Supplements I Recommend To My Patients Around the Time of Eye Surgery

For many with glaucoma it’s not possible to adequately control the condition with oral supplements and/or topical prescription medications. It may be necessary to consider surgical treatments in order to avoid additional loss of vision. I am often asked by my own patients whether there are any supplements that should be added or discontinued around the time of surgery.

What follows are some guidelines that I have found useful for my patients who are anticipating surgical treatment of glaucoma. 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 may not apply to you nor should they be considered medical advice. When adding any supplement or other medication prior to or early after surgery it is important to make your surgeon aware of this change as many supplements can interact with the healing process.

First – Supplements that Should be Discontinued Prior to Surgery

A number of supplements have anti-platelet/anticoagulant activity. Undesirable and potentially dangerous bleeding could occur if these supplements are being taken at the time of many eye surgeries. This is especially true for incisional glaucoma surgeries. “Incisional” just means that a cut is made with a blade.

Unless your surgeon specifically indicates otherwise, the following supplements should be discontinued prior to eye surgery:

  • Black Currant[1]
  • Dan Shen (Salvia miltiorrhiza)[2]
  • Forskolin (Coleus)[3]
  • Ginkgo biloba[4]
  • Magnesium[5]
  • Omega-3 Fatty Acids (combined DHA and EPA)[6]
    • May be OK if only DHA is taken
  • Quercetin[7]
  • Resveratrol[8]
  • Tumeric (Curcumin)[9]
  • Vitamin E[[10]
  • Wolfberry (Goji Berry)[11]

Some eye surgeries (such as Laser Trabeculoplasty and “clear corneal” cataract surgery) do not damage blood vessels. With these surgeries it may be OK to continue using the supplements listed above if your surgeon agrees.

Supplements that May Prevent IOP “Spikes” After Surgery

Intraocular pressure (IOP) elevations (”spikes”) after eye surgery are common. Most people without glaucoma can tolerate moderate post-operative IOP elevations without fear of losing vision. This is not necessarily so in those with glaucoma. Optic nerves that have already been damaged are more likely to sustain additional damage by post-operative IOP elevations. Thus, it is important that IOP spikes be avoided or effectively blunted in those with glaucoma.

Melatonin

Melatonin has been shown to lower IOP, reduce anxiety, and enhance pain relief when taken prior to eye surgery.[12] I recommend that my patients take 0.5-10mg of Melatonin with a sip of water the morning of planned cataract or glaucoma surgery.

Palmitoylethanolamide (PEA)

Palmitoylethanolamide (PEA) has been demonstrated to prevent post-operative IOP elevation in those who have undergone YAG peripheral iridotomy.[13] Although this supplement can be both expensive and difficult to find, for my patients who are at greatest risk of vision loss from post-operative IOP spike I will often recommend taking two capsules per day beginning two weeks prior to anticipated surgery.

Supplements that Work to Reduce Inflammation

All surgeries result in inflammation. This is the natural response of the body. With eye surgery, however, inflammation is seldom beneficial. It is for this reason that most eye surgeons will prescribe either steroid or non-steroidal anti-inflammatory drops to be used after surgery. The following supplements may also work to reduce inflammation after eye surgery. Take note, however, that as these may also have blood-thinning properties they should not be initiated until a few days to a week after surgery.

Summary

The decision to proceed with eye surgery is not one to be taken lightly. Even with a technically perfect surgery the final result will depend upon how the eye heals during the months after surgery. Thus, it is important to consider therapies that may decrease both IOP elevations as well as undesirable inflammation. It is equally important to discontinue supplements that might add risks due to such conditions as blood thinning. Given this, it’s important to let your surgeon know about your current and anticipated use of supplements.

References

[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] 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.

[6] 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

[7] 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.

[8] 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

[9] 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.

[10] 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.

[11] 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.

[12] Ismail SA, Mowafi HA. Melatonin provides anxiolysis, enhances analgesia, decreases intraocular pressure, and promotes better operating conditions during cataract surgery under topical anesthesia. Anesth Analg. (2009)

[13] Pescosolido N, Librando A, Puzzono M, Nebbioso M. Palmitoylethanolamide effects on intraocular pressure after Nd:YAG laser iridotomy: an experimental clinical study. J Ocul Pharmacol Ther. 2011 Dec;27(6):629-35.

Looking for an Ophthalmologist in California?

Dr. David Richardson is taking new patients at his office in San Marino, CA., and is always willing to provide a second opinion for those who would like the peace-of-mind that such a consultation would provide.

For Inquiries or Consultation, Call (626) 289-7856
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