GLAUCOMA

Hi everyone. I've been a lurker for some time, reading and learning. I have osteoporosis of the spine and osteopenia of the hips. Like many people here I try to avoid medications and take a lot of supplements.
A month ago, I have a surprise when my eye doctor noticed the rising eye pressure and started to ask questions about my family glaucoma history. Naturally, I started to revise everything in my life, including supplements.
I noticed studies indicating that excess of calcium can trigger glaucoma and I reduced my supplement intake to some 200 in multi. Now, I am focusing on Strontium. I found this website http://mueller_ranges.tripod.com/links/compendium/myminerals.html
and, frankly, I am unable to evaluate the information it offers.
I had another visit to my eye doctor (eye pain and headaches). This time my eye pressure was normal.
Unfortunately, I can't know what caused the spike during my first visit (possibly blood donation which preceded the visit by some 3 weeks), but at this moment I am uncomfortable taking Strontium, particularly that I have a lifelong tendency to headaches.
Can anyone with scientific background evaluate the claims, such as "i do suspect however that in these tiny amounts it just thickens the blood a bit without promoting clotting, however this blood thickening is enough to create problems if you have any tendency to glaucoma !"?

Thank you,
funny girl1

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I tried strontium several years ago was fine for 7 months. I then got a pain deep in my thigh. I had it for three weeks, so I decided to stop taking the strontium. The pain stopped. I do believe it was the strontium. Another problem I was having was, when I worked out I do reverse sit ups and I was getting light headed when I stopped, which I never did before. After I stopped the strontium I no longer got light headed. I think you are right it can do something to some people. I hope someone will be able to help with this to clarify it, on a more scientific level.

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Hi funnygirl1 I also have glaucoma, but it's under control with Zalatan and Timolol drops. I also have Von Willebrands type 1 which is a clotting disorder (I don't clot properly) so I bleed easily. I've never taken Strontium Citrate, and I can't actually say why other than just a gut feeling I have that can't be explained. If SC causes some clotting, then I guess that might help me, but I have nothing to prove this and that seems like circular logic that isn't very sound. I have friends who take SC and are doing well, so there are many on this. It's connection to clotting and then possibly glaucoma is one I'm not familiar with. I guess I should look into this and see what I can find.

Hopefully someone with more specific information or education in this area will see this, since I don't remember many topics posted here on glaucoma. I would also look into the Inspire Group for Glaucoma and ask the question there. Inspire has thousands of other discussion forums which you can access alphabetically above by clicking "Groups." Here's Inspires Glaucoma Group http://www.inspire.com/conditions/glaucoma/ Here's a link for Inspire on ALL eye disorders that you may be interested in. http://www.inspire.com/groups/vision-disorders-and-blindness/

A slight thickening of blood may be of issue with glaucoma, but see if you can get a more substantial answer to this.

I do hope you find the answers you're looking for. Good luck and I would be interested in what you find.

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Thank you, Sally and Windblown.
Thank you, Windblown, for the links. Yes, I think I should join glaucoma forums. I don't have glaucoma yet, but I most certainly want to prevent or at least postpone it.

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Funnygirl1 - Hi there. Did your optician do a full diagnostic test on your eyes? That is: Goldman applanation for the IOP. OCT to check the full back of the eye and the retina. A Humphrey Field of Vision Test - most important. A Contrast Sensitivity Test - not all do this test, but is considered an excellent area to check.

Glaucoma comes in many guises! Not all glaucoma has an elevated IOP (intraoptic pressure). You can have severe retinal damage with normal IOPs. 'Normal' being pressures under 21mmHg. You can ALSO have an IOP in the 30s and 40s and NO glaucoma. This last, not too often, but not that rare. IOPs can alter day-by-day, and from daytime to night time, night time often being lower. With NTG (normal IOP) then this is where one needs to be particularly careful, as very low IOP can cause even more retinal damage.

First off, suggest that you find the best glaucoma consultant in your area, one who has the FULL diagnostic set up and have a complete check done.

As for Strontium CITRATE causing 'sticky' blood. No. Strontium RANELATE, yes. Is one of the many side effects of Protelos Strontium Ranelate. Stront Ran being a chemical version of plain Stront Cit, and, is buffered with excipients that have rather toxic side effects: Aspartame, Maltodextrin, Mannitol. Plain Stront Citrate has no such excipients - basically no side effects, excepting for (in 'some' cases) constipation.

Calcium. You can have a blood test for yr Calcium levels, Vitamins and Micronutrients. Suggest that you have this done. See what your levels are. Don't forget to have yr Vit-D3 tested (OH). Recommended levels, 60ng/mL - 80ng/mL (some opine 65 - 85/90). The old recommendation, c.40ng/mL is proven to be way way out, far too low.

As for osteoporosis/osteopenia. Can thoroughly recomment Lara Pizzorno's superbly researched book on Osteoporosis: 'Your Bones'. Lara covers all the alternative ways to treat osteo. Recommends the full range of supplements and vitamins.

I have NTG (no tension glaucoma) with severed retinal damage. My IOPs range between R.12-18mmHg. L.8-14mmHg.
I also have spiking hypertension - not good for glaucoma, whether POAG or NTG. Not good: mine 135 - 227/85-120...boom-boom!
I have osteopenia/osteoporosis, should say, 'did' as I reversed mine by following Lara's recommendations, including taking Strontium Citrate, that I have been on since five years now. Now I only take a maintenance dose. (I was taking the Stront Cit before even hearing of Lara Pizzorno, Stront Cit was recommended to my by my excellent rheumatologist, in the UK. She was right on the buckle with her recommendation).

So first, what was your IOP reading? What diagnostic did yr optomertrist use to measure your IOP? Goldman applanation is considered gold standard. The hand held puffer is near useless for professional use. The big Reichart air tonometer is good for NTG. Best is to use a big air tonometer followed by the Goldman - then compare. But remember, readings different days etc etc can vary by as much as 20mmHg...and sometimes even more. (Refer you back [above] to my readings).

Two good books 'for patients' are: -

Glaucoma - A Guide for Patients - Prof Josef Flammer. Textbook - Shop | International ...
www.glaucoma-association.com/shop/product/glaucoma---a-guide-for-patients--...
The latest edition of this book by Professor Josef Flammer presents the latest results ... This book is written for glaucoma patients and the interested lay reader as ...
[PDF]
Is There More to Glaucoma Treatment Than Lowering ...
www.v2020la.org/pub/PUBLICATIONS_BY_TOPICS/Glaucoma/Is%20There%20More%20to% 20Gla...
Than Lowering IOP? Maneli Mozaffarieh, MD, and Josef Flammer, MD. University Eye Clinic, Basel, Switzerland. Abstract. Classic glaucoma treatment focuses ...

and

Review of Optometry® > The Glaucoma Handbook
www.revoptom.com/supplement_toc/s/106/ - Similarto Review of Optometry® > The Glaucoma Handbook
28 Oct 2009 ... Welcome to the fifth edition of The Glaucoma Handbook, a publication developed under the auspices of the Optometric Glaucoma Society This ...

NOW Dr. Robert Ritch in NYEEI has participated in the Glaucoma ...
www.topix.com/forum/health/glaucoma/TQKV7E24BCUUDGDM7
Don't forget to update the Glaucoma Handbook App on your iPhone! NOW two ... "Doctor, I Have a Question" by Dr. Robert Ritch, who holds the ...

----------#

Prof Josef Flammer, Switzerland and Prof Robert Ritch, N.Y. are the two top glaucoma specialists in the world. Ritch has written some nine ophthalmic textbooks and hundreds of papers, Flammer has an equal number of publications to his name. Suggest checking them both out. Many of the bookks will be available from yr library - or can be ordered for you, inter-library. Meantime, laymans' books, from both Flammer and Ritch, can be bought (not expensive) or try library.

If you have any questions - fire away.

Take care - Go well

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Molly,
Thank you for such a detailed and informative comment.
I had a full examination and my ophthalmologist is an expert (Columbia Presbyterian in NY) and a great person - she has been taking care of a friend of mine with severe eye problems for many years.
I don't know much about the details, except that once my pressure was elevated, the second time not and that my nerves are strong (so far) and my vision field (?) is fine. There is still the possibility that my first examination was affected by my blood donation. And I have low blood pressure. Thank you for the links, I will read and try to understand - I really would like to prevent glaucoma. I'll start (and end?) with layman's books.
I still have my doubts about Strontium citrate. If I understand it correctly, there aren't many studies of this form of strontium. If not, don't we just have an axiomatic approach - it's pure, it must be good. Calcium is pure too, but its excess is clearly problematic. Is it possible that pure strontium is problematic too?
I was diagnosed with osteoporosis some three years ago and I've made some significant changes in my diet (bakery stuff is mostly out, vegetables are in), added supplements and exercise. This forums has been very helpful.
Thank you again.

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Strontium has been taken in Europe for many years. So far, Strontium Citrate is not known for untoward side effects.

Calcium? Read up on the latest research: 'NOT leading to heart attacks/build of of plaque in arteries'. Published a couple of days ago. Ensure Calcium Citrate, not calcium carbonate (poor bioavailability!)

You need to be au fait with your IOPs. Note the numbers. Crucial. Be proactive. OK?
Need to have the full gamut of diagnostics - 'just' elevated IOPs are not a sign of glaucoma!
BTW - low BP and NTG are bad bedfellows! Would need to sleep with upper body & head elevated. With glaucoma, low BP AND low IOPs lead to retinal damage/more severe retinal damage.

Always be prepared to take a second opinion. Can recommend Prof Robert Ritch, N.Y. That is not putting the consultant you saw to one side, au contraire, but a second opinion can always be a confidence booster. Another very good glaucoma specialist in N.Y. is Dr Eleanor Faye, Lighthouse International Group - excellent. Very wise lady - and wonderfully empathic.

Take care - Go well

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Molly,
Thank you again. I need to read - at this point I don't know what are the IOPs.
When I mentioned calcium, I had in mind this study for example:
"The association between glaucoma prevalence and supplementation with the oxidants calcium and iron"
http://www.iovs.org/content/early/2012/01/10/iovs.11-9038

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Will read tomorrow, as gone 2.30 a.m. here (!!) going to hit the hay, gotta get going in a short while (help - time ran away...)

Meantime was just reading this paper by Prof Josef Flammer. Excellent. Going to send to my ophtho here for discussion.
http://www.v2020la.org/pub/PUBLICATIONS_BY_TOPICS/Glaucoma/Is%20There%20Mor e%20to%20Glaucoma....pdf

Worth reading -

Will read yr link, later, and get back to you in the evening -

Night

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funnygirl1: Ref yr link, here is the abstract:-

nvest Ophthalmol Vis Sci. 2012 Feb 13;53(2):725-31. Print 2012 Feb.
The association between glaucoma prevalence and supplementation with the oxidants calcium and iron.
Wang SY, Singh K, Lin SC.
Source
Department of Ophthalmology, University of California, San Francisco, California, USA.
Abstract
PURPOSE:
To investigate the relationship between supplementary consumption of the oxidants calcium and iron and the prevalence of glaucoma.
METHODS:
This cross-sectional study included 3833 participants in the National Health and Nutrition Examination Survey (NHANES) for 2007 and 2008, ≥ 40 years of age, who reported a presence or absence of glaucoma. Participants were interviewed regarding the use of dietary supplements and antacids during the preceding 30-day period. Data pertaining to the supplementary intake of calcium and iron was aggregated and divided into quintiles. Information regarding the presence or absence of glaucoma and demographics, comorbidities, and health-related behavior was obtained via interview.
RESULTS:
Participants who consumed ≥ 800 mg/d of supplementary calcium or ≥ 18 mg/d of supplementary iron had significantly higher odds of having been diagnosed with glaucoma than did those who had not consumed supplementary calcium or iron, after adjustment for potential confounders (odds ratio [OR] 2.44, 95% confidence interval [CI] 1.25-4.76 for calcium; OR 3.80, 95% CI 1.79-8.06 for iron). Concurrent consumption of both calcium and iron above these levels was associated with still greater odds of having been diagnosed with glaucoma (OR 7.24, 95% CI 2.42-21.62). A clear dose-response relationship between quintiles of supplementary calcium or iron intake and glaucoma prevalence was not found.
CONCLUSIONS:
These results suggest that there may be a threshold intake of iron and calcium above which there is an increased risk of development of glaucoma. Prospective longitudinal studies are needed, to assess whether oxidant intake is a risk factor for development and progression of glaucoma.
Comment in
The association between glaucoma prevalence and supplementation with the oxidants calcium and iron. [Invest Ophthalmol Vis Sci. 2012]

First off women around age 40yrs. Second, taking 800mg/d calcium (type of calcium not disclosed). Third, taking 18mg/d iron. Fourth 30 day period.
Age: +/- 40yrs. Some will have hit 'menopause', others will be 'perimenopause', others will be 'premenopause'
Calcium - 800mg/d is too high, 500mg/d is the better dose, and 500mg/d is considered a *maximum...but, do NOT supplement if UNecessary! Get a blood test, then discuss with a consultant who knows what they are doing (this is possibly 'outside' the scope of a GP). Relationship calcium to eyes NOT established.
Iron - 18mg/d iron. IF fully menopausal, do not take iron supplements. Can get a build up of iron and menstruation no longer protecting against iron build-up! If 'premenopause' then 'maybe' a need, but TEST for ferritin in standard blood test - same applies for perimenopause: blood test for ferritin. TEST for ferritin *anyway BEFORE taking additional iron.
Time frame of study - 30 day period! 30 day period is not going to give sufficient data. This is a springboard for further 'possible' studies.

Let's look at their conclusions:
"...may be a threshold intake of iron and calcium above which there is an increased risk of development of glaucoma. Prospective longitudinal studies are needed, to assess whether oxidant intake is a risk factor for development and progression of glaucoma."

",,,may be..." - "Prospective longitudinal studies are needed." - "...is a risk factor for..."

ALL very nebulous. Quite frankly, suggest discussion with Prof Robert Ritch and/or Prof Josef Flammer.

Note on Calcium :

No Heart Risk for Women From Calcium
By Nancy Walsh, Staff Writer, MedPage Today
Published: October 17, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

http://www.medpagetoday.com/MeetingCoverage/ASBMR/35368?
_________________________

It 'looks' like the calcium part of this study is linked/a linkage to, 'calcium channel blockers for glaucoma' with particular reference to hypertension, :

Use of calcium channel blockers for glaucoma.
www.ncbi.nlm.nih.gov/pubmed/20933604
8 Oct 2010 ... Use of calcium channel blockers for glaucoma. Araie M, Mayama C. Department of Ophthalmology, University of Tokyo Graduate School of ...
Conclusion: "Based on the reported findings of CCBs and that the results of clinical studies in acute cerebral ischemia may not be directly applicable to a chronic neurodegenerative ocular disorder, such as OAG, CCBs deserve future study to investigate strategies that are additive or synergetic to ocular hypotensive therapy for OAG, especially in patients with lower IOP."
(glossary: CCBs=calcium channel blockers. OAG=open angle glaucoma. Lower IOP=NTG, no pressure/tension glaucoma)

As reported:: "A 'clear' dose-response relationship between quintiles of supplementary calcium or iron intake 'and glaucoma prevalence' was 'not' found." The study does NO more than "...generate a hypotheses for future studies" and "If future research corroborates our findings, then there may be implications for understanding the pathogenesis of glaucoma and the treatment of glaucoma.” (Sophia Y. Wang, a medical student and a clinical and translational research fellow at the University of California, San Francisco)

http://www.encognitive.com/node/5338 - This is a sensible and easy to comprehend summary of cataract and glaucoma. Starts with cataract and the second half of the article is on glaucoma.

(snip...) "Restricted Blood Row

"Swedish ophthalmologists suggest that the primary cause of glaucoma might be progressive increase in flow resistance in the veins in the eye.( 15) This ischaemia (lack of blood), combined with impaired nutrition, starts off the glaucoma.

The elevated intraocular pressure (lOP) is the result of narrowing or hardening of the exit channels through the trabecular meshwork that was referred to earlier. The cause of this narrowing or hardening appears to be not dealt with by the researchers.

The actual cause of diminished vision or blindness is thought to be the result of ischaemia damaging the optic nerve. The pressure in the eyeball reduces the flow in the veins, producing the ischaemia.

Other likely causes of ischaemia are atherosclerosis or blood clots in the capillaries of the eyes.

As this is the same process that occurs in the coronary arteries of the heart and causes heart attack, so the same lifestyle factors that prevent heart attack can be expected to prevent at least one possible cause of glaucoma.

The ischaemia theory was proposed by the Department of Ophthalmology of the University of Miami in 1999.( 16)

It appears that there is a vicious circle acting here. Diseased capillaries in the eye restrict the flow of blood which damages and blocks the drainage channels for the fluid in the eye (aqueous humor).

This creates pressure in this fluid which in turn presses on the veins and further restricts blood flow.

More damage is done to the drainage channels, the escape of fluid is even further restricted and its pressure climbs. The spiralling ischaemia eventually damages the optic nerve and hence impairs vision.

"Vitamin B1 Deficiency

"An early study of patients with glaucoma found that they had significantly lower blood levels of thiamine (vitamin B[ 1]) than people without glaucoma.( 17)

In view of the general association between B vitamins and nerve function, this finding is understandable." (more...)

Among strong recommendations is this: "Avoid surplus iron. Never take iron supplements unless there is iron deficiency, and beware of the more readily available iron in red meat.." (And that will especially refer to offal).

The article then goes on with reference to 'natural' treatments - interesting summation these, as, 'natural' treatments are indeed advocated by Ritch and Flammer. But, in conjunction with pharmacy and surgery as applicable. There is much new information - by references, this article seems (!) to have been written in 1999/2000 - such as vascular dysregulation in connection with NTG - people suffering from Reynaud's disease, which is a vascular dysregulation, often suffer from NTG. Hypotension in connection with NTG. Hypertension in connection with POAG. In addition, glaucoma is now being recognised as a systemic disease, and 'often' linked to 'a' autoimmune disease (not just diabetes!)

It is facinating. There is much hyped up journalese, just put in a search for 'iron and glaucoma' - see the links, much confusion even in reporting what the small study was all about in the first place! Do the same for 'calcium and glaucoma' - and the same applies. Journalese and much confusion.

Keep a questioning and open mind - and above all, enjoy 'digging'.

Go well -

Cataracts - removed, phacoemulsification (*Very successful)
Spiking Hypertension
Vascular Dysregulation - DDx Reynaud's disease
Autoimmune disease - ankylosing spondylitis
Peripheral arthritis
Psoriasis - very light
NTG Glaucoma
MIs - miocardial infarction
CVAs - cerebral vascular accident/s (minor stroke/s)
Actinic Keratosis - pre skin cancer

Sure been handed a bundle of great genes :((
Don't weaken - just take another pill (not <LOL>)

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Thank you, Molly. I have a certain deadline and I need more time to digest the information you provided, but I'll be back with more questions.
And good luck in dealing with your health problems. I am not familiar with many illnesses you mentioned (my knowledge of medicine is obviously non-existing), but I noticed several autoimmune diseases and we'll risk a question: "Do you have some vegan diet experience?"
Frankly, as we get older, we begin to accumulate illnesses. I am still considered to be a healthy person, but when I start counting my problems, active and potential, they look discouraging.

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windblown,

Regarding "I also have Von Willebrands type 1 which is a clotting disorder (I don't clot properly) so I bleed easily," may I ask what your symptoms are, how you were diagnosed and what treatment (if any) you received?

My sister thinks we might have this because we bruise so easily. I have so many black and blue marks that seem to come from nowhere.

Also, I had a wisdom tooth out some years ago and bled so much for hours afterwards that I had to go to the emergency room.

Thanks,
Uma

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Hi Uma! There is a blood test to see if you have Von Willebrands type 1-4. I've had this since childhood, and the symptoms are: easily bruise, nose bleeds, heavy heavy menses, excessive bleeding whenever you are cut (shaving, dental work, surgery, paper cut :o)) Ask your doc for a test. You may need to see a hematologist to get the test, but maybe not.

Whenever I have surgery I have pre-op DDAVP (desomopressin) via I.V. one hour prior to surgery, during and one post-op and one 3 days later because with VWD, you usually have "delayed" bleeding. In the past, before the DDAVP was used (long time ago) you were stuck having transfusions. I've had so many of those and I was always worried about contracting something from it. Years ago, they didn't screen for Hep C. My husband has thrombocytopenia and the two combined would be lethal for a child.

If you need anything further...just ask...happy to help!

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Uma I forgot something. There really isn't any tx other than the prophylactic type. You just need to have a clotting drug before minor/major surgery. When I have a dental extraction, I can bleed for days. It's not non-stop, of course, but you do spit out blood throughout the day, for several days. Everyone has varying amounts of bleeding. Some are worse than others and some aren't.

See this http://labtestsonline.org/index.php/understanding/conditions/bleeding-disor ders/ go through all the tabs. Actually, VWD type 1 is the most common bleeding disorder. I always thought hemophilia was semi-common, but I guess not. My platelet count is normal, but they don't work well in clotting. I've never had DDAVP prior to an extraction (only had one in past 20 yrs) but now with the perio/dentist/oral surgeon I have (from UCLA) they would rather I have the infusion prior to say oral bone graft surgery. Probably a cya situation. ;o)

Hope you find out what's going on and don't hesitate to ask more questions!

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Thanks so much, windblown. This is very helpful information that I will discuss with my doctor.

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Glaucoma for 5 years - just walked in the door and saw this in my inbox. Will have to read through it all. I guard my vision so carefully - my IOP spiked to 22-23 when they gave me steroids in the hospital following a spinal fusion (which has developed into Failed Spinal Fusion Syndrome - but that is not the topic here). I manage it with Travatan Z at night and Restasis (a prescription wetting solution) morning and night which has brought it down to 12-14 range. It took a year before my IOP was down after the surgery. I have all the tests regularly - OTC, visual field, etc. The last thing I want is increased pressure as I just started Strontium with some trepidation and increased my calcium and magnesium supplements also with trepidation. Too many loosy-goosy supplements for my liking but I am doing it.

Last comment before I read all the above, there was a period in my life when I was an editor of scientific/ medical research submitted for publication to a well known medical journal. I have read many of the cited papers on this site and one of the worst for any of us to hang our "O" hats on is the much referred to COMB study.........................but I digress from glaucoma.

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http://www.hindawi.com/journals/jeph/2012/354151/ - the COMB Study.
Quote SCW: "one of the worst for any of us to hang our "O" hats on is the much referred to COMB study."

Why do you say 'One of the worst studies'? Looks to be a very good study.

Steroids can lead to glaucoma and IF have a DDx of glaucoma then steer clear of steroids.

In addition. Be aware of anaesthesia as anaesthesia can lead to a worsening of glaucoma - damage to the retina. There is new evidence re the dangers of anaesthesia and glaucoma and, surgery, especially 'spinal' surgery. The worst damage of surgery and anaesthesia is that coming from/as showing from, spinal surgery.

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Hi funnygirl1 - Vegan diet? No. Was vegetarian for a number of years - when I lived in India. Most of my friends (Indians) were strict vegetarian though non were vegan - and the servants were also vegetarian, so, far easier to be vegetarian. The odd few times I ate meat, they all complained that I 'smelt' of...marketplace meat (IOW rotten food...!) And the servants used to wrinkle their noses! We did eat eggs - though I am not that keen on eggs. Will eat at a pinch, but...

Being a vegetarian in India was no biggie deal - fantastic food. I was assuredly NOT malnourished. In fact, have NEVER been so well as when I lived in India - seven years. The country has changed much since I lived there: 59 - 66.

Nowadays I do not eat that much meat, and very rarely beef - the smell is off-putting! When I do eat meat it is mainly fowl and game (wild and therefore organic) - but very little chicken. Can manage chicken soup. In winter eat a lot of home made soup from home made base stock - like a good mix of good bones, but again, not beef nor mutton nor pork.

My autoimmune conditions are nowt to do with age - in the main are genetic. Big bore. But had no choice in the matter....<LOL>

Take care - Go well

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