glaucoma

When Glaucoma Is More Than an Eye Disease

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Dr. Marrs and I are very much on the same plane of thinking. We both believe that much of the illness in America is not being recognized for what it really represents, hence the publication of our book:  Thiamine Deficiency Disease, Dysautonomia and High Calorie Malnutrition. I want to give you an illustration of a typical situation where the patient is falling through the cracks of modern medicine. I live in a retirement home and one of my friends who is resident here told me the following story, believing that his medical history was a reflection of how well he had been treated.

Open Angle Glaucoma: A Marker of Autonomic System Dysfunction

His story begins in his forties with a burgeoning glaucoma in the left eye. He told me that the surgeon had to make a cut in his eye to let the fluid out and he later required a corneal transplant. At the time he was smoking a pack a day of cigarettes. He continued by telling me that he periodically had cardiac palpitations and in his fifties he had cardiac bypass surgery and was being treated with aspirin. He still experiences heart palpitations. At present, he has periods where he is unable to catch his breath, sometimes for half an hour or so. As he was telling me his story, I could clearly see that all of these events might easily be put together with one underlying cause. Ophthalmologists (eye specialists) know perfectly well that one type of glaucoma known as “open angle” is not a disease of the eye. It is a disease of the autonomic nervous system (ANS), so let me try to explain this.

The eye-ball is filled with fluid that has entry and exit portals, allowing for the circulation of nutrient bearing fluid throughout the eye. Entrance and exit are controlled by a branch of the ANS. If the exit mechanism fails, the fluid cannot leave the eye and the pressure builds up. The exit is in an angle representing the detailed way in which the eyeball is constructed, hence the termination “open angle”. The key to relieving the fluid buildup is by fixing the neurological control of the entrance and exit of fluid.

The trouble with this is that the pressure can build up slowly and even the vaguest eye symptoms are unlikely. Even when visual limits are first noted, the disease is usually quite advanced. Increased blood pressure or family history of glaucoma may be an indication for an eye examination on a regular basis. The next thing to be understood is that the ANS is not symmetrical. In other words the right half of the body is controlled differently from the left half, thus explaining why the glaucoma can be in only one eye. In my view, in an ideal medical situation, the eye doctor should have advised the patient of the underlying cause and referred him for further evaluation. The patient should have been informed that the “pack a day” of cigarettes was the underlying cause of the glaucoma. He is unlikely to have suspected the connection.

Other Symptoms of Autonomic Disruption: Sleep Apnea, Dyspnea and Heart Palpitations

Evidence for the ANS association has been shown by the fact that sleep apnea (repeated temporary cessation of automatic breathing in sleep), surprisingly common in the United States, is prevalent in primary open-angle glaucoma patients. Although this would be a potential clue for an eye examination, there was no history of sleep apnea indicated by my friend. This disease develops because of defective control mechanisms in the brainstem and automatic breathing, particularly necessary in sleep, is mediated through the ANS. The complaint of cardiac palpitations also indicates abnormal activity of the ANS, because the speed and regularity of the heart is controlled by this system. Finally, his difficulty in breathing with the technical name of dyspnea is typical of heart and lung disease. His previous history of heart palpitations suggests that this is heart-related. I would suggest that his health is in a precarious state and I think that he might wind up eventually by being treated with nasally administered oxygen, as I see repeatedly in other elderly residents. I often wonder whether the oxygen is really giving benefit if the catalysts that enable cells to use it are in insufficient supply, because they are never given a thought.

Disparate Symptoms within the Framework of Dysautonomia

Most people know that we have two nervous systems. One is known as voluntary and the other that takes care of all automatic mechanisms in the body, is called the ANS. This is the nervous system with which we are concerned here. The brain may be thought of as having two primary sections. The upper part thinks while the lower part automates by signals to and from all the organs in the body through the wiring of the ANS and a bunch of glands known as the endocrine system. Another illustration of asymmetry, as indicated in this case of glaucoma, is the fact that nerves from the ANS deliver a different signal to the heart from the right side of the body versus the left side. One controls the strength of contraction of the heart while the other controls the speed at which it beats. Therefore, it is not too difficult to understand that heart palpitations are a function of this nervous control and that their cause is the same one that gave rise to glaucoma, faulty action of the ANS. Finally, the difficulty in breathing is because of defective metabolism in the brainstem where automatic breathing is controlled. That is why glaucoma and sleep apnea sometimes occur together as we have stated.

Why the Autonomic System Becomes Disturbed? Poor Oxidative Metabolism

The lower part of the brain, known as the limbic system, is a complex of cells that come together in the operation of the ANS and endocrine system. The metabolism of these cells is inordinately dependent on a high rate of oxygen utilization. Because of this, they are very sensitive to thiamine deficiency, resulting in what is sometimes referred to as brain pseudohypoxia (false lack of oxygen). The lack of energy in these cells produces abnormal function in the ANS.

The toxic effect of smoking results in slowly producing damage in oxidative metabolism. This may give rise only to minor changes in mental or physical fitness, sometimes for years, but the metabolic inefficiency eventually affects the ANS, often initiating serious disease, as in this case. Although smoking is generally thought of as the commonest cause of lung cancer, it has a much wider danger of triggering virtually any disease because of its role in reducing cellular energy. There is circumstantial evidence that many, if not all, diseases are the result of oxidative dysfunction. Zbinden published a paper in which he found 696 papers that described treatment of 242 different diseases, other than beriberi, with thiamine, providing a variable degree of success.

We can now see why the patient described above had a series of events that could be ascribed to an underlying cause in common, inefficient oxidation. In fact, the symptoms of beriberi, none of which are pathognomonic (strong indicators of that disease exclusively), are so prolific that it can be looked at as the great imitator of disease. Chronic fatigue, heart palpitations, insomnia, abdominal bloating, constipation, panic attacks and many other symptoms, so often regarded erroneously as psychological or referred to as Chronic Fatigue Syndrome are common in America today. The official medical denial of it as an acceptable solution leave the unfortunate patient in limbo without the necessary, relatively simple treatment that is so effective.

The Problems with Compartmentalized Medicine

It seems to me that the patient that I have described represents a failure of perspective in modern medicine. The glaucoma is treated as an eye disease and changes in heart function are seen as diseases of the heart, whereas the two have an identical underlying cause, chiefly in the brain. The patient can be seen as slipping through the cracks in perspective and it carries with it a serious indictment of the present medical model. The surgical approach to the glaucoma was unavoidable and saved the patient’s eye. We know that that kind of glaucoma can build up slowly without the patient being aware.

My point is this: I would be willing to bet that the patient had other trivial symptoms at the time of his glaucoma that would be a reflection of abnormal ANS activity. They could have been so trivial that they weren’t even mentioned to the physician and long forgotten by the patient when serious disease made its appearance. Although the glaucoma could not have been predicted even under those circumstances, at least it would not have been a surprise to the ophthalmologist. In an ideal doctor/patient relationship, the ophthalmologist would be aware of the ANS connection and refer the patient to a colleague who understands this underlying cause. The later development of heart palpitations might have been seen differently as dysfunction in the ANS. Modern heart disease and thiamine deficiency have recently been connected.

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“Photo showing acute angle-closure glaucoma which is a sudden elevation in intraocular pressure that occurs when the iris blocks the eye’s drainage channel—the trabecular meshwork.”

Image credit: Jonathan Trobe, M.D., CC BY 3.0, via Wikimedia Commons.

This article was published originally on August 22, 2019.

Birth Control Problems? The Eyes Have It

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I have a lot of conversations about birth control. It’s what I do. I’m kind of a one trick pony that way. Anytime you engage in a similar discussion with a variety of people, you begin to see patterns in how they respond.

The first pattern that pleasantly surprised me was that a vast majority of women enthusiastically welcome the voice of a concerned man in their conversations about the dangers of birth control, even among women who haven’t necessarily embraced the idea that birth control carries unnecessary risks. However, as a sort of soft rebuttal, I have heard this response more than a few times: “I’ve been taking birth control for x-number of years, and it hasn’t affected me.”

I wrote in my book and in a few articles since, that this statement saddens me because it leads me to think about how this woman’s story has yet to be fully written. Sure, maybe she hasn’t experienced any of the immediate complications we think of that injure or kill women – like strokes, blood clots, DVT, or pulmonary emboli, but birth control is the gift that keeps on giving.

There’s still time for her to develop a liver adenoma or maybe an autoimmune disease like lupus, multiple sclerosis, or Crohn’s disease – and further down the road, breast cancer, skin cancer, or gallstones. There’s a good chance whenever she develops any of these conditions she won’t even realize it could have been caused by taking these potent steroids.

Heck, I’ve spent years researching birth control, and I’m still finding connections I never knew existed.

The Eyes Have It

I recently attended a meeting of glaucoma specialists discussing diagnosis and treatment of the disease. I’m not a medical professional, but as they spoke, I happened to recognize a couple of the biomarkers they mentioned. It made me wonder whether hormonal birth control might contribute to an increased risk of glaucoma later in life.

I pulled out my phone and turned to my trusted friend, Google Scholar. Sure enough, a large population-based study released in 2013 incorporated a multivariate analysis of nearly 3,500 women over the age of 40 and found that those who had used hormonal birth control for three years or longer more than doubled their risk of developing glaucoma.

That’s significant and alarming. However, when we’re younger, over-40 sounds so far away and it’s easy to convince ourselves it won’t happen to us. That’s human nature. If it wasn’t, literally nobody would still be smoking.

A Deeper Look

Let’s look at what might cause this dramatic surge in glaucoma patients among women who took birth control. At first, the research makes this entire concept seem counterintuitive.

A few studies over the past 25 years demonstrated that postmenopausal women taking hormone replacement therapy actually saw an improvement in their intraocular pressure. High intraocular pressure is the key factor in most glaucoma patients.

If the synthetic steroids in hormone replacement therapy for menopausal women benefit intraocular pressure, the assumption might be that similar synthetic sex hormones in birth control during the reproductive years should also be beneficial.

Digging deeper, we find that a 2012 study demonstrated that estrogen deficiency accelerates aging of the optic nerve. Okay, so it still makes sense that a chemical that mimics natural estrogen might offer relief to postmenopausal women whose bodies have drastically reduced natural estrogen production, but what about younger women on birth control?

Actually, that question is what made the 2013 study so fascinating. Rather than a protective effect, researchers found that women who had taken birth control were at a much greater risk of developing glaucoma and consequently had higher intraocular pressure.

Is It Really Counterintuitive?

The first study that sheds some light on what might trigger this negative effect dates back to 1975. It revealed that hormonal birth control effectively shuts down a woman’s natural cycle. With The Pill, their synthetic ‘estrogen’ levels remained constant throughout the month, rather than the ebb and flow of natural hormones that accompany the various phases of their cycle when birth control isn’t present.

In a recent plea for ‘pharmacovigilance’ published in the Journal of Pharmacology & Pharmacotherapeutics, doctors theorized that birth control’s flattened curve of estrogens could be responsible for this threat to the eye. The destruction of the natural peaks and troughs of estrogen throughout the cycle leaves the woman’s body in a virtual state of estrogen-deficiency.

While a woman takes the drug, the flattened curve may create a ‘virtual’ estrogen-deficiency, but by shutting down her natural estrogen production, when she stops taking birth control, she faces a very real estrogen-deficiency. Consequently, hormonal birth control poses a dual-pronged threat. The depletion of natural estrogen exposes her to premature aging of the optic nerve and higher intraocular pressure, both of which could contribute to a future glaucoma diagnosis.

Not So Distant Future

Perhaps the most sobering thing to remember is that glaucoma is not just an old person’s disease.

A 2021 study of over 4.8 million subjects found that women currently using hormonal birth control, which included modern delivery methods like rings, inserts, and IUDs, were more than twice as likely to be diagnosed with glaucoma – today, right now, not later in life.

While the relative risk of developing glaucoma during the reproductive years remains pretty low, we can now include glaucoma among the diseases that we think of as an old person’s disease, which is being skewed younger thanks to these potent drugs.

Removing the Blinders

But, concern for how hormonal contraceptives affect the eyes doesn’t end with glaucoma. I decided to extend my search to see if scientists had discovered any other complications. In fact, recent years have seen a growing unease among ophthalmologists regarding the overall impact these steroids may be having on women’s eyes.

A recent study looked at how this drug affects the thickness of the macula, retinal nerve fiber layer, ganglion cell layer, and choroid. The researchers found that, after only one year, women on birth control experienced a significant change to their retinal and choroidal thickness, which could affect their central vision.

In discussing their findings, the researchers suggested that women taking hormonal birth control should have regular OCT imaging done on their eyes and stated:

It is important to find out when these thickness alterations can be clinically significant or symptomatic and if these changes are reversible or not.

It Doesn’t End There

In a way, none of these findings should be surprising. I’ve written extensively about how the steroids in birth control affect nearly every system of the body because of how ubiquitous hormone receptors are on the various cells throughout our body.

But for those us who don’t spend a lot of time contemplating the eyeball, it can be easy to overlook the fact that our eyes also have a complex vascular system.

Again, The Pill’s contribution to blood clots, strokes, and heart attacks has been pretty well documented on this website and in my book. So, is it possible the drug could cause a similar effect in the eyes?

The most common disease of the retina, which causes severe vision loss, is known as Retinal Vascular Occlusion (RVO), essentially the blockage of a blood vessel in the retina. It usually occurs in middle-aged and older people. However, a study from 1997 showed that of the female patients under 35 years old with RVO, 66% were taking hormonal birth control.

A follow-up study in 2013 affirmed the previous study’s correlation, stating that apart from hypertension, diabetes, advancing age, or genetic predisposition, hormonal birth control is the most common predisposing factor for RVO.

The authors pointed out that doctors now commonly prescribe birth control off-label to treat ovarian cysts, ‘regulate periods’ in PCOS or puberty, and down-regulate IVF cycles. With this increase in prescriptions, they warned:

The risk for retinal vascular catastrophes is also rising.

This isn’t just a theoretical concern in the labs. Some leading ophthalmic practices now list oral contraceptives as a risk factor for RVO alongside obesity and smoking.

Seeing the Light

I ran this article past a friend, Dr. Anne Malatt, an eye surgeon, and asked her for any thoughts or feedback. Here’s what she wrote:

I am amazed that as an eye specialist who is also a woman, mother and grandmother, I have not previously heard of any association between the contraceptive pill and eye disease, and particularly nothing about glaucoma. This is important information to share with everyone, including eye specialists and we should now be asking all the women we see as patients about any history of taking the pill. We currently screen everyone over the age of 40 for glaucoma, but in light of these findings, we should be considering screening all adult women who are taking or have taken hormonal birth control, for both glaucoma and retinal disease. And it would be wise to consider alternative modes of family planning, rather than taking these powerful and potentially harmful medications.

It’s wonderful that ophthalmologists and optometrists are taking note of birth control’s role in eye disease. Unfortunately, they aren’t the ones prescribing hormonal contraceptives. Do you think any ObGyn, primary care physician, or Planned Parenthood clinic tells women they need to schedule routine OCT imaging to monitor changes in their eyes?

Neither do I.

Hopefully, the word will spread to those doctors soon enough and they too will see the light.

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We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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This article was published originally on  February 7, 2022. 

Blinded By Side Effects: Vision and Hormonal Birth Control

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I don’t know about you but my vision is pretty important to me. I’m using it right now to type this article. I use it all the time, every waking hour of the day (except maybe when I’m meditating). So when I read the Nelson Pill Hearings and I came across the testimony of Dr. Guttmacher, I was shocked.

“Now, in addition to the danger from thromboembolism which has been described to this committee on several occasions by several witnesses, I think that there are other dangers for the pill… such as high blood pressure, headache, depression, interference with vision, and so on.” (page 6566)

Wait… the birth control pill affects your vision??? How can that be? And how could he just say that in passing? Why did no one on the Senate committee stop him and make him explain that that statement? It turns out, just like diabetes, yeast infections and UTIs, depression, weight gain, and so many other side effects, no one had told me that my vision could be affected by using hormonal birth control.

How Hormonal Birth Control Affects Vision

Hormones affect every system of the body so perhaps it should come as no surprise that they can greatly impact your vision. In fact, it is the fluctuation in hormones that is the primary reason for worsening eyesight with age. So of course, manipulating the body’s natural chemistry by using hormonal birth control can cause a variety of vision problems.

Dry Eye

According to the National Eye Institute (NEI), “Dry eye occurs when the eye does not produce tears properly, or when the tears are not of the correct consistency and evaporate too quickly.” While usually more uncomfortable than dangerous, if dry eye is left untreated it can cause pain, ulcers, scars on the cornea, and in rare cases, some loss of vision.

The NEI also states that it can be temporary or chronic and that one of the causes of dry eye is medications such as birth control. Unfortunately, that means dry eye is often overlooked in young women and teen girls using the pill. As Dr. Reiser of the Cornea Institute at the Children’s Hospital of Los Angeles points out, doctors “may not even think of it, but these drugs are frequently prescribed to treat skin problems and dysmenorrhea. Some [ocular] symptoms can mimic what you see in menopausal women.”

We also see dry eyes as a side effect of women who’ve had hysterectomies. Robin Karr details her experience with it here. It’s obvious that eye health is linked to hormones but the vision problems associated with hormonal birth control don’t stop there. Dry eyes may be the least of our worries.

Glaucoma

Dry eye may be uncomfortable and inconvenient but glaucoma, another eye condition linked to hormonal birth control, can be much more dangerous. Glaucoma causes damage to the optic nerve and can lead to permanent loss of vision. Perhaps the scariest thing about glaucoma is that most patients have no symptoms and are only diagnosed when having an eye exam. A researcher and ophthalmologist from the University of San Francisco found that use of birth control pills for three years or longer doubles the risk of glaucoma.

The fact that glaucoma is the second leading cause of blindness and that there is no cure  is very disturbing. The American Optometric Association downplays the findings of this study and calls for more research. Yet, that seems to be the response to all of the research about the dangerous side effects of hormonal contraception. How much more research do we need to show that these medications are dangerous and dangerously over-prescribed? A woman could literally go blind from a medication she’s been prescribed to treat acne.

Retinal Occlusion

As someone who had a stroke while using hormonal birth control, this risk probably shouldn’t have come as a surprise to me. Retinal occlusion is a stroke of the eye caused by a blockage in the blood vessels of your retina. These blockages can be caused by blood clots, a well-researched and documented side effect of hormonal contraception. Like with a stroke of the brain, recovery isn’t guaranteed. Some people who suffer these retinal occlusions will never see again.

In fact, the risk with oral contraceptive use is so substantiated that you can find it in the “Practicing Ophthalmologists Curriculum Core Ophthalmic Knowledge” on the American Academy of Ophthalmologists website.

It should also be said that many of our Real Risk: Birth Control and Blood Clots study participants experienced vision changes before and during their blood clots. This was the case not just in the women who had had strokes but surprisingly also in the women who suffered pulmonary embolisms.

Seeing Clearly

I used birth control pills for 10 years and I never once had a healthcare professional- not my gynecologist, not my general practitioner, not my ophthalmologist- tell me that vision problems were a side effect. That Dr. Guttmacher mentioned it in passing at Nelson Pill Hearings seemed to indicate that the risk was well-known, even back in 1970. Current research supports that hormonal contraceptives adversely affect vision. Where does that leave us? What would you be willing to give up for a medication? Your physical health? Your mental health? Your libido? Your vision? Your life?

What else do we need in order to see that hormonal contraception is not worth it?

Real Risk Study: Birth Control and Blood Clots

Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.