Latest / Glaucoma, Vision & Longevity: Supplements & Science / A timing roadmap: Supplements that may be safe two weeks after trabeculectomy

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A timing roadmap: Supplements that may be safe two weeks after trabeculectomy · Glaucoma, Vision & Longevity: Supplements & Science

• 0:00
  SPEAKER_00: Introduction.
• 0:00
  SPEAKER_00: A trabeculectomy is a glaucoma surgery that creates a small drainage bleb under the eyelid to lower eye pressure.
• 0:08
  SPEAKER_00: Like any surgery, the eye needs time to heal.
• 0:11
  SPEAKER_00: In the subacute phase, about two to four weeks after surgery, the new wound is still forming tissue and delicate.
• 0:18
  SPEAKER_00: Many patients wonder if they can take vitamins or herbal supplements during this time.
• 0:23
  SPEAKER_00: In general, healing requires good nutrition and care, but some supplements may raise bleeding risk, alter the pressure in the eye, or interfere with medications.
• 0:32
  SPEAKER_00: We summarize what the eye's healing process involves and review evidence about common supplements.
• 0:38
  SPEAKER_00: The goal is safe guidance, what might help gentle healing of the bleb, what could do harm, and when to stop a supplement if problems arise.
• 0:47
  SPEAKER_00: Wound healing of the filtering bleb.
• 0:49
  SPEAKER_00: After trabeculectomy, the eye's tissues heal in stages.
• 0:53
  SPEAKER_00: First, hemostasis and inflammation.
• 0:56
  SPEAKER_00: Immediately after cutting, small clots form and white blood cells arrive to clean up debris.
• 1:01
  SPEAKER_00: Second, proliferation granulation.
• 1:04
  SPEAKER_00: Over the next two to four weeks, the wound builds new tissue.
• 1:08
  SPEAKER_00: Blood vessels grow in and a soft, red granulation layer forms.
• 1:12
  SPEAKER_00: This stage usually lasts into the second or third month after surgery.
• 1:16
  SPEAKER_00: Third, fibroblast activation and collagen deposition.
• 1:19
  SPEAKER_00: Starting around week three, specialized cells, fibroblasts in Tinin's capsule under the conjunctiva, lay down collagen fibers and connective tissue.
• 1:28
  SPEAKER_00: Fourth, remodeling and scarring.
• 1:31
  SPEAKER_00: After a few months, the collagen contracts and the tissue strengthens.
• 1:35
  SPEAKER_00: Ideally, this scarring seals incision sites but leaves a controlled, thin bleb that permits fluid to drain slowly.
• 1:42
  SPEAKER_00: Too much scarring will block the bleb and cause the surgery to fail.
• 1:46
  SPEAKER_00: Indeed, excessive wound fibrosis is the main reason trabeculectomy fails.
• 1:52
  SPEAKER_00: Around two to four weeks, the eye is in the middle of this process.
• 1:55
  SPEAKER_00: Inflammation is subsiding, and fibroblasts are laying collagen.
• 2:00
  SPEAKER_00: The bleb still has blood vessels and is fairly soft, not yet a rigid scar.
• 2:05
  SPEAKER_00: In this subacute period, wound healing is still active, but past the highest risks of bleeding and of infection that occur immediately after surgery.
• 2:14
  SPEAKER_00: Carefully chosen supplements or good nutrition might support healthy healing, but anything that dramatically boosts blood flow, disorganizes collagen, or strongly alters inflammation could alter the outcome.
• 2:26
  SPEAKER_00: Supplements and bleb healing nutritional support for healing.
• 2:30
  SPEAKER_00: The body needs basic nutrients to heal any wound.
• 2:34
  SPEAKER_00: A balanced diet rich in vitamins, minerals, protein, and calories supports normal recovery.
• 2:39
  SPEAKER_00: For example, fruits and vegetables rich in vitamins C and E, beta-carotene, vitamin A precursor, and other antioxidants help maintain healthy tissues.
• 2:48
  SPEAKER_00: A varied diet or a standard multivitamin will cover these needs.
• 2:53
  SPEAKER_00: In fact, diets high in fruits, sources of vitamin C, E, and carotenoids, are associated with lower risk of glaucoma in population studies.
• 3:02
  SPEAKER_00: While this is not direct proof for bleb healing, it suggests antioxidants support eye health.
• 3:07
  SPEAKER_00: Vitamin C is especially important for collagen formation in wounds, deficiency causes poor healing.
• 3:14
  SPEAKER_00: And vitamin A is essential for normal skin and mucous membranes.
• 3:18
  SPEAKER_00: Zinc and protein are also needed for tissue repair.
• 3:21
  SPEAKER_00: Inadequate nutrition can delay healing, so patients should avoid prolonged fasting or very restrictive diets during recovery.
• 3:29
  SPEAKER_00: However, more is not always better.
• 3:31
  SPEAKER_00: There is little evidence that megadoses of vitamins speed up or change bleb healing.
• 3:36
  SPEAKER_00: For instance, a small clinical trial gave patients 300 milligrams of vitamin E, alpha tocopherol, daily for two months after tribeculectomy and found no difference in surgical success or complications compared to placebo.
• 3:50
  SPEAKER_00: In that study, the success rate, achieving low pressure without more treatment, was similar whether or not patients took extra vitamin E.
• 3:58
  SPEAKER_00: In short, routine high-dose vitamin E did not hurt but also did not help improve outcomes.
• 4:05
  SPEAKER_00: Some natural compounds have been studied for anti-scarring or anti-inflammatory effects.
• 4:10
  SPEAKER_00: For example, curcumin from turmeric and other plant antioxidants can suppress fibroblast activity in lab tests.
• 4:18
  SPEAKER_00: One laboratory study showed curcumin can inhibit growth of human ocular fibroblasts, cells like those in the bleb at certain doses.
• 4:26
  SPEAKER_00: In theory, curcumin's anti-inflammatory properties might reduce too much scarring.
• 4:31
  SPEAKER_00: Similarly, omega-3 fatty acids, fish oil, have anti-inflammatory effects that might stabilize healing, although their impact on ocular fibrosis is not proven.
• 4:41
  SPEAKER_00: However, any theoretical benefit is unproven in trabeculectomy patients, and fish oil has other concerns, see below.
• 4:49
  SPEAKER_00: Overall, strong evidence is lacking for any supplements specifically improving trabeculectomy healing.
• 4:55
  SPEAKER_00: The best approach is a healthy diet, include fruits, vegetables, lean protein, and fluids.
• 5:00
  SPEAKER_00: Additional supplements, vitamins, minerals, should match recommended daily allowances unless a deficiency is known.
• 5:08
  SPEAKER_00: Cancer and other wound care guides sometimes recommend nutrients like arginine or glutamine for general healing, but these are not specifically studied for filtering bleb wounds.
• 5:19
  SPEAKER_00: In some, good nutrition aids healing, but assume supplements give only modest help and discuss them with your doctor.
• 5:26
  SPEAKER_00: Supplements that may sharply alter healing.
• 5:29
  SPEAKER_00: Just as some supplements may mildly support healing, others could push the wound too hard or in an unwanted direction.
• 5:37
  SPEAKER_00: In the context of a filtering bleb, overly aggressive healing can be harmful.
• 5:42
  SPEAKER_00: For example, extremely rapid collagen buildup might close the drainage path.
• 5:47
  SPEAKER_00: High dose protein or collagen supplements.
• 5:50
  SPEAKER_00: Some people take collagen powders or broths to heal incisions.
• 5:53
  SPEAKER_00: In most surgeries, collagen helps closure.
• 5:56
  SPEAKER_00: But for trabeculectomy, surgeons often avoid anything that might speed up scarring at the bleb.
• 6:01
  SPEAKER_00: In fact, traditional advice warns against very high protein bone broths or collagen extracts after glaucoma surgery.
• 6:09
  SPEAKER_00: If you feel you need more protein, a modest increase, chicken, fish, eggs is fine, but avoid megadoses or specialized collagen supplements without doctor's advice.
• 6:19
  SPEAKER_00: Blood-moving herbs and formulas.
• 6:21
  SPEAKER_00: In Chinese and folk medicine, some herbs, ginseng, ginkgo, dongquai, angelica, etc., are believed to promote circulation.
• 6:29
  SPEAKER_00: These can actually accelerate healing and scar formation, something you do not want at the filtering site.
• 6:35
  SPEAKER_00: For example, tonics or placentas, some cosmetic and health products, can have growth factors or hormones that stimulate tissue growth.
• 6:44
  SPEAKER_00: We advise against using any herbal formula intended to replenish or strongly activate healing during the first few months after trabeculectomy.
• 6:52
  SPEAKER_00: High doses of zinc or vitamin A.
• 6:55
  SPEAKER_00: Zinc and vitamin A are needed, but in very high amounts they can actually dry tissues or affect collagen remodeling.
• 7:02
  SPEAKER_00: Stick to recommended doses.
• 7:04
  SPEAKER_00: For example, topical vitamin A speeds corneal healing, but oral excess can cause other issues.
• 7:10
  SPEAKER_00: Omega-3 fish oil.
• 7:12
  SPEAKER_00: Many take fish oil for heart health.
• 7:14
  SPEAKER_00: It has mild anti-inflammatory effects, which could be helpful, but it also thins the blood.
• 7:19
  SPEAKER_00: Traditional surgical advice recommended stopping fish oil one to two weeks before surgery due to bleeding risk, though some recent reviews suggest the risk is small.
• 7:29
  SPEAKER_00: In the post op phase, it's safer to hold off fish oil until healing is more settled after several weeks, unless your doctor says you need it for another condition.
• 7:39
  SPEAKER_00: In short, after trabeculectomy, avoid mega boosts to wound healing.
• 7:44
  SPEAKER_00: If a supplement is known to drive repair strongly, consult your surgeon.
• 7:49
  SPEAKER_00: A little extra nutrition is fine, but supplements meant to accelerate healing or improve performance should be postponed or cleared with your doctor.
• 7:58
  SPEAKER_00: Bleeding risks from supplements.
• 8:00
  SPEAKER_00: Though the eye surgery uses fine control, bleeding under the conjunctiva, causing a red bruise, or inside the eye, hyphema, can occur if blood doesn't clot well.
• 8:10
  SPEAKER_00: Some dietary supplements thin the blood or interfere with clotting factors.
• 8:15
  SPEAKER_00: In the weeks after surgery, when fragile capillaries are growing, these can increase the risk of a bleed at the surgical site.
• 8:22
  SPEAKER_00: Key culprits include garlic, aged garlic, garlic extract.
• 8:27
  SPEAKER_00: This herbal supplement is a strong platelet inhibitor.
• 8:30
  SPEAKER_00: Studies show garlic significantly increases bleeding in surgery.
• 8:34
  SPEAKER_00: It is one of the most consistently dangerous herbs for post-op bleeding.
• 8:39
  SPEAKER_00: Hawthorn, another cardiovascular herb also linked to surgical bleeding.
• 8:43
  SPEAKER_00: Ginkgo boloba can increase bleeding tendency, especially if taken with blood thinners.
• 8:49
  SPEAKER_00: Reviews listed among supplements to stop before surgery.
• 8:52
  SPEAKER_00: Ginseng Panax has mixed reports.
• 8:55
  SPEAKER_00: Some case reports of bleeding exist, but one review found no clear link in trials.
• 9:00
  SPEAKER_00: Still, standard advice is to stop Panax ginseng after surgery.
• 9:04
  SPEAKER_00: Ginger, turmeric, green tea, large quantities, these have mild antiplatelet effects.
• 9:09
  SPEAKER_00: The evidence is mixed, but in undiluted supplement form, not normal tea, they might tip the balance.
• 9:16
  SPEAKER_00: In general, avoid high-dose ginger or curcumin supplements in the first four to six weeks, although culinary amounts like seasoning or a cup of tea are likely fine.
• 9:26
  SPEAKER_00: Fish oil, omega-3 capsules, once thought very risky, recent large studies indicate no strong evidence of excess bleeding in normal doses.
• 9:35
  SPEAKER_00: However, many doctors still recommend holding fish oil one to two weeks before any surgery, just in case.
• 9:42
  SPEAKER_00: After surgery, it's prudent to wait until the initial healing is stable, often after four to six weeks before resuming high dose fish oil.
• 9:50
  SPEAKER_00: Vitamin E, very high doses, over 1000 mg per day, act like a blood thinner.
• 9:55
  SPEAKER_00: The trial mentioned above used 300 mg per day long-term safely, but megadoses should be avoided post-op.
• 10:02
  SPEAKER_00: In practice, surgeons typically instruct patients to stop blood-thinning supplements during the perioperative period and often for a few weeks after.
• 10:11
  SPEAKER_00: If you plan to start or restart something like garlic pills, ginkgo, or high-dose fish oil after trabeculectomy, discuss timing with your surgeon.
• 10:20
  SPEAKER_00: Effects on intraocular pressure, IOP.
• 10:23
  SPEAKER_00: While most supplement concerns are about healing or bleeding, we also consider any direct effect on eye pressure.
• 10:29
  SPEAKER_00: In glaucoma, the goal is to keep IOP low.
• 10:33
  SPEAKER_00: Here's what is known: Caffeine.
• 10:35
  SPEAKER_00: Common in coffee, tea, cocoa.
• 10:38
  SPEAKER_00: In glaucoma patients, a single dose of caffeine can raise eye pressure by a small amount on the order of 1 to 3 mmHg for about 1 to 2 hours.
• 10:46
  SPEAKER_00: For most people, this is minor, but if your eye pressure is very sensitive, avoiding a strong coffee soon after surgery might be wise.
• 10:54
  SPEAKER_00: Decaffeinated coffee or green tea has less effect.
• 10:57
  SPEAKER_00: Vitamin C at extremely high doses, several grams, vitamin C can lower IOP because it pulls fluid osmotically.
• 11:05
  SPEAKER_00: However, such doses cause side effects, such as diarrhea, dehydration, and are not practical.
• 11:10
  SPEAKER_00: Normal dietary vitamin C or a standard multivitamin will not meaningfully change IOP.
• 11:16
  SPEAKER_00: Other vitamins, review articles show that vitamins A, B1, and E have no significant effect on eye pressure or glaucoma measures.
• 11:24
  SPEAKER_00: Vitamin B3 niacin at very high doses can cause transient visual side effects, but its effect on IOP is negligible.
• 11:31
  SPEAKER_00: Herbal supplements, aside from caffeine, in herbs like guarana, most herbal supplements don't directly affect IOP.
• 11:38
  SPEAKER_00: There is no evidence that taking probiotics, minerals, garlic, or ginkgo will raise or lower eye pressure.
• 11:45
  SPEAKER_00: Cannabis marijuana can lower IOP, but unhelpfully short-lived and not practical as a medical strategy.
• 11:52
  SPEAKER_00: Bottom line, at usual supplement doses, do not expect major pressure changes.
• 11:56
  SPEAKER_00: If you notice new pressure spikes after starting something, e.g., feeling glaucoma symptoms worsen, stop that supplement and check with your eye doctor.
• 12:05
  SPEAKER_00: Medication and supplement interactions.
• 12:08
  SPEAKER_00: Eye drops themselves rarely interact systemically, but some general principles apply.
• 12:14
  SPEAKER_00: Blood thinners and supplements.
• 12:15
  SPEAKER_00: Many glaucoma patients take blood thinners, aspirin, warfarin, for other conditions.
• 12:21
  SPEAKER_00: Supplements like ginkgo or garlic add to those thinning effects.
• 12:25
  SPEAKER_00: If you are on any anticoagulant, always tell all your doctors about such supplements.
• 12:30
  SPEAKER_00: Heart or blood pressure meds.
• 12:33
  SPEAKER_00: If you use timolol, a beta blocker drop that can lower heart rate, be cautious with supplements that also lower heart rate or blood pressure, like high-dose fish oil, stinging nettle, or sedatives.
• 12:44
  SPEAKER_00: Similarly, if you use bromonidine, an alpha agonist on the eye, combining it with systemic blood pressure drugs or supplements that lower blood pressure could cause lightheadedness.
• 12:54
  SPEAKER_00: There is no specific list of clashes, but general warning any supplement that affects heart rate, blood pressure, or sedation can, in theory, add to glaucoma medications.
• 13:06
  SPEAKER_00: Enzyme interactions.
• 13:08
  SPEAKER_00: Some supplements, St.
• 13:09
  SPEAKER_00: John's Wirt, for instance, affect liver enzymes that metabolize drugs.
• 13:13
  SPEAKER_00: Although this is more an issue for pills like hormone therapies or steroids, it can matter if you take things like oral acetazolamide, a systemic glaucoma pill, or steroid eye drops long term.
• 13:25
  SPEAKER_00: These cases are rare, but again, inform your physician about all supplements so they can judge any interactions.
• 13:31
  SPEAKER_00: In summary, major drug supplement surprises are rare with routine glaucoma drops.
• 13:37
  SPEAKER_00: The biggest concerns are cardiovascular supplements versus cardiovascular drugs, or warfarin.
• 13:43
  SPEAKER_00: If in doubt, ask your pharmacist to check interactions using a reliable tool before starting a new supplement.
• 13:50
  SPEAKER_00: Monitoring and red flags.
• 13:52
  SPEAKER_00: If you do start a supplement in the weeks after trabeculectomy, keep a close watch on how you feel and your eye status.
• 13:59
  SPEAKER_00: Follow-up appointments.
• 14:01
  SPEAKER_00: Your surgeon will check your eye regularly, often one week, three weeks, etc.
• 14:06
  SPEAKER_00: Always tell them any supplements you are taking at each visit.
• 14:10
  SPEAKER_00: They will measure your IOP and inspect the bleb.
• 14:13
  SPEAKER_00: Check for bleeding.
• 14:14
  SPEAKER_00: Look in the mirror each day for new red bruising or blood in the white of the eye or in the front chamber.
• 14:19
  SPEAKER_00: A small red spot on the sclera, subconjunctival hemorrhage, can be harmless, but a large bruise or blood inside the eye, hyphema, is a major emergency.
• 14:30
  SPEAKER_00: If you notice significant bleeding, immediately stop any blood-thinning supplement and call your doctor.
• 14:36
  SPEAKER_00: Vision and pain.
• 14:38
  SPEAKER_00: If vision suddenly worsens, blurry vision beyond the usual, or if you develop new eye pain, headache, or nausea that could signal a pressure problem, stop any suspect supplement and seek prompt care.
• 14:50
  SPEAKER_00: Signs of infection or leak.
• 14:52
  SPEAKER_00: Although rare, watch for increasing eye discharge, fever, or a very soft or flat eye, the bleb leaking.
• 14:58
  SPEAKER_00: If the eye feels very different, too soft or very painful with redness, stop the supplement and contact your surgeon.
• 15:05
  SPEAKER_00: Systemic side effects.
• 15:06
  SPEAKER_00: Monitor any general reactions.
• 15:08
  SPEAKER_00: For example, if a supplement causes dizziness, stomach upset, or allergic rash, discontinue it.
• 15:15
  SPEAKER_00: Any severe allergic reaction, rash, itching, swelling, should be treated immediately like any drug allergy.
• 15:21
  SPEAKER_00: Red flags to stop a supplement.
• 15:23
  SPEAKER_00: Bleeding events, sudden change in vision, pressure symptoms, uncontrolled eye pain, or any systemic side effect.
• 15:31
  SPEAKER_00: Always keep your care team informed.
• 15:33
  SPEAKER_00: Using a new supplement near the time of eye surgery should be done cautiously.
• 15:37
  SPEAKER_00: If you see any charted problem, higher IOP readings or bleb issues at the next visit, your surgeon may advise you to stop the supplement.
• 15:46
  SPEAKER_00: Conclusion Two to four weeks after trabeculectomy is still a critical healing time.
• 15:51
  SPEAKER_00: Good nutrition and a healthy lifestyle help the bleb develop normally, but healing boosters should be used carefully.
• 15:58
  SPEAKER_00: In practice, most patients do not need special supplements beyond their multivitamin.
• 16:04
  SPEAKER_00: If you consider a specific supplement, first consult your eye doctor, especially if it is known to affect bleeding or blood pressure.
• 16:11
  SPEAKER_00: When used, start lower doses and watch for any eye or systemic problems.
• 16:17
  SPEAKER_00: Key steps are clear follow-up visits and communication with your surgeon.
• 16:21
  SPEAKER_00: In summary, support normal recovery with a balanced diet, appropriate vitamins if you are deficient, and caution with herbs or high dose nutrients.
• 16:31
  SPEAKER_00: Avoid supplements known to thin blood or dramatically alter healing during the early post-op phase.
• 16:36
  SPEAKER_00: By monitoring carefully and reporting any worrying symptoms right away, you can help ensure your surgical outcome is optimal.
• 16:44
  SPEAKER_00: All links to sources are available in the text version of this article.
• 16:48
  SPEAKER_00: You can find the full article at VisualFieldtest.com.
• 16:52
  SPEAKER_00: Thanks for listening.
• 16:53
  SPEAKER_00: To check your visual field, click the link at the bottom of this article or visit VisualFieldTest.com.