treatment and/or surgical procedures. It may be challenging to get conventional doctors to agree to allow an individual to use magnetic therapy as a sole approach. However, since glaucoma is typically a gradually progressive process, and there is significant inter-individual variation in response, not only to magnetic fields but also to other therapies, initiating PEMF therapies as a sole therapy with close monitoring is probably worthwhile.
