For the past two years I've been in a holding pattern, diagnosed with suspected pre-glaucoma but not at the point of needing/being prescribed any medicinal eye drops. My optic nerves are showing some "cupping" and are larger than they were 3 years ago. There's no indication of diabetes, hypertension, intraocular pressure or visual field changes. I've worn glasses since I was 10 for myopia, contact lenses since I was 16 and bifocals since my mid-forties with very little changes in prescription needed. There's no family history of glaucoma. I had a few concussions as a child and teen. I'm 74, walk at least 1.5 miles daily, do stretching exercises daily (attended yoga classes 3X week before the pandemic), take no prescription medications, eat very healthfully and am in good health. My question is can you guide me in the direction of being more proactive? I've been taking H&A's Insight Compound, as well as ginkgo extract and St. John's Wort extract. I just ordered Pure Encapsulation's Vit A 10,000 IU, lutein 20mg, bilberry 160mg (standardized to 25% anthocyanosides). Do you think there is more I could be doing? I realize I'm not providing you with an in-depth intake but would be happy to schedule a virtual consult with you, if you do that. Thanks for taking a quick look! Lin

I am sorry I am not taking new patients, I simply do not have the time to give you the attention you deserve. As for Glaucoma here is some information from one of my papers. Glaucoma Glaucoma is a group of eye diseases where the intraocular pressure (IOP) in the eye increases (in most cases only 50% of people with open angle glaucoma have elevated IOP) and causes damage to the retinal ganglion cells (RGC). If untreated, it is progressive and is a leading cause of blindness. There are 4 types of glaucoma, open-angle (chronic) glaucoma, angle-closure (acute) glaucoma, infant or congenital glaucoma and secondary glaucoma. Although the cause of glaucoma is not entirely understood, it is clear that there can be a strong genetic component. If a parent or grandparent has glaucoma a person has an increased risk of developing this disease. People of East Asian descent have a much greater risk of developing angle-closure glaucoma, as do Innuit people and women. People of African descent are at greater risk of developing open-angle glaucoma. One human RCT found that glucosamine supplementation, especially in the elderly, increased intraocular pressure (Esfandian, et al, 2017). Orthodox treatment for glaucoma includes prescription eye drops (prostaglandins, beta blockers, alpha-adrenergic agonists, carbonic anhydrase inhibitors and parasympathomimetics), laser therapy and eye surgery. Research using electron microscopes has found that congestion of micro-capillaries and lymph vessels plays a role in glaucoma (Prünte, et al, 1998). Using herbs that move blood and lymph may enhance the efficacy of treatments for glaucoma. Herbs and Supplements For Glaucoma Blood moving herbs for glaucoma Hong Hua/Safflower flos (Carthamus tinctoria) Dang Gui root (Angelica sinensis) Peach seed/Tao Ren (Prunus persica) Dan Shen root (Salvia miltiorrhiza) Tienqi Ginseng root (Panax notoginseng) Red Peony root (Paeonia albiflora) Tree Peony bark (Paeonia suffruticosa) Ligusticum root/Chuan Xiong (Ligusticum chuanxiong) Lymphatic herbs for glaucoma Poke root (Phytolacca americana) Red Clover blossoms (Trifolium pratense) Figwort herb/root (Scrophularia marilandica) Cleavers herb (Galium aparine) Self Heal herb (Prunella vulgaris) Burdock root (Arctium lappa, A. minus) Calendula flower (Calendula officinalis Red Root (Ceanothus spp.) Astragalus root (Astragalus membranaceus) Is used for treating many conditions in Chinese medicine including respiratory, cardiac and immune issues. It has not been used traditionally for treating glaucoma. In an animal study, researchers found that Astragalus given orally significantly reduced intra-ocular pressure (IOP) as well as enhancing glutathione peroxidase (GPX) levels and reducing ocular oxidation (Horng, et al, 2011). While it is not known if it will have the same effect in humans, it is safe and may offer some benefits as part of a glaucoma protocol. Dose: Tea (Decoction): 2 tsp. dried root, 12 oz. water, decoct 20 minutes, reduce to 6 oz, steep 30 minutes, take 3 cups/day Tincture (1:5): 2-4 mL TID Extract granules (6.7:1): 1.5 g, 1-3 times per day mixed in water Cannabis (Cannabis sativa) Regular use of the herb reduces intraocular pressure by enhancing uveoscleral outflow. The effects are short-lived and some research suggests that when Cannabis is discontinued there can be a significant rebound effect, with a worsening of IOP. With the exception of states with medical marijuana laws, this drug is illegal even when prescribed for medical usage. The synthetic derivatives, such as Marinol, are not effective for treating glaucoma or for pain relief. Coleus extract (Coleus forskohlii) Eye drops made with the standardized extract (15-18% forskohlin) have shown benefits for treating glaucoma. Oral use of the product has not shown therapeutic activity for this condition. Unfortunately standardized Coleus eye drops are not available in the United States. Dan Shen root (Salvia miltiorrhiza) Has been used in TCM to move blood, for treating cardiovascular, liver and female reproductive problems due to blood stagnation. Several of the major active constituents of this herb, baicalein, baicalin and wogonin, have been shown to have benefits for eye problems due to their antiinflammatory, antioxidant and circulatory-enhancing activity (Xiao, et al, 2014). In a report from the Association for Research in Vision and Ophthalmology (ARVO) isolated baicalein was found in an animal study to significantly reduce intraocular pressure by improving fluid drainage from the eye (ARVO, 2015). Dose: Tea (Decoction), 2 tsp. dried root, 16 oz. water, decoct 30 minutes, steep 1-2 hours, take 2 cups/day Tincture (1:4 or 1:5): 2-4 mL TID/QID Extract granules (6.7:1): 1.5 g, 1-2 times per day mixed in water Fennel seed (Foeniculum vulgare) Has a history of use as an eyewash to treat eye irritation and conjunctivitis. In an animal study, a single drop of a Fennel infusion dramatically reduced IOP (approximately 30%) in experimental models of glaucoma (Agarwal, et al, 2008). There is no human research to confirm this but the results are intriguing. If this was going to be used, a saline decoction would be appropriate. Dose: ¼ tsp. dried, ground fennel seed, 4 oz. water, decoct 5 minutes, steep ½ hour. Add ¼ tsp. Kosher salt and 1/16 tsp. baking soda, strain through a fine filter or linen. Use 1 drop per eye BID. Ginkgo standardized extract (Ginkgo biloba) Is an adjunctive therapy to help increase ophthalmic circulation, decrease oxidative damage to eye tissue and modestly improve vision in patients with normal tension glaucoma (NTG). In a clinical study done over 12 years, people with NTG who took a standardized Ginkgo preparation had a significant reduction in visual field damage, especially in the superior central visual field (Lee, et al, 2013). In another human study, participants with NTG were given a combination of standardized Ginkgo and Bilberry anthocyanins or no medication. Those receiving the herbs had improved visual function compared to the control group (Shim, et al, 2012). Dose: Standardized extract (24% Ginkgo flavones, 6% terpenes): 120-240 mg per day Goji berry/Gou Qi Zi (Lycium chinense, L. barbarum) This bright red fruit, known as Gou Qi Zi, is used in TCM for treating a wide variety of eye problems. In an animal study oral intake of a water extract of the fruit strongly protected the retinal ganglion cells (RGCs) from damage caused by an ocular hypertension model of glaucoma (Chan, et al, 2007). Dose: Tea (Decoction): 2-3 tsp. dried fruit, 12 oz. water, decoct 15-20 minutes, steep 1 hour, take 3 cups/day Tincture (1:4): 3-5 mL QID Extract granules (2.5:1): 2 g, 1-3 times per day mixed in water *Pulsatilla fresh herb (Anemone pulsatilla, A. patens) Was recommended by Rudolf Weiss, MD for glaucoma caused by constitutional disturbance. Dose: Fresh Tincture (1:2): 10 gtt. in 4 oz. water, mix, take 1 tsp. TID PycnogenolⓇ (Pinus pinaster) with Bilberry (Vaccinium myrtillus) In a human clinical trial, patients with ocular hypertension were given either a pharmaceutical drug (Latanoprost), Pycnogenol® (40 mg) and Bilberry (80 mg) BID or both. All three groups had a significant drop in intraocular pressure with the group given the drug and supplement having the most significant results (Steigerwalt, et al, 2010). In a second RCT of the same product (MertogenolⓇ), participants were given either Latanoprost, Dorzolamide-Timolol and MertogenolⓇ or Latanoprost and MertogenolⓇ. All three groups had decreased intraocular pressure (IOP) and improved retinal microcirculation. Patients given the herb combination had better perfusion patterns and reduced oxidative stress (Rizzi, et al, 2017). Saffron (Crocus sativus) In a preliminary human study, a Saffron extract was given along with conventional medication to people with clinically stabile primary open angle glaucoma (POAG). During the study and after the wash-out period, the intraocular pressure (IOP) of the Saffron group was reduced significantly from test subjects receiving a placebo (Jabbarpoor Bonyadi, et al, 2014). In an animal study, a standardized Saffron extract decreased inflammation, activation of microglial cells, intraocular pressure and prevented retinal ganglion cell death in a glaucoma model (Fernandez-Albarral, et al, 2019). Dose: Tea (Infusion): 4-6 stigmas to 8 oz. hot water, steep covered 10-15 minutes. Take 2 oz. BID Tincture (1:5): 5-15 gtt BID Capsule – standardized extract: 30 mg. per day Wu Ling San (Hoelen five herb formula) This classic TCM formula is used to drain excess fluids and open the circulatory channels. It contains Poria, Water Plantain root, Polyporus/Zhu Ling, Atractylodes macrocephala root and Cinnamon twigs. In a Chinese study 63.6% of glaucoma patients had a significant decline in intraocular pressure after using this formula (Dharmananda, 1997). Tablets: 6 tablets, 2-3 times per day

Thank you so much, David, for sharing your knowledge. You've given me a lot to consider!