Glaucoma Supplement Therapy, Guidelines to Initiating

My Guidelines to Initiating Glaucoma Supplement Therapy

I currently recommend over a dozen supplements to my patients with glaucoma. Do I expect any of my patients with glaucoma to take all of them? No. Taking so many different supplements daily could be overwhelming. Most of my patients have medical conditions other than glaucoma requiring them to take prescription medications multiple times each day. Additionally, many of the supplements I recommend can cost over $40 for a monthly supply. It would simply be unreasonable to expect all of my patients to both afford and coordinate the dosing schedule of so many additional supplements each day.

So, how do I make my recommendations? I do so individually, based upon laboratory test results, what each patient can afford, and what other conditions (such as diabetes) may be present. As I know that not everyone will have the opportunity to consult with me for a personalized recommendation, I’ve outlined the basic approach I take to recommending glaucoma supplement therapy.

Please note that these are guidelines I use when making personalized recommendations to my patients in whom I have a knowledge of both their glaucoma and general health conditions. These guidelines should not be considered medical advice. When adding any supplement to your daily routine it is important to make your physician aware of this change as many supplements can interact with prescription medications.

First Consider What Should be Avoided

“Natural” supplements may be extracted from fruits, leaves, and other plant-based sources. That doesn’t mean they are without risk. Many supplements that are generally recognized as safe (GRAS) by the FDA when taken in commonly available over-the-counter doses can still interact with prescription medications or other health conditions in undesirable ways.

Be Aware of Interactions with Blood Thinners

Anyone taking prescription blood thinners must be very careful with what they ingest. This is true for food, drink, and supplements. A number of supplements have anti-platelet/anticoagulant activity. Undesirable and potentially dangerous bleeding could occur if these supplements are added to a daily routine of prescription anticoagulant therapy. The following supplements should be used with care or not at all if you are already on a prescription blood thinner such as aspirin, apixaban (Eliquis), clopidogrel (Plavix), dabigatran (Pradaxa), rivaroxaban (Xarelto)and warfarin (Coumadin):

Supplements may Negatively Impact Hormone Sensitive Cancers or Conditions

Many supplements (such as the flavonoids) have a structure that is similar to estrogen. As such, they may alter estrogen metabolism. Women with breast, uterine, and ovarian cancer, as well as endometriosis and uterine fibroids should avoid use of the following supplements:

Start with what’s Easy, Inexpensive, and has Evidence Supporting other Health Benefits

If you’re going to start a supplement program for glaucoma, wouldn’t it be great if the supplements not only treated your glaucoma, but your general health as well? The following have well-established health benefits, can be taken only once daily, and are inexpensive:

Consider Glaucoma Type

Normal Tension Glaucoma in those Not Taking a Blood Thinner

Normal Tension Glaucoma (aka Low Tension Glaucoma) results in loss of vision even when the intraocular pressure (IOP) is in the “normal” range. It is a particularly challenging type of glaucoma to treat. This is because all available prescription and surgical treatments work by lowering the IOP. If the IOP is already low what else is there to do?

It appears that Ginkgo biloba may be able to protect those with Normal Tension Glaucoma from progressive visual field loss.[15] However, Ginkgo biloba may also increase the risk of bleeding so should be avoided in those who are using prescription blood thinning medications.

Consider How Each Supplement Will Interact with Other Health Conditions and Medications

There are no supplements that affect only glaucoma. The mechanisms by which they protect the optic nerve are also used in the body for other biochemical processes. Thus supplements will often benefit multiple conditions. This also means that supplements can interfere or be additive to other supplements and prescription medications. Too much of a good thing is seldom good. However, when more than one condition is not well-controlled there is the opportunity to select supplements that can potentially benefit both conditions. Following are a few conditions that if not well-controlled could be used to guide glaucoma supplement use:

Difficulty Sleeping

There are multiple compelling reasons to consider adding oral supplementation with Melatonin. For those with trouble getting to sleep, as little as 0.5mg of Melatonin can be of benefit. Melatonin may also lower IOP as well as protect the optic nerve and retinal ganglion cells from oxidative damage. It is also one of the less expensive supplements available with few potential side effects.

Low Serum Vitamin D Levels

If you are over 40 years old it’s not a bad idea to get your Vitamin D blood levels checked. If low, your internist would likely recommend initiating supplementation with Vitamin D. Patients with glaucoma should definitely have this blood test done as Vitamin D deficiency is associated with a higher risk of glaucoma. At least for those with a deficiency, Vitamin D supplementation may provide some protection from glaucomatous damage.

Diabetes that is Not Well-Controlled

The following supplements appear to have blood sugar lowering properties in addition to their potential glaucoma treatment benefits. For those with uncontrolled blood sugar one or more of these supplements may be worth considering:

Systemic Hypertension (High Blood Pressure) that is Not Well-Controlled

The following supplements appear to have blood pressure lowering properties in addition to their potential glaucoma treatment benefits. For those with uncontrolled blood pressure one or more of these supplements may be worth considering:

Purchase only from Trusted Brands

“But the brand name supplements are so expensive!” you say? Well, which is more expensive: paying a premium for a product that contains the amount of active ingredient you wish to take or paying a discount for a bottle of filler with essentially no active ingredient? The latter is what you may be doing if you purchase generic or store brand (aka “Private Label”) supplements. The New York Attorney General conducted an investigation of privately labeled supplements sold by GNC, Target, Walgreens, and Walmart. They found that 80% of the supplements they tested contained none of the active ingredient!

What supplement brands do I recommend to my patients? The following brands have (to date at least) demonstrated a commitment to quality:

  • Jarrow Formulas
  • Life Extension
  • Nordic Naturals
  • NOW
  • Paradise Herbs

Add One Supplement at a Time

Not everyone responds to all supplements. Additionally, supplements are not without side effects. If more than one supplement is added at a time and side effects are encountered it will be more challenging to determine which supplement caused the unwanted side effect. By adding one supplement at a time it is possible to pair side effects and results to individual supplements. This will save time, frustration, and money.

Give Each Supplement a Chance to Work

Unlike glaucoma eye drops, many supplements can take weeks or even months to result in a measurable glaucoma treatment benefit. It is important, therefore, when adding a supplement to give it adequate time to produce a result before deciding that it is or is not worth continuing.

If Possible, Monitor Your Own Intraocular Pressure (IOP)

Although expensive, IOP measuring devices can be purchased for use at home. Why make such an investment? Because IOP naturally fluctuates. By self-measuring, an individual can become aware of his or her IOP trends in a manner that is simply not possible with one in-office measurement performed every few months.

Recognize that Not All Supplements Work to Reduce IOP

Supplements such as Forskolin (Coleus), Melatonin, Mirtogenol, Palmitoylethanolamide (PEA), Rutin, and Saffran may have IOP lowering benefits. Other supplements, however, appear to work through anti-oxidative, anti-inflammatory, and neuroprotective mechanisms. Such IOP-independent benefits are much harder to measure requiring in-office tests such as threshold visual fields and nerve fiber layer scans.

Include Your Physician in Your Supplement Treatment

It’s important to let your physicians know about your use of supplements. Why? Because they are there to help you and because they need to know what you are putting in your body in order to adequately monitor and treat your medical conditions.

Granted, Western-trained medical doctors have in the past been known to pooh-pooh the use of herbs, supplements, and all forms of Eastern-based medicine. That attitude is changing as modern research is demonstrating the potential medical benefit of many easily available supplements.


Adding supplements to one’s glaucoma treatment program can easily become overwhelming and expensive. A step-wise approach taking into account other medical conditions can decrease both complexity and cost. Using such a method, it is possible to develop a personalized supplement program that has the potential to benefit not only one’s glaucoma but one’s general health as well.


[1] Guivernau M, Meza N, Barja P, Roman O. Clinical and experimental study on the long-term effect of dietary gamma-linolenic acid on plasma lipids, platelet aggregation, thromboxane formation, and prostacyclin production. Prostaglandins Leukot Essent Fatty Acids 1994;51:311-6.

[2] Chan TY. Interaction between warfarin and danshen (Salvia miltiorrhiza). Ann Pharmacother 2001;35:501-4.

[3] Agarwal KC, Zielinski BA, Maitra RS. Significance of plasma adenosine in the antiplatelet activity of forskolin: potentiation by dipyridamole and dilazep. Thromb Haemost 1989;61:106-10.

Christenson JT, Thulesius O, Nazzal MM. The effect of forskolin on blood flow, platelet metabolism, aggregation and ATP release. Vasa 1995;24:56-61.

[4] Braquet P: Proofs of involvement of PAF-acether in various immune disorders using BN 52021 (ginkgolide B): a powerful PAF-acether antagonist isolated from Ginkgo biloba L. Adv Prostaglandin Thromboxane Leukot Res 16:179–98, 1986

Bent S, Goldberg H, Padula A, Avins AL. Spontaneous bleeding associated with Ginkgo biloba: a case report and systematic review of the literature. J Gen Intern Med 2005;20;657-61.

[5] Wolf HR. Does Ginkgo biloba special extract EGb 761 provide additional effects on coagulation and bleeding when added to acetylsalicylic acid 500 mg daily. Drugs R D. (2006)

Gardner CD, et al. Effect of Ginkgo biloba (EGb 761) and aspirin on platelet aggregation and platelet function analysis among older adults at risk of cardiovascular disease: a randomized clinical trial. Blood Coagul Fibrinolysis. (2007)

[6] Ravn HB, Vissinger H, Kristensen SD, et al. Magnesium inhibits platelet activity–an in vitro study. Thromb Haemost. 1996;76(1):88-93. View abstract.

Ravn HB, Kristensen SD, Vissinger H, et al. Magnesium inhibits human platelets. Blood Coagul Fibrinolysis. 1996;7(2):241-4.

[7] Terano T, Hirai A, Hamazaki T, et al. Effect of oral administration of highly purified eicosapentaenoic acid on platelet function, blood viscosity and red cell deformability in healthy human subjects. Atherosclerosis 1983;46:321-31

[8] Janssen K, Mensink RP, Cox FJ, et al. Effects of the flavonoids quercetin and apigenin on hemostasis in healthy volunteers: results from an in vitro and a dietary supplement study. Am J Clin Nutr 1998;67:255-62.

Hubbard GP, Wolffram S, Lovegrove JA, Gibbins JM. Ingestion of quercetin inhibits platelet aggregation and essential components of the collagen-stimulated platelet activation pathway in humans. J Thromb Haemost 2004;2:2138-45.

[9] Pace-Asciak CR, Hahn S, Diamandis EP, et al. The red wine phenolics trans-resveratrol and quercetin block human platelet aggregation and eicosanoid synthesis: implications for protection against coronary heart disease. Clin Chim Acta 1995;235:207-19.

Bertelli AA, Giovannini L, Giannessi D, et al. Antiplatelet activity of synthetic and natural resveratrol in red wine. Int J Tissue React 1995;17:1-3.

Pace-Asciak CR, Rounova O, Hahn SE, et al. Wines and grape juices as modulators of platelet aggregation in healthy human subjects. Clin Chim Acta 1996;246:163-82.

Bertelli AA, Giovannini L, Bernini W, et al. Antiplatelet activity of cis-resveratrol. Drugs Exp Clin Res 1996;22:61-3.

[10] Srivastava, R., Dikshit, M., Srimal, R. C., and Dhawan, B. N. Anti-thrombotic effect of curcumin. Thromb Res 11-1-1985;40(3):413-417.

Srivastava, R., Puri, V., Srimal, R. C., and Dhawan, B. N. Effect of curcumin on platelet aggregation and vascular prostacyclin synthesis. Arzneimittelforschung. 1986;36(4):715-717.

Srivastava, K. C., Bordia, A., and Verma, S. K. Curcumin, a major component of food spice turmeric (Curcuma longa) inhibits aggregation and alters eicosanoid metabolism in human blood platelets. Prostaglandins Leukot.Essent.Fatty Acids 1995;52(4):223-227.

Shah BH, Nawaz Z, Pertani SA. Inhibitory effect of curcumin, a food spice from turmeric, on platelet-activating factor- and arachidonic acid-mediated platelet aggregation through inhibition of thromboxane formation and Ca2+ signaling. Biochem Pharmacol 1999;58:1167-72.

[11] Celestini A, Pulcinelli FM, Pignatelli P, et al. Vitamin E potentiates the antiplatelet activity of aspirin in collagen-stimulated platelets. Haematologica 2002;87:420-6.

Freedman JE, Farhat JH, Loscalzo J, Keaney JF. Alpha-tocopherol inhibits aggregation of human platelets by a protein kinase C-dependent mechanism. Circulation 1996;94:2434-40.

Stampfer MJ, Jakubowski JA, Faigel D, et al. Vitamin E supplementation effect on human platelet function, arachidonic acid metabolism, and plasma prostacyclin levels. Am J Clin Nutr 1988;47:700-6.

[12] Lam AY, Elmer GW, Mohutsky MA. Possible interaction between warfarin and Lycium Barbarum. Ann Pharmacother 2001;35:1199-201.

Leung H, Hung A, Hui AC, Chan TY. Warfarin overdose due to the possible effects of Lycium barbarum L. Food Chem Toxicol. 2008;46:1860-2.

Rivera, C. A., Ferro, C. L., Bursua, A. J., and Gerber, B. S. Probable interaction between Lycium barbarum (goji) and warfarin. Pharmacotherapy. 2012;32(3):e50-e53.

[13] Miksicek RJ. Commonly occurring plant flavonoids have estrogenic activity. Mol Pharmacol. 1993 Jul;44(1):37-43.

[14] Gehm BD, McAndrews JM, Chien PY, Jameson JL. Resveratrol, a polyphenolic compound found in grapes and wine, is an agonist for the estrogen receptor. Proc Natl Acad Sci U S A 1997;94:14138-43.

Basly, J. P., Marre-Fournier, F., Le Bail, J. C., Habrioux, G., and Chulia, A. J. Estrogenic/antiestrogenic and scavenging properties of (E)- and (Z)-resveratrol. Life Sci. 1-21-2000;66(9):769-777.

Levenson, A. S., Gehm, B. D., Pearce, S. T., Horiguchi, J., Simons, L. A., Ward, J. E., III, Jameson, J. L., and Jordan, V. C. Resveratrol acts as an estrogen receptor (ER) agonist in breast cancer cells stably transfected with ER alpha. Int.J.Cancer 5-1-2003;104(5):587-596.

[15] 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;110:359-62.

Lee J, Sohn S, Kee C. Effect of Ginkgo biloba Extract on Visual Field Progression in Normal Tension Glaucoma. Journal of Glaucoma. 2013; 22:780-784.

[16] Jacob S, Henriksen EJ, Schiemann AL, et al. Enhancement of glucose disposal in patients with type 2 diabetes by alpha-lipoic acid. Arzneimittelforschung 1995;45:872-4.

Jacob S, Ruus P, Hermann R, et al. Oral administration of RAC-alpha-lipoic acid modulates insulin sensitivity in patients with type-2 diabetes mellitus: a placebo-controlled, pilot trial. Free Rad Biol Med 1999;27:309-14.

Ansar H., Mazloom Z., Kazemi F., Hejazi N. Effect of alpha-lipoic acid on blood glucose, insulin resistance and glutathione peroxidase of type 2 diabetic patients. Saudi Med J 2011;32(6):584-588.

Porasuphatana S, Suddee S, Nartnampong A, et al. Glycemic and oxidative status of patients with type 2 diabetes mellitus following oral administration of alpha-lipoic acid: a randomized double-blinded placebo-controlled study. Asia Pac J Clin Nutr 2012;21(1):12-21.

[17] Lankinen, M., Schwab, U., Kolehmainen, M., Paananen, J., Poutanen, K., Mykkanen, H., Seppanen-Laakso, T., Gylling, H., Uusitupa, M., and Oresic, M. Whole grain products, fish and bilberries alter glucose and lipid metabolism in a randomized, controlled trial: the Sysdimet study. PLoS One 2011;6(8).

Liu X, Wei J, Tan F, et al. Antidiabetic effect of Pycnogenol French maritime pine bark extract in patients with diabetes type II. Life Sci 2004;75:2505-13.

[18] Timmers S, et al. Calorie restriction-like effects of 30 days of resveratrol supplementation on energy metabolism and metabolic profile in obese humans. Cell Metab. (2011)

[19] Arun, N. and Nalini, N. Efficacy of turmeric on blood sugar and polyol pathway in diabetic albino rats. Plant Foods Hum.Nutr. 2002;57(1):41-52.

Nishiyama, T., Mae, T., Kishida, H., Tsukagawa, M., Mimaki, Y., Kuroda, M., Sashida, Y., Takahashi, K., Kawada, T., Nakagawa, K., and Kitahara, M. Curcuminoids and sesquiterpenoids in turmeric (Curcuma longa L.) suppress an increase in blood glucose level in type 2 diabetic KK-Ay mice. J Agric Food Chem. 2005;53(4):959-963.

Seo, K. I., Choi, M. S., Jung, U. J., Kim, H. J., Yeo, J., Jeon, S. M., and Lee, M. K. Effect of curcumin supplementation on blood glucose, plasma insulin, and glucose homeostasis related enzyme activities in diabetic db/db mice. Mol Nutr Food Res 2008;52(9):995-1004.

Weisberg, S. P., Leibel, R., and Tortoriello, D. V. Dietary curcumin significantly improves obesity-associated inflammation and diabetes in mouse models of diabesity. Endocrinology 2008;149(7):3549-3558.

Yu, Y., Hu, S. K., and Yan, H. [The study of insulin resistance and leptin resistance on the model of simplicity obesity rats by curcumin]. Zhonghua Yu Fang Yi.Xue.Za Zhi. 2008;42(11):818-822.

Madkor, H. R., Mansour, S. W., and Ramadan, G. Modulatory effects of garlic, ginger, turmeric and their mixture on hyperglycaemia, dyslipidaemia and oxidative stress in streptozotocin-nicotinamide diabetic rats. Br J Nutr 2011;105(8):1210-1217.

Srinivasan, M. Effect of curcumin on blood sugar as seen in a diabetic subject. Indian J Med Sci 1972;26(4):269-270.

[20] Lindner E, Dohadwalla AN, Bhattacharya BK. Positive inotropic and blood pressure lowering activity of a diterpene derivative isolated from Coleus forskohli: Forskolin. Arzneimittelforschung 1978;28(2):284-289.

Schlepper M, Thormann J, Mitrovic V. Cardiovascular effects of forskolin and phosphodiesterase-III inhibitors. Basic Res Cardiol 1989;84 Suppl 1:197-212.

[21] Arangino S, et al. Effects of melatonin on vascular reactivity, catecholamine levels, and blood pressure in healthy men. Am J Cardiol. (1999)

Nishiyama K, et al. Acute effects of melatonin administration on cardiovascular autonomic regulation in healthy men. Am Heart J. (2001)

Cagnacci A, et al. Influences of melatonin administration on the circulation of women. Am J Physiol. (1998)

[22] Prisco D, Paniccia R, Bandinelli B, et al. Effect of medium-term supplementation with a moderate dose of n-3 polyunsaturated fatty acids on blood pressure in mild hypertensive patients. Thromb Res 1998;1:105-12.

Toft I, Bonaa KH, Ingebretsen OC, et al. Effects of n-3 polyunsaturated fatty acids on glucose homeostasis and blood pressure in essential hypertension. A randomized, controlled trial. Ann Intern Med 1995;123:911-8.

 Sacks FM, Hebert P, Appel LJ, et al. Short report: the effect of fish oil on blood pressure and high-density lipoprotein-cholesterol levels in phase I of the trials of hypertension prevention. J Hypertens 1994;12:209-13.

Vandongen R, Mori TA, Burke V, et al. Effects on blood pressure of omega 3 fats in subjects at increased risk of cardiovascular disease. Hypertension 1993;22:371-9.

[23] Imenshahidi M, Hosseinzadeh H, Javadpour Y. Hypotensive effect of aqueous saffron extract (Crocus sativus L.) and its constituents, safranal and crocin, in normotensive and hypertensive rats. Phytother.Res 12-9-2009.

Fatehi M, Rashidabady T, Fatehi-Hassanabad Z. Effects of Crocus sativus petals’ extract on rat blood pressure and on responses induced by electrical field stimulation in the rat isolated vas deferens and guinea-pig ileum. J Ethnopharmacol. 2003;84(2-3):199-203.

David Richardson, MD

Medical Director, San Marino Eye

David Richardson, MD is widely recognized as one of the top cataract and glaucoma surgeons in the US and is among an elite group of glaucoma surgeons in the country performing the highly specialized canaloplasty procedure. Morever, Dr. Richardson is one of only a few surgeons in the greater Los Angeles area that performs Micropulse® "Cyclophotocoagulation" (MP3) glaucoma laser surgery. Dr. Richardson graduated Magna Cum Laude from University of Southern California and earned his Medical Degree from Harvard Medical School. He completed his ophthalmology residency at the LAC+USC Medical Center/ Doheny Institute. Dr. David Richardson is also an Adjunct Assistant Professor of Clinical Ophthalmology at Keck School of Medicine of USC. Twice weekly, he treats veterans at the VA Greater Los Angeles Veterans Healthcare System. → Learn more about Dr. David Richardson

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