Light Adaptation and Glaucoma | Driving with Dr. David Richardson Ep 06

Hello I’m Dr. David Richardson. I am a cataract and glaucoma surgeon in Southern California. Today I’d like to talk about one of the misconceptions about symptoms of glaucoma.

So let’s get going!

Delayed Dark Adaptation

So if you ask people, “what is lost with glaucoma?” many will tell you peripheral vision. And although that’s true, that’s far from complete. Both peripheral and central vision can be lost, and are lost, in more advanced forms of glaucoma but there’s something else that is misunderstood and that is the idea that early on with glaucoma, there are essentially no symptoms. And this is just not the case.

Delayed Dark Adaptation  is the increased time it takes for the retina to adjust sensitivity when moving from high luminescence or bright lights to low luminescence or low dark areas of lighting.  

Many of my patients with all stages of glaucoma will report to me the difficulty in seeing after initially moving from bright lights to dark lights. Now, this condition called, “delayed dark adaptation”, which is essentially the increased time it takes for the retina to adjust sensitivity when moving from high luminescence or bright lights to low luminescence or low dark areas of lighting. It’s something that’s actually been researched for over 50 years.

Collaborative Initial Glaucoma Treatment Study (CIGTS)

Now, the research has been ongoing and there are newer studies that try to figure out how this works…how we can particularly address it with treatments. One of the more recent studies is one from the Collaborative Initial Glaucoma Treatment Study (CIGTS). It’s a large study of approximately 600 patients, looking at the quality of life issues and this was upon initial diagnosis. So, this is early glaucoma for the most part.

And the most common or some of the most common symptoms that were noted in this study included difficulty in extremes of lighting. So not just low lighting or transitioning from bright to light low lighting, which was one of the symptoms that was quite common in the study but actually extremes including bright light.

…if one has difficulty in low-light situations or adapting from bright to low light this can impact one’s risk of driving at night especially.

Now it gets even worse than that because another study looked at those who had ocular hypertension without any evidence of glaucoma so no visual field loss, no retinal fiber loss… essentially just high pressures. And even in these patients there was delayed light adaptation. Now this is particularly concerning because if one has difficulty in low-light situations or adapting from bright to low light this can impact one’s risk of driving at night especially. And may be one of the reasons why many patients with glaucoma will voluntarily try to avoid driving at night.

What Can Be Done To Prevent Delayed Dark Adaptation 

So the question of course becomes what can be done about this? Well certainly to keep things from getting worse treating the glaucoma by lowering the intraocular pressure as well as addressing some of the other more holistic issues that I’ve discussed in other videos and will continue to discuss these are all things that are worth doing in order to prevent this from getting worse. But in terms of trying to improve the delayed dark adaptation or difficulty with extremes of lighting, such as I’m having right here, as I Drive through a series of trees, there’s not a lot in the literature. there is however a recent study that looked at treating patients with macular degeneration who also tends to have issues with dark adaptation.

Lutein Zeaxanthin

In this study patients were given lutein zeaxanthin which is a naturally occurring substance that occurs both in vegetables fruits and importantly the retina. Now in this study half of the patients were not given a supplement or if they were doing a placebo I can’t remember right now but it was either placebo or no supplement. And the other half were given lutein zeaxanthin supplement. And after a month of taking a supplement there was a noticeable improvement in those who took the lutein zeaxanthin supplement.

So the nice thing about this is the lutein zeaxanthin is a relatively inexpensive supplement that is also one without many risks or side effects. So there’s really no downside for most people to try some lutein zeaxanthin for a month or so and see whether or not it benefits vision in the extremes of lighting or transitioning from bright light to low light and low light to dark little light to bright light.

Kale has one of the highest natural concentrations of lutein zeaxanthin of any food source

Now for those of you who would like to take a more natural form, meaning in the in your food source. The good news is that lutein zeaxanthin is found in many natural sources vegetables and fruits, I mentioned. And for those who are into this this new Kale craze you’ll be very happy to know that kale has one of the highest natural concentrations of lutein zeaxanthin of any food source. Twice as much as spinach does. So if you like spinach, you and Popeye can feel good about that but the kale is a great source.

Other fruits and vegetables have plenty in them as well, collard greens (I’m not a big fan of these myself) but their lists online that you can take a look at so I do generally recommend either improving the dietary supplementation or getting a supplement in a in a bottle of lutein zeaxanthin from a reliable source–life extension or paradise herbs are two that I tend to recommend and I’ll continue to recommend these supplements to my patients as a low risk of potentially symptom improving treatment for issues with dark adaptation and extremes of light in both my patients with glaucoma and macular degeneration.

So anyway I hope that this was a benefit to you and that you didn’t find the glare too annoying sorry but my commute times right now in the fall are all pretty glarey, which actually is apropos for today’s topic of conversation.

All right have a great day and we’ll be chatting again soon if you’d like to come back.

References:

1. Zuege P, Drance SM. Studies of dark adaptation of discrete paracentral retinal areas in glaucomatous subjects. Am J Ophthalmol.1967;64:56–63. https://www.sciencedirect.com/science/article/pii/0002939467933430 
2. Bierings R, van Sonderen FLP, Jansonius NM. Visual complaints of patients with glaucoma and controls under optimal and extreme luminance conditions. Acta Ophthalmol. 2018;96:288–294. https://www.ncbi.nlm.nih.gov/pubmed/29520960 
3. Janz NK, Wren PA, Lichter PR, et al. Quality of life in newly diagnosed glaucoma patients: The Collaborative Initial Glaucoma Treatment Study. Ophthalmology. 2001;108:887–897; discussion 898.
   https://www.ncbi.nlm.nih.gov/pubmed/11320018 
4. Goldthwaite D, Lakowski R, Drance SM. A study of dark adaptation in ocular hypertensives. Can J Ophthalmol. 1976;11:55–60. http://europepmc.org/abstract/MED/1247940 
5. Berendschot et al, 2011, IOVS ARVO abstract. 
6. Mangels AR, Holden JM, Beecher GR, et. al. Carotenoid content of fruits and vegetables: an evaluation of analytic data. J Am Diet Assoc. 1993 Mar;93(3):284-96. (Erratum in J Am Diet Assoc 1993 May;93(5):527.)
   https://www.ncbi.nlm.nih.gov/pubmed/8440826 

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