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Personalizing a supplement plan after trabeculectomy · Glaucoma, Vision & Longevity: Supplements & Science

• 0:00
  SPEAKER_00: Personalizing your posttrabeculectomy diet and supplements.
• 0:03
  SPEAKER_00: After a trabeculectomy, glaucoma surgery, your eye is healing through several stages.
• 0:09
  SPEAKER_00: In the first two to four weeks, new blood vessels and soft granulation tissue form under the conjunctiva.
• 0:15
  SPEAKER_00: By about three weeks, collagen and scar tissue begin to develop.
• 0:19
  SPEAKER_00: During this subacute phase, two to four weeks, the bleb fluid filtering bubble is still soft and vascular.
• 0:26
  SPEAKER_00: Good nutrition helps healing.
• 0:28
  SPEAKER_00: A balanced diet rich in fruits, vegetables, vitamins, like C and A, protein, and fluids supports tissue repair.
• 0:36
  SPEAKER_00: However, very high dose or specialty supplements generally show only modest benefit.
• 0:42
  SPEAKER_00: For example, a clinical trial found that taking 300 mg of vitamin E daily after trabeculectomy did not improve surgical success or complication rates compared to placebo.
• 0:52
  SPEAKER_00: Instead of relying on megadoses, follow your doctor's orders for eye drops and medication.
• 0:58
  SPEAKER_00: Use supplements only if needed and in safe doses.
• 1:01
  SPEAKER_00: This means usually not exceeding the recommended daily allowance for vitamins, minerals unless a deficiency is known.
• 1:08
  SPEAKER_00: Discuss any new supplement with your doctor before starting.
• 1:12
  SPEAKER_00: Consider your medical history and medications.
• 1:15
  SPEAKER_00: Your overall health can affect healing and interactions with supplements, blood thinners or anticoagulants, like warfarin, zerelto, aspirin, plavix.
• 1:25
  SPEAKER_00: These make bleeding more likely.
• 1:26
  SPEAKER_00: Many herbal supplements also have blood thinning effects.
• 1:29
  SPEAKER_00: For example, garlic, ginkgo boloba, ginger, ginseng, turmeric, curcumin, and high-dose vitamin E can all increase bleeding risk.
• 1:40
  SPEAKER_00: One review found that garlic and hawthorn supplements were strongly linked to surgical bleeding, and that herbs like ginkgo, turmeric, and others raised bleeding risk in patients on blood thinners.
• 1:51
  SPEAKER_00: If you take any of these, tell your doctor.
• 1:53
  SPEAKER_00: He or she may suggest stopping them or monitoring you closely.
• 1:57
  SPEAKER_00: On the other hand, normal dose fish oil, omega-3, ginseng, and saw palmetto did not show increased bleeding in studies, though we still caution if you are on blood thinners.
• 2:07
  SPEAKER_00: Practical point: if you are on warfarin, your doctor should check your INR after starting any new supplement.
• 2:14
  SPEAKER_00: For example, substances like vitamin E or CoQ10 can raise INR and require a dose adjustment.
• 2:21
  SPEAKER_00: Vitamin K in green vegetables lowers warfarin effect, so keep your vitamin K intake steady.
• 2:28
  SPEAKER_00: Blood pressure, heart meds, and kidney meds.
• 2:30
  SPEAKER_00: Some supplements affect blood pressure or potassium levels.
• 2:34
  SPEAKER_00: For example, potassium-rich supplements or teas, like high-dose potassium or warm medicinal teas, can add to potassium if you're on ACE inhibitors or potassium-sparing diuretics.
• 2:45
  SPEAKER_00: Herbals like licorice can also raise blood pressure.
• 2:48
  SPEAKER_00: Always check with your doctor.
• 2:50
  SPEAKER_00: If you have high blood pressure or heart disease, do not take supplements that significantly raise or lower blood pressure without approval.
• 2:58
  SPEAKER_00: Diabetes.
• 2:59
  SPEAKER_00: If you have diabetes, avoid supplements that spike blood sugar.
• 3:03
  SPEAKER_00: Some herbal formulas, like certain Chinese or Ayurvedic mixes, can raise or lower blood sugar, so discuss any new herbals with your endocrinologist.
• 3:12
  SPEAKER_00: Generally, stick to multivitamins and avoid sweet syrups or products with lots of sugar.
• 3:17
  SPEAKER_00: Other conditions, chronic inflammatory conditions or steroid use, can slow healing or suppress immune response.
• 3:25
  SPEAKER_00: In these cases, your doctor may want to avoid immune-boosting herbs like echinacea or anti-inflammatory ones, like high-dose turmeric that could theoretically interfere with your medications.
• 3:36
  SPEAKER_00: If you have liver or kidney problems, high doses of fat-soluble vitamins A, D, E, K, or minerals might need lab monitoring.
• 3:45
  SPEAKER_00: Bottom line, write down all your health conditions and medications.
• 3:48
  SPEAKER_00: Review them with your doctor to flag any supplement interactions.
• 3:52
  SPEAKER_00: For instance, if you use aspirin or warfarin, your doctor will advise stopping blood-thinning herbs well before or after surgery.
• 4:01
  SPEAKER_00: Surgical details matter.
• 4:02
  SPEAKER_00: Details of your surgery guide, what to watch for.
• 4:06
  SPEAKER_00: Anti-scarring agents, MM5FU.
• 4:08
  SPEAKER_00: Many trabeculectomies use antifibrotic drugs, mitomycin C or five fluorauoric, during surgery to prevent aggressive scarring.
• 4:16
  SPEAKER_00: If your surgeon used these, the wound is intentionally kept from scarring too fast.
• 4:21
  SPEAKER_00: In that case, you may tolerate normal healing better and have less natural scarring.
• 4:26
  SPEAKER_00: You usually do not need extra anti-scarring supplements since the medication already reduces fibrosis.
• 4:33
  SPEAKER_00: No anti-scarring agents.
• 4:34
  SPEAKER_00: If no mitomycin C or 5FU was used, your eye relies on its own healing.
• 4:40
  SPEAKER_00: Certain types of glaucoma, like neovascular or uveitic glaucoma, or repeat surgery cases, are known to scar excessively and often drive surgeons to use antifibrotics.
• 4:50
  SPEAKER_00: In these high-risk eyes, supplements that might inhibit scarring, like curcumin, could be considered, but evidence is weak.
• 4:57
  SPEAKER_00: It's safer to ensure good steroid use, as prescribed eye drops, and a healthy diet rich in antioxidants, fruits, vegetables, rather than special pills.
• 5:07
  SPEAKER_00: Needling or leaks.
• 5:08
  SPEAKER_00: If in follow-up the doctor performed a needling procedure to break scar tissue, or there's a bleb leak, it means your eye is having trouble.
• 5:15
  SPEAKER_00: In such cases, avoid any supplement that could worsen bleeding or fluid leaks.
• 5:20
  SPEAKER_00: Focus on healing.
• 5:22
  SPEAKER_00: Adequate rest, avoiding strain.
• 5:24
  SPEAKER_00: For example, if your bleb is leaking, keep eyes lubricated and avoid thickening supplements that dry out fluids.
• 5:31
  SPEAKER_00: Also notify your surgeon before adding anything new.
• 5:34
  SPEAKER_00: Assess healing status.
• 5:36
  SPEAKER_00: At two weeks, your surgeon will examine the bleb.
• 5:38
  SPEAKER_00: Here's what to consider for supplements: bleb appearance and fluids.
• 5:42
  SPEAKER_00: If the bleb is very vascular, red, or has a tiny leak, skip blood-thinning supplements, fish oil, ginkgo, garlic, etc., until it's stable.
• 5:51
  SPEAKER_00: The aim is to avoid new minor hemorrhages around the surgical site.
• 5:55
  SPEAKER_00: Intraocular pressure, IOP.
• 5:58
  SPEAKER_00: Keep track at each visit.
• 5:59
  SPEAKER_00: A slight upward trend in IOP during the first month could signal scarring.
• 6:04
  SPEAKER_00: Avoid supplements that might raise IOP.
• 6:07
  SPEAKER_00: Some people worry about caffeine or certain steroids.
• 6:10
  SPEAKER_00: Check with doctor.
• 6:11
  SPEAKER_00: Conjunctival and wound health.
• 6:13
  SPEAKER_00: No serious infection or inflammation should be present.
• 6:16
  SPEAKER_00: If your eye shows signs of infection, redness, discharge, or excessive inflammation, do not take new supplements that you haven't used before the surgery.
• 6:25
  SPEAKER_00: Contact your doctor right away.
• 6:28
  SPEAKER_00: Weighing bleeding versus fibrosis risks.
• 6:31
  SPEAKER_00: Weigh your risk of bleeding complications against risk of scar formation.
• 6:35
  SPEAKER_00: High bleeding risk.
• 6:37
  SPEAKER_00: This includes patients on blood thinners with bleeding disorders or those who had a bloody operative course.
• 6:43
  SPEAKER_00: Also, older patients can have more fragile vessels.
• 6:46
  SPEAKER_00: In high bleeding risk cases, be cautious with any supplement that thins blood.
• 6:51
  SPEAKER_00: For example, a Baylor University review cautions that many supplements can alter bleeding and coagulation during surgery.
• 6:58
  SPEAKER_00: Garlic and hawthorn were strongly associated with surgical bleeding, and others, ginkgo, turmeric, fenugreek, etc., posed risks in patients on anticoagulants.
• 7:09
  SPEAKER_00: If you fall into this category, skip herbals like ginkgo, ginseng, ginger, and stop any high-dose multivitamins or fish oil until your doctor gives clearance.
• 7:18
  SPEAKER_00: Your doctor may even suggest stopping non-essential supplements two weeks before and after surgery.
• 7:25
  SPEAKER_00: High fibrosis, scarring risk.
• 7:27
  SPEAKER_00: Younger patients, black or African ancestry, and patients with inflammatory glaucoma, like uveitic or prior failed traps tend to scar more.
• 7:36
  SPEAKER_00: If you're in this group, your doctor likely already used an antifibrotic medicine.
• 7:41
  SPEAKER_00: Still, you can support healthy healing, ensure enough protein but not extreme bone broth, stay hydrated, and possibly use mild anti-inflammatories, see below.
• 7:51
  SPEAKER_00: There's no proven supplement that mimics mitomycin, but maintaining a healthy diet of fruits and vegetables, vitamins A, C, and omega-3 fatty acids can modulate inflammation.
• 8:02
  SPEAKER_00: Safe supplements to consider when healing is on track and risk factors are managed, these may be safe.
• 8:08
  SPEAKER_00: Basic vitamins minerals.
• 8:10
  SPEAKER_00: A standard multivitamin, 100% of daily values, is fine if your diet is poor or you have a known deficiency.
• 8:16
  SPEAKER_00: Vitamins C and A are important for collagen and tissue repair.
• 8:20
  SPEAKER_00: Vitamin C deficiency especially delays healing.
• 8:23
  SPEAKER_00: However, don't take megadoses.
• 8:25
  SPEAKER_00: For example, excess vitamin A can be toxic, stick to normal amounts.
• 8:29
  SPEAKER_00: Zinc, an essential mineral for wound repair.
• 8:33
  SPEAKER_00: Zinc serves in cell growth and immune function.
• 8:35
  SPEAKER_00: Studies show zinc deficiency is linked to delayed healing.
• 8:39
  SPEAKER_00: If you're deficient or diet poor, a modest zinc supplement, e.g., 8 to 11 mg daily, can be helpful, but high dose zinc can cause nausea or anemia, so don't overdo it.
• 8:50
  SPEAKER_00: Omega-3, fish oil.
• 8:52
  SPEAKER_00: These fatty acids help resolve inflammation.
• 8:54
  SPEAKER_00: Some research in wound care notes omega-3s have profound effects on wound healing.
• 9:00
  SPEAKER_00: Small doses, e.g., 1000 mg fish oil daily, can be safe and may calm inflammation around the bleb.
• 9:06
  SPEAKER_00: Large doses may thin blood slightly.
• 9:09
  SPEAKER_00: If you're on blood thinners, check with your doctor.
• 9:11
  SPEAKER_00: Large trials have found no significant bleeding risk from normal fish oil use, but caution is wise with any anticoagulant use.
• 9:20
  SPEAKER_00: Arginine, an amino acid involved in collagen production and immune function.
• 9:25
  SPEAKER_00: Some wound healing protocols include arginine to support tissue growth.
• 9:29
  SPEAKER_00: There's no specific study in TRABs, but a review notes arginine with omega-3s can improve wound outcomes.
• 9:36
  SPEAKER_00: You might get arginine from foods, nuts, meat, or as a supplement after checking with your doctor.
• 9:42
  SPEAKER_00: Turmeric curcumin, a natural anti-inflammatory.
• 9:45
  SPEAKER_00: Low doses, e.g., a pinch of turmeric in food, are generally safe.
• 9:49
  SPEAKER_00: There's lab evidence curcumin can inhibit fibroblasts, but human data is lacking, because high amounts can thin blood, use only under guidance.
• 9:58
  SPEAKER_00: Antioxidants.
• 9:59
  SPEAKER_00: A diet rich in colorful fruits and veggies naturally provides antioxidants, vitamin C, E, carotenoids.
• 10:06
  SPEAKER_00: Though high-dose antioxidant pills haven't shown clear surgical benefits, eating berries, citrus, leafy greens, nuts, and seeds can support overall eye health.
• 10:15
  SPEAKER_00: Supplements to avoid or use caution.
• 10:17
  SPEAKER_00: Blood-moving herbs.
• 10:19
  SPEAKER_00: Avoid supplements known to thin blood or increase circulation, especially with a fresh bleb.
• 10:24
  SPEAKER_00: This includes garlic, ginkgo, ginseng, ginger, fenygreek, cinnamon, vitamin E, high dose, fish oil, if on other blood thinners, St.
• 10:33
  SPEAKER_00: John's wort, and herbal multi-ingredient blends.
• 10:36
  SPEAKER_00: Even some teas, green tea leg red clover, etc., have mild antiplatelet effects.
• 10:41
  SPEAKER_00: These can lead to subconjunctival or anterior chamber bleeding.
• 10:45
  SPEAKER_00: High dose protein collagen.
• 10:47
  SPEAKER_00: Contrary to general healing advice, after trabeculectomy, too much collagen intake may speed scarring of the bleb.
• 10:54
  SPEAKER_00: Supplements like collagen powder, bone broth, gelatin, or protein shakes in megadoses could encourage fibroblasts to close the drain path.
• 11:02
  SPEAKER_00: Traditional guidance specifically warns against high protein bone broths or collagen extracts after glaucoma surgery.
• 11:10
  SPEAKER_00: You still need enough protein for healing, so eat normal portions, eggs, poultry, beans, but don't binge protein shakes or collagen supplements.
• 11:19
  SPEAKER_00: Other herbs and formulations.
• 11:21
  SPEAKER_00: Your surgeon likely advised stopping any herbal remedies two to four weeks before surgery.
• 11:26
  SPEAKER_00: Continue to be wary of them now.
• 11:28
  SPEAKER_00: For example, Chinese herbs that move blood, such as ginseng, angelica, dong quai, danchin, or those that affect hormones can be risky.
• 11:37
  SPEAKER_00: Always talk to your doctor before resuming any herbal medication or tea you use for unrelated health reasons.
• 11:44
  SPEAKER_00: Lab monitoring and safety checks.
• 11:46
  SPEAKER_00: For some supplements and conditions, labs help keep things safe.
• 11:50
  SPEAKER_00: Blood thinners.
• 11:51
  SPEAKER_00: If on warfarin, your INR should be checked one to two weeks after adding any supplement, per standard guidelines.
• 11:57
  SPEAKER_00: Supplements like vitamin E, CoQ10, or high dose vitamin K can all alter warfarin effect, so get an INR test to adjust your dose if needed.
• 12:06
  SPEAKER_00: Electrolytes.
• 12:07
  SPEAKER_00: If you take potassium or magnesium supplements, or if you are on diuretics, periodic blood tests ensure potassium and magnesium stay in safe ranges.
• 12:16
  SPEAKER_00: Vitamin levels.
• 12:17
  SPEAKER_00: If taking high dose vitamin D for bone health, get a 25 OHD level and calcium checked.
• 12:23
  SPEAKER_00: Overdoing vitamin D can raise calcium and risk kidney stones.
• 12:27
  SPEAKER_00: Blood counts.
• 12:28
  SPEAKER_00: A complete blood count CBC can catch anemia or unexpected bleeding, low red cells or platelets.
• 12:34
  SPEAKER_00: If you start a supplement here and notice bruising or nosebleeds, a CBC can tell if platelets dropped.
• 12:40
  SPEAKER_00: Kidney liver.
• 12:42
  SPEAKER_00: Some herbs stress the liver or kidneys.
• 12:44
  SPEAKER_00: For example, if you use curcumin or green tea extracts in high doses, periodic liver function tests are wise.
• 12:51
  SPEAKER_00: And high protein diets or supplements might require a kidney function check if you have kidney disease.
• 12:57
  SPEAKER_00: In general, any lab monitoring should be done under your doctor's guidance based on the specific supplement and your health background.
• 13:04
  SPEAKER_00: Stopping guidelines for adverse effects.
• 13:07
  SPEAKER_00: Always watch for signs that a supplement isn't agreeing with you.
• 13:10
  SPEAKER_00: Stop the supplement immediately if you experience allergic reactions, hives, itching, rash, swelling, particularly of face or lips, asthma attacks, or any new breathing difficulty, gastrointestinal upset, prolonged nausea, vomiting, severe diarrhea, or abdominal pain, neurological or vision changes, headache that won't go away, dizziness, confusion, or any change in vision, like new blurriness after starting a supplement.
• 13:38
  SPEAKER_00: Unusual bleeding or bruising, new nosebleeds, bleeding gums, or blood in stools urine signal increased bleeding risk.
• 13:45
  SPEAKER_00: Signs of infection, fever, increasing eye redness or pus could indicate bleb infection.
• 13:51
  SPEAKER_00: Laboratory warning if a required lab test, INR, electrolytes, etc., goes outside safe range.
• 13:56
  SPEAKER_00: Likewise, if any new eye symptom occurs, pressure rising, pain, flashes, etc., stop the supplement and inform your doctor.
• 14:05
  SPEAKER_00: These are the red flags that should end the supplement and prompt medical review.
• 14:10
  SPEAKER_00: Shared decision making and tools.
• 14:12
  SPEAKER_00: Choosing supplements is a team effort between you and your doctor.
• 14:16
  SPEAKER_00: In shared decision making, clinicians and patients work together to evaluate options and make the best health decisions.
• 14:23
  SPEAKER_00: For example, your doctor should explain the potential benefits and risks of each supplement and listen to your concerns and preferences.
• 14:31
  SPEAKER_00: You might use tools like a simple pros and cons chart.
• 14:35
  SPEAKER_00: List each supplement you're considering and check off benefits, risks, interactions.
• 14:41
  SPEAKER_00: For instance, fish oil, omega-3, may reduce inflammation, risk of increased bleeding if on blood thinner.
• 14:48
  SPEAKER_00: Turmeric curcumin may reduce scarring, risk of stomach upset and blood thinning at high doses.
• 14:53
  SPEAKER_00: Multivitamin, general nutrition support, usually safe, but vitamin K content could affect anticoagulants.
• 15:01
  SPEAKER_00: Ask your doctor, do I need this supplement?
• 15:04
  SPEAKER_00: If an item is non-essential, like high-dose antioxidant pills, your doctor might suggest skipping it.
• 15:10
  SPEAKER_00: If you decide together to try something, agree on how and when to monitor.
• 15:15
  SPEAKER_00: Written or online decision aids for glaucoma may not explicitly cover supplements, but any glaucoma educational material can help you frame questions.
• 15:23
  SPEAKER_00: For example, one study highlighted how using decision guides in glaucoma care improved patient involvement and satisfaction.
• 15:31
  SPEAKER_00: Finally, keep your healthcare providers updated on every supplement or over-the-counter remedy you take.
• 15:37
  SPEAKER_00: They can better protect your safety and measure outcomes.
• 15:41
  SPEAKER_00: Follow-up and outcomes tracking.
• 15:44
  SPEAKER_00: After surgery and when starting any supplement, stick to the follow-up schedule recommended by your surgeon.
• 15:50
  SPEAKER_00: Commonly, this means checks at day one.
• 15:52
  SPEAKER_00: The surgeon checks IOP, bleb formation, and early complications, bleeding leaks.
• 15:57
  SPEAKER_00: 1-2 weeks, evaluate wound healing, adjust eye drops or stitch tension as needed.
• 16:03
  SPEAKER_00: 1 month, check IOP trend in bleb health.
• 16:06
  SPEAKER_00: Look for vascularity or scarring.
• 16:08
  SPEAKER_00: 3 months, confirm stable IOP in bleb, and that no additional interventions like needling have been needed.
• 16:14
  SPEAKER_00: 6 months, gauge surgical success.
• 16:17
  SPEAKER_00: Key outcomes to track over three to six months include intraocular pressure IOP.
• 16:22
  SPEAKER_00: The main goal is keeping IOP at or below the target, often 15 to 18 milligram without extra treatment.
• 16:28
  SPEAKER_00: For example, in a clinical trial, success was defined as IOP 18 millimeter holograms without any glaucoma medications or needling.
• 16:36
  SPEAKER_00: Ask, do I need fewer eye drops now than before surgery, or is my IOP at goal?
• 16:42
  SPEAKER_00: Bleb function.
• 16:43
  SPEAKER_00: A functioning bleb is slightly elevated with microcyst fluid waves and minimal vascularity.
• 16:49
  SPEAKER_00: Note any flattening of the bleb or excessive redness.
• 16:52
  SPEAKER_00: Increased vascularity or a flattened bleb can precede pressure rises.
• 16:57
  SPEAKER_00: Vision and comfort.
• 16:58
  SPEAKER_00: Monitor your visual acuity and symptoms.
• 17:01
  SPEAKER_00: Any loss of vision or new discomfort should prompt immediate attention.
• 17:05
  SPEAKER_00: Vision changes can indicate problems like bleb failure, choroidal effusion, or glaucoma progression.
• 17:10
  SPEAKER_00: Need for additional procedures.
• 17:12
  SPEAKER_00: If you had needlings, 5FU injections, or eyes dropped back on medications, track how often and why.
• 17:19
  SPEAKER_00: A low number of interventions suggests good healing.
• 17:22
  SPEAKER_00: Side effects.
• 17:23
  SPEAKER_00: Keep record of any side effects that might be due to supplements, bleeding, GI issues, etc., or from the surgery, chronic dry eye, lens opacities.
• 17:32
  SPEAKER_00: Share these outcomes with your doctor at each visit.
• 17:35
  SPEAKER_00: They provide feedback on how well your supplement plan and overall care is working.
• 17:40
  SPEAKER_00: Adjustments can be made.
• 17:41
  SPEAKER_00: For example, if the bleb seems too flat, your doctor might tighten sutures instead of changing supplements.
• 17:47
  SPEAKER_00: If IOP creeps up, more aggressive scar prevention might be needed.
• 17:52
  SPEAKER_00: Conclusion.
• 17:54
  SPEAKER_00: In summary, personalizing supplements after trabeculectomy involves a careful balance.
• 17:59
  SPEAKER_00: You want to support healing and eye health without causing bleeding or scarring problems.
• 18:04
  SPEAKER_00: Start by evaluating your comorbidities, medications, and surgical details.
• 18:08
  SPEAKER_00: Stratify your bleeding risk and fibrosis risk.
• 18:11
  SPEAKER_00: Favor basic nutrition and safe mild support, like a multivitamin at RDA, omega-3, zinc, vitamin C over unproven megadoses.
• 18:20
  SPEAKER_00: Avoid high-risk herbs or high-protein collagen therapies that could harm your delicate bleb.
• 18:26
  SPEAKER_00: Always coordinate with your surgeon or doctor before starting anything new.
• 18:31
  SPEAKER_00: Use shared decision-making to weigh each option and stick rigorously to follow-up and monitoring.
• 18:36
  SPEAKER_00: By tracking key outcomes, IOP control, bleb appearance, vision stability, you and your doctor can adjust the plan over three to six months to ensure the best possible result from your glaucoma surgery.
• 18:49
  SPEAKER_00: Ultimately, careful discussion and follow-up are your best tools for a successful recovery.
• 18:54
  SPEAKER_00: Sources?
• 18:55
  SPEAKER_00: Current glaucoma and wound healing literature and clinical studies.
• 19:01
  SPEAKER_00: All links to sources are available in the text version of this article.
• 19:06
  SPEAKER_00: You can find the full article at Visualftest.com.
• 19:09
  SPEAKER_00: Thanks for listening.
• 19:10
  SPEAKER_00: To check your visual field, click the link at the bottom of this article or visit visualfieldtest.com.