Improvement of regulation
| If we assume in a patient that vascular dysregulation is partly responsible for the damage, then it is worth treating it. This generally leads to better regulation of blood flow and improves autoregulation in the eye in particular. This in turn results in better tolerance of both eye pressure and blood pressure fluctuations. Such treatment usually also improves the general well-being and it helps not only the eyes but also other organs. We must not forget that vascular dysregulation is not only a risk for glaucoma, but also for other diseases, such as acute hearing loss. We will limit ourselves here to discussing calcium channel blockers and magnesium. Other therapies such as Triflusal, acupuncture, traditional Chinese therapy or Ocufolin have been discussed elsewhere on this webpage and / or on www.flammer-syndrome.ch. | |
 K Konieczka, J Flammer: Treatment of Glaucoma Patients with Flammer Syndrome |
The most common cause of vascular dysregulation in glaucoma is Flammer syndrome. If glaucoma damage progresses, despite an eye pressure in the statistical norm, then it is reasonable and useful to treat the FS. However, this treatment must be highly individualized and is based on three pillars: behavior, diet, and medication. In this review, Konieczka and Flammer provide detailed guidance for such treatment. The recommendations are based on both scientific studies and the authors' many years of experience. |
 M Mozaffarieh, K Konieczka, J Flammer: Calcium channel blockers: their use in normal tension glaucoma |
Among the drugs used to treat vasospasm and vascular dysregulation, calcium channel blockers play a central role. They inhibit the influx of calcium into cells which is induced, among other things, by endothelin. In this review, Mozaffarieh et al. describe the mechanism of action and clinical effect of calcium channel blockers in normal tension glaucoma. |
 P Gasser, J Flammer: Short- and Long-term Effect of Nifedipine on the Visual Field in Patients with Presumed Vasospasm |
Gasser and Flammer were the first to use calcium channel blockers, especially nifedipine, in ophthalmology. Also, for historical reasons, we show here one of their papers at that time. It shows that in patients with vasospasm, the visual field improves with nifedipine therapy. This improvement can be observed after as little as one hour and, with continued therapy, lasts for at least 12 months. Meanwhile, we have learned that nifedipine (and similar calcium channel blockers) are much better tolerated at much lower doses and still have the same improving effect on regulation. |
 AZ Gaspar, J Flammer, P Hendrickson: Influence of nifedipine on the visual fields of patients with optic-nerve-head diseases |
Gaspar et al. compared the effect of nifedipine on visual field in different optic nerve diseases and showed that the effect of nifedipine was very different. In patients with vascular dysregulation, with or without glaucomatous excavation, the visual field improved on average, but not, for example, in a condition after AION. The observed visual field reversibility was significantly better in younger than in older patients. |
 P Meyer, MF Lang, J Flammer, TF Lüscher: Effects of Calcium Channel Blockers on the Response to Endothelin-1, Bradykinin and Sodium Nitroprusside in Porcine Ciliary Arteries |
To understand why calcium channel blockers, improve ocular blood flow and thus visual field, Meyer et al. isolated ciliary arteries and studied the effect of calcium channel blockers on endothelin-induced vasoconstriction. They demonstrated that calcium channel blockers significantly reduced endothelin-induced vasoconstriction. In contrast, endothelium-dependent and endothelium-independent vasodilatation remained unchanged. |
 AZ Gaspar, P Gasser, J Flammer: The lnfluence of Magnesium on Visual Field and Peripheral Vasospasm in Glaucoma |
Magnesium is a physiological but weak calcium channel blocker. Therefore, we can also expect a similar effect on the visual fields of glaucoma patients. Gaspar et al. studied ten glaucoma patients with peripheral vasospasm. After four weeks of therapy with magnesium, blood flow in nailfold capillaries improved significantly and visual fields tended to show improvement. |
 ES Dettmann, TF. Lüscher, J Flammer, I O. Haefliger: Modulation of endothelin-l-induced contractions by magnesium/calcium in porcine ciliary arteries |
To understand the effect of magnesium on ocular blood flow, Dettmann et al. isolated ciliary arteries and saw that magnesium, similar to a calcium channel blocker, inhibited endothelin-induced vasoconstriction. Endothelium-dependent and endothelium-independent vasodilation remained unchanged. Therefore, magnesium is also called a physiological calcium channel blocker. This fits with the clinical observation that magnesium has a similar effect on the visual field as nifedipine, only much weaker. |