Glaucoma

The word “glaucoma” implies that the pressure inside the eye is high enough to cause damage to the optic nerve that runs from the retina of the eye to the brain.  This damage causes you to lose your ability to see.

There have been many things developed to measure the pressure inside the eye.  The first was to simply use your fingers to see if the eye feels abnormally hard.  Obviously this is very subjective and cannot identify small, but significant, increases in pressure.  Next was a device called the Schiotz tonometer.  This device has a piston that moves up and down inside a shaft that has a curved end to fit onto the cornea (front clear part of the eye).  How deep the piston will indent the eye is determined by three factors: 

   Schiotz Tonometer

   Schiotz Tonometer

1.  The pressure inside the eye

2.  The weight of the piston

3.  The stiffness of the tissue

One can increase the weight of the piston by adding a washer of known weight to it.  This is only necessary if the eye pressure is very high.

The Schiotz tonometer was used for many years as the standard method for measuring eye pressure and is still a very economical method of doing so.

                                       Applanation Tonometer

                                       Applanation Tonometer

The applanation tonometer was the next device invented for measuring pressure.  The basic concept is that one presses a flat plate of known diameter against the cornea of the eye until the cornea touches exactly all of the flat plate.  One can determine the pressure necessary to cause the eye to flatten exactly this amount and convert that pressure into the pressure of the eye.  Obviously the higher the pressure in the eye, the more pressure it will take to flatten it to a known amount.  The applanation tonometer is usually attached to the eye microscope (known as a slit lamp) so the doctor/nurse can view down the center of the tonometer head to see when the exact flattening occurs.

 

For many years the applanation tonometer was the “gold standard” for measuring eye pressure.  It does require the skill of someone that can effectively use the eye microscope.  This encouraged the use of a device that did not require that skill and could thus be performed by someone not able to use the microscope.  In addition, both the Schiotz tonometer and the applanation tonometer require the use of an anesthetic drop to numb the eye to perform the test.  Many years ago, optometrists were not licensed to use these medications, so there was a stimulus to find another way to measure eye pressures.  This led to the development of the “puff tonometer”.  This involves blowing a puff of air of known quantity and intensity at the cornea.  The distortion caused by this puff of air changes the reflection of light from the cornea.  This distortion can be measured and converted to an estimate of the eye pressure.  This device is convenient for having a staff member measure the pressure, but it is generally hated by patients because of the startle that occurs even when you know the blast of air into your eye is coming. 

                                Tonopen

                                Tonopen

In the 1990’s, a miniaturized and digitized version of the Schiotz tonometer was developed.  It is called the Tonopen.  One can simply “peck” at the cornea with this device and it will give you the pressure.  One advantage is that one can measure in the periphery of the cornea away from where Lasik is performed.  Measuring over the site of Lasik surgery with a Schiotz, applanation tonometer, or puff tonometer gives abnormally low readings.  Since so many people have had Lasik surgery, the Tonopen has become widely used.

 

You may experience any of these methods of measuring pressure when you visit your eye doctor.

There are several things that can give erroneous readings:

1.  Pressure from the squeezing of your eyelids while the pressure is being taken.

2.  Pressure from the fingers of the examiner.

3.  Change in the thickness of the cornea.

4.  Change in the elasticity of the sclera (white covering of the eye).

5.  Holding your breath while taking the pressure.

How Does An Increased Pressure Damage the Eye?

The eye is a part of the nervous system.  As such, it has a high demand for voltage, oxygen, and glucose.  All cells in the body are designed to run on fat as their primary fuel except for neurons.  They are designed to run on lactate (it used to be believed it was glucose)[1]. “The ability of the heart and skeletal muscles to metabolize glucose depends critically on the bioavailability of cholesterol sulfate, which is supplied through sunlight exposure to the skin.   When sulfate supplies are depleted, sugar piles up in the blood, and this can be very destructive to the blood proteins. The result of an overload of nutrients to a fragile vasculature is the formation of blood clots, for example, thrombosis, a life-threatening and vision-threatening condition. [2]

A normal liver can store about 1 1/2 hours of glucose for the nervous system and then it must be replenished if the nervous system is to run correctly.  As fuel (glucose) runs low, it is often vision symptoms that you notice first as your nervous system begins to malfunction.

The way that glucose and oxygen get to the eyes is by way of the vascular system.  If your circulation is inadequate, the nervous system begins to malfunction and eventually the neurons die.

The ability of the cardiovascular system and the respiratory system to bring blood and oxygen to the eyes is a careful balance of both systems.  Your heart must beat adequately to push the blood to the head and lungs.  You must have enough hemoglobin in your blood to carry oxygen to the eyes.  Your lungs must be able to move air in and out to provide oxygen to the blood so it can be distributed throughout the body.

A great problem in Western Medicine is that doctors forget that the body is a SYSTEM.  Heart doctors want the blood pressure as low as they can get it.  The reason is that the lower the blood pressure, the less work is placed on the heart.  They forget that it takes adequate pressure to push blood uphill to the brain and eyes.  Heart doctors and family practitioners/internists forget we have a brain and eyes.  Eye doctors forget we have a heart and often don’t check blood pressure to see if it is adequate to serve the needs of the eyes.  Both heart doctors and eye doctors tend to ignore the fact that the liver is the “fuel tank” for the brain and the eyes. 

Almost everyone forgets that neurons in the eyes replace themselves every couple of days.  Since they are made from fat, there needs to be a constant supply of fat to be able to make new cells.  If you are on a low fat diet, it is hard to maintain your brain, eyes, and nervous system. 

You cannot absorb the fat you eat if you don’t have bile.  The liver makes 1 1/2 quarts of bile a day.  Thus it needs a storage tank.  That is the reason we have a gall bladder.  If your gall bladder is removed, your liver cannot make bile fast enough to service a meal, so you will become fat depleted (fat around your hips and belly don’t count).  Without an ongoing source of good fat, you cannot keep your eyes in good repair.  Thus if you don’t have a gall bladder, you must take a bile supplement with each meal for the rest of your life.

Many are aware that vitamin A is important to vision.  It is rare to find an internist/family practitioner or ophthalmologist that remembers that vitamin A is a fat-soluble vitamin.  Without a gall bladder, you often become vitamin A deficient because without bile, you become deficient in the fat-soluble vitamins.  Ophthalmologists and optometrist should be very interested in whether you have a gall bladder, but few ever ask.

Another important issues is nitric oxide.  It is the master hormone of the body and also is responsible for dilation of blood vessels and bronchioles.  If you don’t have enough nitric oxide, your blood vessels can’t dilate and you get high blood pressure.  In addition, your lungs don’t work efficiently so you don’t move air in and out efficiently.  This compromises your ability to have adequate oxygen.

Nitric oxide is made from an amino acid.  You make amino acids by having your stomach acid break down the proteins you eat into amino acids.  If you don’t have enough stomach acid because you can’t make it or because you are taking medications to keep you from making stomach acid, you can’t break your proteins down into amino acids so you can’t make nitric oxide.  Thus you become unable to keep your vessels and bronchioles dilated.  To make stomach acid requires iodine, zinc, and vitamin B1.  Again we have the problem that doctors don’t think about how they are contributing to glaucoma, brain fog, depression etc. when they prescribe pills to shut down your stomach acid.  And certainly eye doctors aren’t trained to consider that your stomach pills are the reason your glaucoma is out of control!  No stomach acid leads to no amino acids and that leads to no nitric oxide and that means you can’t dilate the vessels in your eye and retina.

Nor are doctors trained that the fluoride in your toothpaste is keeping you from making adequate stomach acid by inactivating the iodine you need to make stomach acid.

It should now be obvious to you that the nutrition necessary to make good neurons is critical to vision and the brain function.  One must also have a functional circulatory system with oxygen from the lungs and glucose from the liver.  The blood pressure must be high enough to put all of this uphill to the head.

 

If the pressure in the eye is high enough to compromise the circulation to the eye, it inhibits the arrival of vitamins, minerals, amino acids, fats, and oxygen necessary to the function of the retina and optic nerve as well as the parts of the brain that allow for vision to work.  This causes the neurons in the optic nerve to die.  Eventually this causes blindness.  This is glaucoma.

The amino acid glutamate is the major signaling chemical in nature. All invertebrates (worms, insects, and the like) use glutamate for conveying messages from nerve to muscle. In mammals, glutamate is mainly present in the central nervous system, brain, and spinal cord, where it plays the role of a neuronal messenger, or neurotransmitter. In fact, almost all brain cells use glutamate to exchange messages. Moreover, glutamate can serve as a source of energy for the brain cells when their regular energy supplier, glucose, is lacking. However, when its levels rise too high in the spaces between cells—known as extracellular spaces—glutamate turns its coat to become a toxin that kills neurons.* http://www.dana.org/news/cerebrum/detail.aspx?id=7376&p=3

When neurons become damaged, the glutamate is spilled out of the damaged neuron.  This allows excess sodium, calcium and other things to enter the cell in large quantities.  This causes an inflow of water.  This makes the nerve cell die as its blood supply is compromised.  This whole process is called a “glutamate storm”. 

One of the protective mechanisms against ongoing glutamate damage is vitamin B12 in large doses.  What is considered “normal blood levels” of B12 may not be adequate in people with glaucoma.  Having high blood levels of B12 is not damaging and thus you should not worry if blood tests find high levels of B12 while you are battling glaucoma.

Another protective mechanism occurs when you eat green apples or grapes.  Apple juice is also useful.  You should increase your intake of these fruits if you have glaucoma or other brain injuries.

Low Pressure Glaucoma

There is a condition where the pressure is in the “normal” range but the retina and optic nerve malfunction as if the pressure were high.  This is called “low-pressure glaucoma” but is really a malfunction of the vascular/respiratory/liver/gall bladder/digestive system and really should be called optic nutritional deficiency syndrome” or something similar to focus attention on where the problem really is.

What Causes the Pressure in the Eye to Increase?

In the opinion of this ophthalmologist, much of the teaching about glaucoma is incorrect because it ignores an understanding of the lymphatic system.  To really understand glaucoma, you must understand the reason we have a lymphatic system and how it works.

The Cellular Sewage System (Lymphatics)

When cells place their garbage at the curb (push it into the extracellular space so it can be removed), most of it is moved into the venous capillaries.  However, proteins are too large to fit there.  Thus we have an entirely separate system to remove waste proteins.

Waste proteins can be considered cellular sewage!

The lymphatic system is dedicated to removing waste proteins.  Thus it is our cells’ sewage disposal system.  These channels are tubes that connect the extracellular spaces around cells with a large vein (subclavian) that enters the heart just under the clavicles (collar bones).  From here, it goes through the liver, into the bile, into the intestine and is removed from the body with your bowel movement.

The power supply for the lymphatic system is the sympathetic (triple burner) acupuncture muscle battery pack.  It can malfunction if you have infection in the bone where your wisdom teeth were removed because the autonomic nervous system runs through these areas.  If you have this, it must be corrected by a knowledgeable dentist.

It can also be affected by emotional baggage.  Emotional releases using the Tennant BioModulator or a similar system is often helpful in correcting eye pressures by activating the lymphatic system.

lymph1.png

What is different about this system is that it has no heart or other pump to move the waste forward except in the head.  (In the head, the craniosacral pump assists in moving fluid in the lymphatics.)  Instead, the tubes are surrounded by a circular muscle and by stretch receptors.  When the tubes are stretched (such as by walking or moving your arms), they activate the circular muscles.  This moves the sewage down the tubes much like squeezing a tube of toothpaste.

 

When you are inactive, the sewage isn’t moved along the tubes.  It can congeal in the tubes.  Now your sewage system backs up just the way it can happen when your toilet gets stopped up by something too large to move through the sewer pipes.  As the sewage backs up, it floods back into the extracellular spaces just as sewage floods your bathroom floor.

Can you see this in your mind?  Your cells are surrounded by sewage.  The sewage cannot be eliminated until you unstop the lymphatic tubes just as your toilet won’t flush until you move the obstruction on down the pipes.

Sewage is a strong electron stealer.  It significantly lowers the voltage in the extracellular space.  This is reflected in a consistently low urine pH.  That is because urine pH is a reflection of the voltage in your extracellular space.  If it is consistently below 6.5, you likely have a stopped up lymphatic system.

People often notice that they are gaining weight or can’t lose weight.  This weight is often sewage instead of fat.

Another way to see if your sewage system is stopped up is to look at the clavicles (collar bones).  They should be clearly visible.  If you can’t see your clavicles, you likely have lymphatic obstruction.

Allergies from Retained Sewage

Imagine what retained sewage does to you immune system.  It drives it crazy!  All of those damaged proteins are everywhere.  It’s like you fell into a pit of snakes and are struggling madly to get out.  You strike out at anything that moves.

The longer that your lymphatics are obstructed, the more different antibodies you make until you become allergic to almost everything.  Now you are called “chemically sensitive”.

Surgery and Sewage

From any point on the body, the sewage must pass through a lymph node so that large particles and particularly bacteria can be filtered out before it reaches your blood stream as it flows into the subclavian vein just above your heart.  Think of lymph nodes as sponges filled with antiseptics.  You could also think of them as sewage treatment plants intended to clean up the sewage water before it comes back to your house.

What happens when a surgeon removes your lymph nodes?  They take out some of the lymphatic pipes and their filters.  Also scars interrupt the lymphatic sewer system and the acupuncture wires that bring voltage to the area.  Now how is the sewage supposed to get cleaned and drained?  It can’t.

The Eye is a Unique Part of the Lymphatic System

 

Remember that the reason we have a lymphatic system is to get rid of waste proteins because they are too large to fit into the venous capillaries.  The waste proteins are from worn out proteins in the cells.

We replace the rods and cones in our retina every 48 hours, so we create a lot of “sewage” in our eyes.  Therefore we need a special system capable of handling all this sewage.  The inside of the eye is hollow so it has the room for all this sewage.  To keep it flowing, some fluid is added by the lining of the focusing muscle (ciliary body) secreting what is known as “aqueous humor”.  Thus aqueous humor is like extracellular fluid in the rest of the body.

Remember that lymphatic tubes have large pores with flaps over them that allow the proteins to enter and be trapped inside the lymphatic tube.  In the eye, this tube is in a circle around the front of the eye where the white sclera meets the clear cornea.  It has a special name, “Schlemms Canal”.  Here the sewage passes out of the eye into the general lymphatic system of the face as seen in the graphics on these pages.  The sewage from the eyes flows from the corners of the eyes to lymph nodes in front of the ears.  It then flows around the ear to a node behind the eyes known as the “water wheel”.  From here, it flows down channels along the sternocleidomastoid (strap) muscles of the neck to nodes just above the clavicles (collar bones).  It then flows behind them into the final common port of the lymphatic system.  This is where the lymphatics flow into a large vein (subclavian) and thus into the general circulation.  It is then taken to the liver for detoxification and finally excreted by the large intestine and kidneys.

canal of schlemm.png

The drainage system I have just described is similar to the one in your home.  Consider a toilet upstairs in your home.  Sewage is deposited in it.  It then is flushed and goes down various sewage pipes until it finally exits your home and is sent to the sewage treatment plant (like your liver) where the proteins are broken down. Now consider what happens when the sewer pipe that leaves you home is stopped up.  When you flush the toilet, the water backs up, overflows and makes a mess on your bathroom floor.  If you closed the bathroom door and it was water-tight and the toilet kept flushing, you would have “toilet glaucoma”.  The pressure of the sewage and water would keep building up inside the bathroom eventually causing destruction of the walls of the bathroom.  This is what happens to the nerves in your eyes when their lymphatic systems become obstructed.  This is glaucoma.

If this were happening in your home, you would attempt to remove the obstruction in the sewer pipe between the bathroom and the street.  That is what we should be doing with glaucoma.

Conventional Treatment of Glaucoma

Most conventional training in glaucoma ignores the lymphatic system and assumes that glaucoma is a malfunction of the venous capillary system. The conventional training in glaucoma is that the fluid manufactured by the ciliary body is intended to nourish the structures of the front of the eye since the cornea doesn’t have blood vessels to bring it nourishment.  As more nourishing fluid is made, it is intended to flow out of Schlemm’s canal into the venous capillaries and thus maintain a normal pressure in the eye.  Thus we are taught that Schlemm’s canal is a part of the venous capillary system instead of a part of the lymphatic system.

When Schlemm’s canal becomes obstructed for unknown reasons, pressure builds up in the eye causing damage to the nerves as they pass from the optic nerve to the retina.  Treatment is then focused on decreasing the production of fluid from the ciliary body and/or increasing the outflow efficiency of Schlemm’s canals.  Drugs used to treat glaucoma are generally divided into those two groups:  those that decrease fluid production and those that try to stretch Schlemm’s canal so it will drain better.  In general, those that are said to stretch Schlemm’s canal are those that cause muscle contraction of the iris and ciliary body muscles.  (They actually work by stimulating the circular muscles of the lymphatic channels.)  They make the pupil very small.  The muscle spasms induced by these drops can be very uncomfortable.  The most famous of these drops are pilocarpine and carbachol.  They are rarely used any more as drops that decrease fluid production are more abundant and profitable and cause fewer symptoms.  However, these forgotten drops are a better in the sense that they encourage the drainage of the lymphatic channels where the real problem lies.  Since their patents ran out years ago, it is hard for drug companies to make any money marketing them, so the newer drops have become standard of care.

An obvious problem with using drugs to decrease the fluid production in the eye is that the sewage gets thicker and more difficult to get into the lymphatic drainage channel called Schlemm’ canal.  Thus glaucoma treated in the standard way is characterized by a need to keep adding more and more medication to lower the pressure.  All this does is increase the amount of sewage that can’t get out of the eye.  This retained sewage is an electron stealer so it lowers the voltage in the eye resulting in more rapid failure of the retina, lens, cornea, etc. with earlier onset of macular degeneration and cataracts.

Think of decreasing the amount of water you can have to flush your toilet.  You decrease it by one pint (start the first eye drop).  Then you decrease it by two pints (add the second eye drop).  Then you keep decreasing it until you have no water left to flush the toilet.  This is typical glaucoma therapy.

If the pressure cannot be lowered enough to stop damage to the nerve with the use of several eye drops (and occasionally oral medication as well), surgery is recommended.  An effort is made to create a new channel where the fluid can flow outside the eye to lower the pressure.

 

Such surgical procedures have their own set of problems.  If too much fluid flows out, the eye becomes too soft and cannot function.  Scarring shut of the new channel is a constant problem and obviously makes the channel fail to lower pressure.  Also, since there is an open tract from the outside to the inside of the eye, an infection inside the eye is a constant threat.

An ongoing effort over the last 30 years have been to create some sort of plastic valve that can be used to connect the inside and outside of the eye so fluid will flow out as necessary without having the valve/tube device scarring shut nor allowing too much fluid to flow out.  As you might guess, there are significant mechanical problems with such devices including keeping them from migrating away from where you put them.

Many years ago, I found a method to create such a channel that worked every time I used it and had no side effects.  I discovered how to do it while removing cataracts in patients that also had glaucoma.  I made the kind of two-stepped incision that I described in this book.  I made it six mm. wide to accommodate the phakoemulsification (cataract removal) devices of that time.  After removing the cataract and putting the lens implant in place, I took a diamond knife and split the inner layer of the two-stepped incision in a radial fashion. I extended this cut one mm. beyond the incision that was circumferential around the eye.  Then I simply brushed the conjunctival flap over the area.  No sutures were used.  By constantly having the intraocular fluid flowing over the parted lips of the incision, it had no tendency to scar or heal.  The tiny trickle of fluid under the conjunctival flap always controlled the eye pressure but did not cause any significant distortion of the conjunctival flap.  There were no “thin blebs” as is often the case in similar filtration surgeries.  There were no eyes that were too soft and no bleeding. Patients loved not having to use eye drops after my surgery.  They couldn’t wait for me to fix the second eye.  Then the government got involved.  They decided that curing glaucoma while I was removing a cataract was “unnecessary surgery” and insisted I stop doing it.  They made me give back all the money I had received for curing the glaucoma AND for removing the cataracts as well!  My patients were furious, especially those that had the first eye cured and wanted the same in the second eye.

Since Medicare told me that curing glaucoma was unnecessary surgery, I created a form that the patients signed saying that if they wanted me to cure their glaucoma at the same time I removed their cataract, I would do so without any additional charge.  However, the next time the Medicare “experts” reviewed my charts and found I was still doing the surgery at no charge, they told me if they caught me curing glaucoma again, I would be permanently banned from treating any Medicare patient.  Thus I had to stop doing this wonderful procedure.  “I’m from the government---I’m here to help you!”  Yeah, right.  The only people the government helped were those selling my patients expensive eye drops.

 

The Craniosacral Pump and Glaucoma

In the chapter on the Bowling Ball Syndrome, I discussed the craniosacral pump.  This unique pump assists the lymphatic system in the skull.  Thus it is critical in controlling eye pressures as well as helping remove fluid from your ears and brain.

I have seen eye pressures fall as much as 20 mm Hg (from 55 to 35 in open angle glaucoma) by just turning on the pump.  Most people get a few mm, of improvement within an hour after correcting the Bowling Ball Syndrome to activate the pump.

The first thing that should be done in treating glaucoma is to turn the craniosacral pump back on.  If you skipped it, go back and read the Bowling Ball Chapter.

A New Paradigm in Curing Glaucoma

What is meant by “curing” glaucoma.  It is important that you realize that when the nerve fibers in the optic nerve die and your vision is significantly diminished, you will likely NOT get your vision back.  If nerves are damaged, they can regenerate in some cases, but this can take 8-12 months.  If they have become scar tissue, they cannot recover.  Thus do not assume that following the steps I outline in this book will miraculously restore lost vision from glaucoma. 

What is often possible is to stop the steady progress toward blindness and reduce or eliminate your need for eye medications to treat glaucoma.  If you have the diagnosis of glaucoma and need to use daily medication to control it, you have glaucoma.  If you had glaucoma but you can now go without drops or other treatments to control it, you are “cured”.  The analogy is diabetes.  If your blood sugars are too high (over 135) and you lower them to 90 using diet and exercise, you are said to be “cured” from your diabetes.  If your eye pressures are too high and causing damage and you use the things I am discussing in this book, you pressures may return to the levels where you no longer need medication.  Like diabetes, you are said to be “cured” from your glaucoma.  This does NOT necessarily mean that your vision returns to normal.

The things that are recommended to treat your glaucoma include:

1.    Correct the Bowling Ball Syndrome and be sure your total body voltage is normal so the craniosacral pump will keep working.

2.    Correct your total body voltage.

3.    Correct lymphatic drainage from the head.

4.    Correct your levels of humic and fulvic acids.

5.    Correct your levels of stomach acid so you can make amino acids.

6.    Correct your nitric oxide levels.

7.    Eliminate any dental infections that are in the acupuncture circuits to the eyes to stop damage from thioethers and gliotoxins.

8.    Be sure your blood pressure is high enough to get blood to the brain and eyes 120-140/80-90.

9.    Be sure your liver is functional to provide glucose to the eyes.

10. Be sure your gall bladder works so it allows you to adsorb fats to repair your eyes.  If you don’t have a gall bladder, take bile with each meal.

11. Your eye doctor must follow you carefully to be sure there is no unrecognized damage occurring to the optic nerves.

12. Use only the amount of eye medication that is needed after the above are accomplished.

13. Don’t stop or reduce your eye medication without being instructed to do so by your eye doctor.

 

[1] Wyss MT, Jolivet R, Buck A, Magistretti PJ, Weber B (May 2011). "In vivo evidence for lactate as a neuronal energy source". J. Neurosci. 31 (20): 7477–85. doi:10.1523/JNEUROSCI.0415-11.2011. PMID 21593331.

[2] Seneff S, Lauritzen A, Davidson R, Lentz-Marino L. Is endothelial nitric oxide synthase a moonlighting protein whose day job is cholesterol sulfate synthesis? Implications for cholesterol transport, diabetes and cardiovascular disease. Entropy 2012, 14:2492-2530.