Green, leafy vegetables can decrease your risk of glaucoma by 20%

Image: Green, leafy vegetables can decrease your risk of glaucoma by 20%

Research provides another reason for you to eat more leafy greens: They prevent the onset of a serious eye disease called glaucoma. In a study published in the journal JAMA Ophthalmology, researchers suggested that eating green leafy vegetables every day may cut one’s risk of glaucoma by 20 to 30 percent over many years.

Glaucoma is an eye problem that typically occurs when fluid in the front part of the eye increases and causes pressure, which in turn damages the optic nerve. This condition can result in loss of vision.

For the study, the research team followed about 64,000 participants in the Nurses’ Health Study from 1984 to 2012. They also followed over 41,000 participants in the Health Professionals Follow-up Study from 1986 to 2014. The participants were all aged 40 and above and did not have glaucoma at the start of the study. They had eye exams every two years.

Throughout the follow-up period, nearly 1,500 participants developed glaucoma. To determine whether diet played a role in the onset of the eye disease, the research team evaluated the diet, particularly the consumption of green leafy vegetables, of the participants. Then, they grouped the participants into five according to how much green leafy vegetables they consumed. Those who consumed the most amount of green leafy vegetables averaged about 1.5 servings a day, or approximately one and a half cups each day; while those who ate the least amount averaged about one serving every three days.

Although there was an association between consuming more leafy greens and a lower risk of glaucoma, it did not prove cause and effect. However, study leader Jae Kang explained that green leafy vegetables contain nitrates, which are precursors to nitric oxide. Nitric oxide plays a key role in regulating blood flow to the eye, and in glaucoma, there is an impairment of blood flow to the optic nerve. As an individual eats more leafy greens, the levels of nitric oxide in the body also increase.

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Kang is an assistant professor of medicine at Brigham and Women’s Hospital and Harvard Medical School in Boston.

Preventing glaucoma with diet

Earlier research has suggested that eating the right foods may help cut the risk of glaucoma, prevent the disease, and help keep eyesight healthy for many years. The study, published in the Archives of the Spanish Society of Ophthalmology, assessed the diets of people in two American ophthalmological studies, and in a study from Rotterdam in the Netherlands.

These large population studies found that consumption of foods rich in retinol, which is a form of vitamin A, helps lower the risk of glaucoma. However, there was no evidence that a diet rich in dietary fats promote the development of glaucoma, although too much fat intake is generally known to cause obesity and cardiovascular disease.

As the researchers dug deeper, they observed a link between lower rates of glaucoma and greater intake of leafy green vegetables, especially cabbage, carrots, fruits, and fruit juices, especially orange-colored fruits like peaches and apricots. In addition, the Spanish study suggested consuming flavonol-rich foods, such as green tea, dark chocolate, coffee (without sugar and little cream), and regular black tea. However, those who already have well-established cases of glaucoma should consume little or no caffeine because it can increase intraocular pressure and worsen the disease. (Related: Reduce glaucoma risk by drinking more green tea.)

In the study, the researchers provided a set of guidelines for lowering glaucoma risk:

  1. Eat plenty of colorful fruits and vegetables.
  2. Patients with hypertensive glaucoma should not consume too much salt.
  3. Avoid high-calorie diets to prevent body fat increase.
  4. Try eating foods rich in omega-3 fatty acids like fatty fish and nut as they seem to reduce risk.
  5. Drink small amounts of liquid throughout the day. Don’t drink large amounts in one shot.
  6. Drink red wine and green tea and eat dark chocolate moderately.
  7. If you already have glaucoma, do not consume caffeinated drinks.

Read more news stories and studies on foods that keep the eyes healthy by going to

Sources include:

10 Tips to reduce Chances of Glaucoma from American Academy of Ophthalmology

NEI-Funded Research Suggests Repetitive Strain From Eye Movement May Play a Role in Glaucoma

Repeated eye injections for age-related macular degeneration associated with increased risk for glaucoma: JAMA

Patients with age-related macular degeneration who received seven or more eye injections of the drug bevacizumab annually had a higher risk of having glaucoma surgery, according to a study published online by JAMA Ophthalmology. The advent of intravitreous (in the vitreous, the fluid behind the lens in the eye) anti-vascular endothelial growth factor (VEGF) injections to treat common causes of vision loss, such as exudative (wet) age-related macular degeneration (AMD) and diabetic macular edema.

Repeated eye injections for age-related macular degeneration associated with increased risk for glaucoma: JAMA

Read more at Medical Dialogues: Repeated eye injections for age-related macular degeneration associated with increased risk for glaucoma: JAMA

Is Glaucoma A Brain Disease

Glaucoma is a disease of the optic nerve, which is the long “cable” that connects the cells that transmit all of the visual information from the retina to visual targets in the brain. Glaucoma is first and foremost an eye disease, and the initial damage to the optic nerve is thought to take place in the eye. However, because the optic nerve is part of the central nervous system, one can certainly think of glaucoma affecting the brain. It is more appropriate to say that glaucoma is a neurodegenerative disease of the eye, although there are some influences of the brain on glaucoma and vice versa. In this article we will discuss some of the ways in which the optic nerve and brain interact in glaucoma.

Illustration of  brain connections

Can Pressure Inside the Brain Influence Glaucoma?

While one of the major risk factors of glaucoma is elevated eye pressure, more recently scientists have discovered that the pressure inside the brain may also influence glaucoma. This may be particularly true in patients who have “normal pressure glaucoma.” The rationale is that when the pressures inside the brain are lower than normal, and the pressures in the eye are “normal,” the difference between these two pressures (also called the translaminar pressure gradient) may still cause damage to the optic nerve.

Several scientists who have received grants from BrightFocus Foundation are studying this hypothesis, including Dr. Brian Samuels, Dr. Michael Fautsch, and Dr. Peter P. De Deyn.

  • Dr. Samuels’ research focuses on understanding which cells in the brain control eye pressure and brain pressure.
  • Dr. Fautsch is developing an animal model to study how lower brain pressures may influence optic nerve health and the development of glaucoma.
  • Dr. De Deyn is tackling this question from a different perspective. It has been known for some time that patients with Alzheimer’s disease may have changes in their optic nerves that mimic glaucoma. It is also known that Alzheimer’s patients have lower brain pressure. Dr. De Deyn’s team is studying the mechanisms by which patients with Alzheimer’s disease have increased risk of glaucoma. All of these studies will help shed light on the impact of brain pressure on the development and progression of glaucoma, in particular “normal pressure glaucoma.”

Indeed, perhaps in the future there will be treatments to influence brain pressure and thus glaucoma.

Do Changes in Retina Cells Affect the Brain?

Another area of active research is uncovering ways in which the degeneration of the retinal cells in glaucoma affects the visual pathways of the brain. Because the final step in neurodegeneration that causes glaucoma is death of the retinal ganglion cells of the optic nerve, it is perhaps not surprising that since these cells project all the way to the brain, that there would be changes in the cells of the brain as well.

  • Funded in part by BrightFocus Foundation, Dr. David Calkins and his team have uncovered some of the very early changes that occur in the brain in response to elevated eye pressure. These include decreased function of the retinal ganglion cells in their visual targets of the brain (Study 1 | Study 2).
  • Another team, funded by the BrightFocus Foundation and led by Dr. Kevin Chan, is developing new imaging techniques using MRI (magnetic resonance imaging) to study early changes in the visual system of the brain in glaucoma patients. They hope to uncover a noninvasive and comprehensive way to evaluate the effect of chronic high eye pressures on the structures of the brain involved in processing vision. A complete understanding of how the visual pathways are affected early in glaucoma neurodegeneration will help investigators identify new targets for treatment and better ways to detect glaucoma progression.

Glaucoma and Alzheimer’s: Is There a Connection?

Does glaucoma share any common degeneration pathways with other neurodegenerative diseases of the brain, such as Alzheimer’s disease? This is another area of active investigation and Dr. Stuart McKinnon, Dr. Ian Trounce, and Dr. John Wood have all contributed to this area.

  • Dr. McKinnon has published studies on the role of several abnormal proteins that are found in the brains of Alzheimer’s disease patients, including amyloid beta, on the retinal ganglion cells that die in glaucoma.
  • Dr. Trounce and his colleagues have studied another Alzheimer’s disease protein in more detail, specifically amyloid precursor protein. Their research focuses on the effect of age and elevated eye pressure on amyloid precursor protein breakdown and whether restoration of this protein may actually protect the optic nerve from injury.
  • Most recently, Dr. Wood was funded to study yet another Alzheimer’s disease protein, called tau. His work suggests that the characteristic changes in the tau protein that occur in Alzheimer’s disease, also occur in glaucoma.

All of these studies bring together what is known about the mechanisms underlying Alzheimer’s disease and applies it to glaucoma, in hopes of identifying new targets for treatment.


So, is glaucoma a brain disease? Certainly, glaucoma is a disease of the optic nerve, which can be considered an extension of the brain. And the optic nerve and brain influence each other in the neurodegenerative processes that results in glaucoma. By studying changes in the optic nerve and the brain, researchers will be advancing our understanding of glaucoma and developing new ways to diagnose, assess, and treat this potentially blinding disease.

Six gene variations linked to glaucoma risk

Scientists have identified six genetic variants associated with the eye condition glaucoma in people from around the world including Australia.

The discovery, in three major studies, could help identify people at higher risk of the disease and lead to earlier screening and treatments.

All three studies, published today in Nature Genetics, identify gene sequence variations of the ABCA1 gene, which is involved in the regulation of cellular cholesterol and lipid metabolism, as playing a role in the eye disease.

Professor Jamie Craig, of the South Australian Health and Medical Research Institute and joint leader of the Australian project, says the finding is significant.

“It’s rock solid that this is an important result because it has been found in three different ways,” says Craig, who is also from Flinders University’s Centre for Ophthalmology and Eye Vision Research.

“All the papers were done in different populations with different strategies and all identified the same gene.

“It has been shown to be involved in eye pressure in normal people and tells us for sure it is contributing to glaucoma at least partly through intraocular pressure pathways.”

Eye check

Glaucoma is the leading cause of irreversible blindness in the world.

It is caused by damage to the optic nerve, usually, but not always due to the eye pressure inside the eye (intraocular pressure) being too high, as the eye fluid does not drain properly.

People with a close relative with the disease are about 10 times more likely to contract the condition.

Early diagnosis of glaucoma is crucial because, if treated early enough, damage to vision can be prevented, says Craig.

Trio of studies

The Australian study, which also involved US researchers who replicated the findings, looked at potential gene targets in primary open-angle glaucoma (POAG).

POAG is the most common type of glaucoma and involves the progressive loss of peripheral vision until the central vision is affected.

The study included a cohort of 1155 patients from the Australian and New Zealand Registry of Advanced Glaucoma with severe POAG, and 1992 matched controls.

Genetic testing identified variants of three genes, ABCA1, AFAP1 and GMDS, which significantly increased the risk in Australians and Americans of European descent.

A second UK-led study, of which Craig is a co-author, involved genetic screening of 35,296 subjects including people with Asian and European descents drawn from across seven countries.

They found four new genes associated with high eye pressure and glaucoma. One of the genes is the ABO gene, which determines blood group, and higher eye pressure appears to be linked to blood group B.

The study also found a genetic change in the ABCA1 gene is associated with an increased risk of developing both high eye pressure and glaucoma.

The third Chinese study is unique says Craig because it is the first large-scale study of POAG in an Asian population.

It identified variants near two genes — ABCA1 and PMM2 — which are associated with glaucoma risk in people from China and Singapore.

Genetic risk

Craig says the findings may in the future be used to develop risk profiles that will allow doctors to know whether a person has high-risk of their glaucoma being severe.

“We are looking at ways to add up a genetic risk profile,” says Craig. “So if you can say if you’ve got a larger load of these variant genes, your risk is high.”

Craig says the ageing population means there is a “potential tsunami of people beyond 90 now going blind in the last years of their life”.

“Sometimes it is the one thing that means they can’t live independently.”

He says if you can identify those people at high-risk of severe glaucoma it can be treated more aggressively early in their life to save their sight.

However, he cautions it will take several years of experiments before the exact role of the genes identified in these studies is known, and these steps need to be taken before new treatment strategies can be planned.

Glaucoma: Sleep Apnea May Raise Risk.

Patients with sleep apnea were 1.67 times more likely to develop glaucoma than patients without apnea, according to a study that compared more than 1000 apnea patients with more than 6000 age-matched participants. The study was published in the August issue of Ophthalmology.

Ching-Chun Lin, MA, from the Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan, and colleagues relied on data from the Taiwan Longitudinal Health Insurance Database 2000, matching 1012 apnea patients aged 40 years and older with 6072 control patients of similar age, sex, and urbanization. A patient was considered to have apnea only if there were a record of him or her undergoing a sleep study. The researchers counted a glaucoma diagnosis only if the patient were prescribed medication.

“The fact that the authors required this [evidence of diagnosis] really increases the validity of their results,” Ahmad A. Aref, MD, assistant professor of ophthalmology, University of Illinois Eye and Ear Infirmary, Chicago, told Medscape Medical News. Dr. Aref, who authored a review on glaucoma and sleep earlier this year was not involved in the current study.

“Armed now with this study, clinicians should start to question their patients about sleep apnea,” Dr. Aref said. “I would treat it like other established risk factors for glaucoma, such as having a family member with glaucoma, or having high eye pressure, or being of African-American race. I would start to think seriously about grouping sleep apnea with those more established risk factors.”

Lin and colleagues found that the incidence rate of open-angle glaucoma among patients diagnosed with apnea was 11.26 per 1000 person years (95% confidence interval [CI], 8.61 – 14.49) compared with 6.76 per 1000 person years (95% CI, 5.80 – 7.83) for patients without an obstructive sleep apnea (OSA) diagnosis.

The adjusted hazard ratio (HR) for a glaucoma diagnosis within 5 years of being diagnosed with apnea was 1.67 (95% CI, 1.30 – 2.17; P < .001) after adjusting for monthly income, geographic region, diabetes, hypertension, heart disease, obesity, hyperlipidemia, renal disease, hypothyroidism, and number of outpatient visits for ophthalmologic care.

The adjusted HR for a glaucoma diagnosis among women in the 5 years after a sleep apnea diagnosis was 1.55 (95% CI, 1.04 – 2.31). For men, the adjusted HR was 1.45 (95% CI, 1.02 – 2.16).

“This study gives the most evidence to date that sleep apnea is a risk factor for OAG,” Parag Gokhale, MD, from Virginia Mason Medical Center, Seattle, Washington, told Medscape Medical News in an email. Dr. Gokhale, the spokesman for the American Academy of Ophthalmology, was not involved in the current research. Among the study’s strengths, he said, was the researchers’ decision to control for other possible causes of glaucoma, something several previous studies failed to do.

In this study, participants in the OSA group had higher levels of hypertension (P < .001), diabetes (P < .001), heart disease (P < .001), hyperlipidemia (P < .001), obesity (P < .001), renal disease (P < .001), and migraine (P < .001), the researchers found. Prevalence of hypothyroidism was equal in each group.

W. Christopher Winter, MD, medical director, Martha Jefferson Hospital Sleep Medicine Center, Charlottesville, Virginia, says this study should influence sleep specialists to include eye health in the list of concerns for apnea patients.

“With the risk [for glaucoma] 3 to 5 years out as high as it is, recommending a baseline eye exam would be a good thing. Eye exams, if your vision is good, usually fall by the wayside. I think I would add that,” Dr. Winter said.

The authors noted several limitations to the current study including a lack of severity information, such as apnea-hypopnea index scores or respiratory disturbance index scores, which would have allowed them to determine whether risk for glaucoma increased with the severity of the sleep apnea.

Source: Ophthalmology





,”san�9rf0� ��� east-font-family:”Times New Roman”; color:black’> ABCG2 (p<0.01), the group writes. In the 134 patients on atorvastatin, explainable blood-level variability was split between two polymorphisms in SLCO1B1 (p<0.01 and p<0.05, respectively) and the activity of cytochrome P3A (CYP3A). The analyses were adjusted for gender, age, body mass index, ethnicity, statin dose, and time from last dose, and echo a 2008 study which concluded that two SLCO1B1 variants were associated with simvastatin-related myopathy, as reported by heartwire . The screening concept is currently being applied to simvastatin therapy at least at one major center.


The group retrospectively tested their ideas, looking at the relationships between genotypic and clinical variables and statin dose, in a validation cohort of 579 patients taking either drug in a primary care setting in the US and at a referral clinic in Canada.

The group found that the transporter genotypes that raise statin concentrations were homogeneously distributed among patients taking a range of atorvastatin and rosuvastatin dosages. That is, the prescribing physicians, armed primarily with their clinical judgment to decide dosage levels, failed to achieve optimal dosing with respect to serum drug levels. But it seemed to be only patients receiving the highest dosages who showed higher-than-safe serum levels according to genotype- and age-based criteria.

“Although we didn’t quite get to the sample size we needed, it did seem like people with the wrong genetic makeup are more likely to stop a statin or switch to [another dyslipidemia drug],” Kim said, at least among patients on the highest statin dosages.

The group’s proposed management algorithm recommends a maximum statin dosage that will result in plasma concentrations below the 90th percentile (reflecting an assumption that 10% of patients will have statin-related muscle issues) based on patient age and transporter-related genotype.

The algorithm is based on data predominantly from whites; the group cautions that some other ethnicities, “particularly Asians,” have increased sensitivity to statins.



Alcon announces FDA approval of Simbrinza(TM) Suspension, a new beta blocker-free, fixed-combination therapy for glaucoma patients.

  • Simbrinza offers a wide range of treatment possibilities due to its strong efficacy, providing sustained control and a 21%-35% reduction in intraocular pressure[1],[2],[3]
  • Alcon provides a broad spectrum of pharmaceutical and surgical glaucoma treatment solutions to address patient needs at all stages of the disease

Alcon, the global leader in eye care and a division of Novartis, announces US FDA approval for Simbrinza(TM) Suspension, indicated for the reduction of elevated intraocular pressure (IOP) in patients with primary open-angle glaucoma or ocular hypertension.[4] Elevated IOP is the only modifiable risk factor for glaucoma.  Glaucoma is a group of eye diseases that lead to progressive damage of the optic nerve[5] and can result in gradual, irreversible loss of vision, and eventually blindness, if left untreated.[6] Glaucoma affects more than 2.2 million Americans[7] and is the second-leading cause of preventable blindness worldwide.[8]

Simbrinza is a fixed-dose combination medication that offers a wide range of treatment possibilities due to its strong efficacy and ability to decrease elevated IOP by 21- 35%.[1],[2],[3] In addition, it is the only available, fixed-dose combination therapy for glaucoma in the US without a beta blocker.[1],[2]

“Alcon is the global leader in providing both pharmaceutical and surgical options for patients living with glaucoma,” said Robert Warner, Area President, US and Canada for Alcon. “The introduction of Simbrinza further expands our ability to provide effective treatments for patients with elevated IOP. Given its excellent efficacy, established safety profile, and the fact that it is the only available, fixed-dose combination without a beta blocker approved in the US, Simbrinza has the potential to re-shape the treatment paradigm for glaucoma.”

The new ophthalmic suspension is a fixed-dose combination of a carbonic anhydrase inhibitor (Brinzolamide 1.0%) and an alpha 2 adrenergic receptor agonist (Brimonidine Tartrate 0.2%).[1],[4] It combines the two drugs into one multi-dose bottle, helping to reduce the medication burden for glaucoma patients.[9] Patients are to administer one drop of Simbrinza into the affected eye(s), three times per day.

“Simbrinza represents an important new option for treating glaucoma patients with elevated IOP,” said Gregory Katz, MD, Glaucoma Service, St. Joseph Mercy Medical Center, Ann Arbor, Michigan. “Glaucoma must be treated over the course of one’s life, and elevated eye pressure must be managed every day. It’s exciting to now have a product available that combines two effective compounds into one multi-dose combination, offering sustained control.”

The FDA approval of Simbrinza is based on data from two pivotal Phase III clinical trials with approximately 1,300 patients.[1],[2] The studies evaluated the safety and efficacy of a fixed-dose combination ofBrinzolamide 1.0% and Brimonidine 0.2%, administered three times daily, compared to separate three-times-per-day dosing of one or the other component.[1],[2] Both studies met their primary endpoint and demonstrated that Simbrinza is statistically superior compared to either component regarding mean IOP at Month 3 for all time points. [1],[2] In both studies, Simbrinza achieved a 5mm Hg to 9mm Hg reduction from baseline to Month 3. Patients’ mean IOP at baseline was 22mm Hg to 36mm Hg. [1],[2],[3]

In the two, three-month clinical trials, the most frequently reported adverse reactions in patients treated with Simbrinza (occurring in approximately 3-5% of patients in descending order of incidence) were blurred vision, eye irritation, dysgeusia (bad taste), dry mouth and eye allergy. Treatment discontinuation mainly due to adverse reaction was reported in 11% of Simbrinza patients.[4] The safety profile of the combination agent (Simbrinza) is comparable to each of the individual components. [1],[2] Additionally, there were no significant cardiovascular or pulmonary events found with Simbrinza in either clinical study conducted. [1],[3]

About Glaucoma

More than 67 million people worldwide have glaucoma, which is the second-leading cause of preventable blindness[8] and a disease that many know little about.[10] Glaucoma is a group of eye diseases that lead to progressive damage of the optic nerve.[5] Because the optic nerve transmits information from the eye to the brain,[11] glaucoma can result in a gradual, irreversible loss of vision and eventually blindness, if left untreated.[6] Elevated eye pressure is often present and is considered a risk factor for glaucoma.[11] However, in rare cases, even patients with a normal range of IOP can develop the disease.[6] The exact cause of glaucoma is unknown.

Source: Novartis newsletter

Inferior Field Loss Increases Rate of Falls in Older Adults with Glaucoma

Purpose. To examine the visual predictors of falls and injurious falls among older adults with glaucoma.

Methods. Prospective falls data were collected for 71 community-dwelling adults with primary open-angle glaucoma (mean age, 73.9 ± 5.7 years) for 1 year using monthly falls diaries. Baseline assessment of central visual function included high-contrast visual acuity and Pelli-Robson contrast sensitivity. Binocular integrated visual fields were derived from monocular Humphrey Field Analyzer plots. Rate ratios (RR) for falls and injurious falls with 95% confidence intervals (CIs) were based on negative binomial regression models.

Results. During the 1-year follow-up, 31 (44%) participants experienced at least one fall and 22 (31%) experienced falls that resulted in an injury. Greater visual impairment was associated with increased falls rate, independent of age and gender. In a multivariate model, more extensive field loss in the inferior region was associated with higher rate of falls (RR, 1.57; 95% CI, 1.06 to 2.32) and falls with injury (RR, 1.80; 95% CI, 1.12 to 2.98), adjusted for all other vision measures and potential confounding factors. Visual acuity, contrast sensitivity, and superior field loss were not associated with the rate of falls; topical beta-blocker use was also not associated with increased falls risk.

Conclusions. Falls are common among older adults with glaucoma and occur more frequently in those with greater visual impairment, particularly in the inferior field region. This finding highlights the importance of the inferior visual field region in falls risk and assists in identifying older adults with glaucoma at risk of future falls, for whom potential interventions should be targeted.

source:American academy of optometry