Today’s focus is on Glaucoma Awareness and a review just published in Current Opinion in Ophthalmology entitled, “Exfoliation syndrome: a disease with an environmental component.”
We found this particularly interesting because we strongly believe that environmental issues, including appropriate dietary intake, supplements and fitness play a huge role in disease prevention and eye and full body health, including glaucoma.
Exfoliation syndrome is the most common cause of secondary open-angle glaucoma, which is a progressive disease characterized by accumulation of fibrillary extracellular deposits on various anterior segment ocular tissues. It’s serious and can lead to glaucomatous optic neuropathy secondary to elevated intraocular pressure, late-onset spontaneous intraocular lens subluxation and retinal vein occlusion. It’s also associated with increased cataract surgery complications, in part due to compromised zonular stability.
Although a common gene variant (LOX1), the receptor protein that binds, internalizes and degrades oxidized low-density lipoprotein, has been strongly linked to exfoliation syndrome, this review suggests that almost the same percentage of those without exfoliation syndrome also carry this gene variant.
The findings from this new Current Opinion in Ophthalmology review point toward other nongenetic factors that influence the development of exfoliation syndrome, with increasing latitude, solar radiation, climatic variables and dietary factors, including excessive coffee consumption and low dietary folate intake being the nongenetic factors associated with increased risk of exfoliation syndrome. Again, the most common cause of secondary open-angle glaucoma.
The review investigators report that elevated homocysteine levels are suggested to increase exfoliation material formation by contributing to vascular damage, oxidative stress and changes in the extracellular matrix. Homocysteine levels are higher in the serum, aqueous humor and tear samples of exfoliation syndrome patients compared with controls.
The synthesis of methionine from homocysteine requires folic acid enzymes and a deficiency of folic acid leads to elevated homocysteine plasma levels. Low serum folate levels are now associated with increased risk of exfoliation syndrome.
Unfortunately, very few ocular-focused products include the full-spectrum of B vitamins, which are proven to be players in eye health.
Given that it’s the height of the season and because Biosyntrx is located in Colorado, I’m going to use this space to speak to skiers and eye care professionals who take care of skier’s eyes because this review also suggests that ocular exposure to light from reflective surfaces like snow may be one of the more important environmental factors in the pathogenesis of exfoliation syndrome.
Another study listed in today’s references by Kang et al., found that the greater time spent outdoors during the summer months from high school up to age 24 was independently associated with greater risk of exfoliation syndrome.
This information also brings up the necessity of making sure we are consuming diets or supplements that include adequate amounts of B vitamins and the carotenoids clinically linked to macular pigment density, which also help protect our retina from the solar radiation associated with exfoliation syndrome and many other ocular diseases including open-angle glaucoma and macular degeneration.
These womb-to-tomb carotenoids are now also associated with skin, brain and bone health, but we will address these benefits in another Friday Pearl.
Ellen Troyer, with Spencer Thornton, MD, and the Biosyntrx staff
PEARL: The best ocular-focused full-spectrum multiple vitamins / minerals / antioxidant formulations are designed to address eye and body nutrient needs because ocular health is most frequently a reflection of full body health status.
References for today’s article plus an instrument announcement from our friends at Crestpoint Management can be found here.