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Vitamin D status and trabeculectomy outcomes · Glaucoma, Vision & Longevity: Supplements & Science

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  SPEAKER_00: Vitamin D status and trabeculectomy outcomes.
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  SPEAKER_00: Vitamin D is a crucial nutrient, actually a hormone known for maintaining bone health, but it also modulates the immune system and inflammation in many tissues, including the I625.
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  SPEAKER_00: Glaucoma, a progressive optic nerve disease, is driven partly by high eye pressure and damaging inflammation.
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  SPEAKER_00: Some studies have found that people with glaucoma tend to have lower blood vitamin D levels than healthy controls 9.
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  SPEAKER_00: Animal and cell studies suggest the vitamin D hormone, calcitriol, can protect retinal ganglion cells, the nerves damaged in glaucoma, and reduce inflammatory signals in the eye 6.
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  SPEAKER_00: In fact, in trabecular meshwork, drainage cells under stress, vitamin D3 blocked many abnormal changes, excessive matrix, collagen, inflammatory cytokines that contribute to glaucoma pathology 6.
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  SPEAKER_00: These findings imply vitamin D could help guard the optic nerve and enhance fluid outflow.
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  SPEAKER_00: However, clinical evidence on glaucoma progression is mixed.
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  SPEAKER_00: For example, one recent study found that glaucomatous progression, changes in visual fields or nerve structure over time, was not significantly different in patients with vitamin D deficiency versus those with normal levels 3.
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  SPEAKER_00: Likewise, an ocular disease review concluded there's no clear link between serum vitamin D levels and glaucoma severity or rate of worsening 6.
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  SPEAKER_00: In summary, observational data are inconsistent.
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  SPEAKER_00: While many case control studies report lower vitamin D in glaucoma patients 9, cohort data do not clearly show that deficiency causes the disease to progress faster 3.
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  SPEAKER_00: Vitamin D, immune modulation, and wound healing.
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  SPEAKER_00: A trabeculectomy creates a flap that drains fluid under the conjunctiva.
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  SPEAKER_00: Proper healing is crucial.
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  SPEAKER_00: Too much scarring, fibrosis can close the new drainage pathway, while too little healing can lead to leaks or infection.
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  SPEAKER_00: Vitamin D's immunomodulatory role may influence these processes.
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  SPEAKER_00: It is known to suppress excessive inflammation and promote tissue repair in general, 3225.
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  SPEAKER_00: For example, ocular surface studies note that vitamin D dampens chronic inflammation but can enhance early healing inflammation and innate defenses third.
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  SPEAKER_00: In a mouse model of corneal abrasion, topical vitamin D actually increased neutrophils in the wound and slightly slowed initial closure, 17% delay at 18H, but it also upregulated antimicrobial peptides 32.
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  SPEAKER_00: In practical terms, this suggests vitamin D is a double-edged sword.
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  SPEAKER_00: It might prolong the acute inflammatory phase, fine if controlled, but also strengthen early immune defense.
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  SPEAKER_00: Importantly, vitamin D has anti-scarring effects in the context of eye surgery.
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  SPEAKER_00: In lab culture of human tenons, fibroblasts, cells that cause scarring after trabeculectomy, vitamin D3 significantly inhibited cell proliferation and migration without harming cell viability.
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  SPEAKER_00: These results indicate that higher vitamin D levels could help prevent the subconjunctival fibrosis that blocks filtration blebs.
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  SPEAKER_00: The authors suggested vitamin D3 might serve as a low toxicity adjunct to standard antifibrotic agents after glaucoma surgery, 17.
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  SPEAKER_00: Vitamin D also supports the health of the ocular surface.
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  SPEAKER_00: Adequate vitamin D stabilizes tear film and nerves on the cornea 25.
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  SPEAKER_00: Vitamin D deficiency has been linked to worse dry eye symptoms.
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  SPEAKER_00: Studies show patients with chronic dry eye often have lower vitamin D than normal and have worse tear production and symptom scores 24.
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  SPEAKER_00: Supplementing vitamin D improved dry eye in both clinical and experimental models, 25.
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  SPEAKER_00: For example, in one small study of cataract surgery patients, those given vitamin D supplements maintained better tear volume and comfort than controls 34.
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  SPEAKER_00: By analogy, after trabeculectomy, when topical glaucoma meds and surgery can cause dryness, ensuring sufficient vitamin D may help the ocular surface recover more quickly.
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  SPEAKER_00: Postoperative repletion, timing, doses, and safety.
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  SPEAKER_00: When to start repletion.
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  SPEAKER_00: There is no formal guideline for glaucoma surgery specifically, but general practice is to correct clear deficiencies.
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  SPEAKER_00: Waiting about two weeks after trabeculectomy is reasonable.
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  SPEAKER_00: The acute inflammation and epithelial healing have usually settled by then, and starting vitamin D does not appear to disrupt normal wound repair.
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  SPEAKER_00: In fact, delaying beyond initial healing may forego the protective anti-inflammatory effects.
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  SPEAKER_00: The approach might be measure vitamin D, 25OH vitamin D soon after surgery, and if it is low, begin repletion a week or two later during routine follow-up.
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  SPEAKER_00: How much to give?
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  SPEAKER_00: Common repletion strategies follow endocrinology guidance.
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  SPEAKER_00: If blood 25OH vitamin D is below 20 nanogram milliliters, 50 nanomol, a loading dose is often used.
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  SPEAKER_00: For example, 50,000 IU of vitamin D3 once weekly for six to eight weeks to rapidly raise levels 59.
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  SPEAKER_00: Alternatively, some regimens use 5000 to 8,000 IU daily for a similar period.
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  SPEAKER_00: After this loading phase, a maintenance dose of 1,000 to 2000 IU daily is typically continued 59.
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  SPEAKER_00: These amounts are within safe limits for most adults.
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  SPEAKER_00: Another option is a modest daily dose, e.g.
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  SPEAKER_00: 2000 IU, started immediately.
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  SPEAKER_00: This will gradually raise levels without a sharp initial spike.
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  SPEAKER_00: The best strategy depends on how deficient the patient is and any risk factors they have, absorption issues, obesity, etc.
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  SPEAKER_00: Safety.
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  SPEAKER_00: Hypercalcemia risk, vitamin D by itself very rarely causes problems at usual doses.
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  SPEAKER_00: The Institute of Medicine's upper limit is about 4,000 IU per day for adults 99.
• 5:54
  SPEAKER_00: Taking vitamin D in recommended ranges is generally safe.
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  SPEAKER_00: Problems can occur if extremely high doses are taken or if other factors raise calcium.
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  SPEAKER_00: For example, older patients on thiazide diuretics, a blood pressure medication, are at higher risk.
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  SPEAKER_00: Thiazides reduce calcium excretion, and if such a patient also takes high dose vitamin D, especially with extra calcium supplements, their blood calcium can climb too high 45.
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  SPEAKER_00: Indeed, case reports describe elderly patients on thiazides who developed hypercalcemia when taking vitamin D plus calcium 45.
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  SPEAKER_00: To stay safe, patients should avoid exceeding 4,000 IU per day for long periods unless under physician supervision.
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  SPEAKER_00: It's wise to avoid unnecessary calcium supplements at the same time.
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  SPEAKER_00: The safe approach is to pick a reasonable dose, often 1,000-2000 IU daily, and check levels after several months, rather than using extremely large one-time doses in someone on a thiazide.
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  SPEAKER_00: Where needed, monitoring blood calcium catch any issue early 45.
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  SPEAKER_00: Interactions.
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  SPEAKER_00: Other glaucoma medications generally do not interact with vitamin D.
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  SPEAKER_00: However, if the patient takes any calcium-based antacids or high-dose multivitamins, that adds to the calcium vitamin D load.
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  SPEAKER_00: In summary, caution is mainly for thiazide diuretics or kidney insufficiency.
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  SPEAKER_00: Both increase hypercalcemia risk with vitamin D45.
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  SPEAKER_00: Otherwise, vitamin D repletion is quite safe when dosed appropriately.
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  SPEAKER_00: The risk of actual vitamin D toxicity, very high levels causing hypercalcemia, kidney problems, etc., requires far more vitamin D than typical supplements provide 48.
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  SPEAKER_00: In ordinary cases, levels up to 1505 nanoma have been needed before true toxicity appears 48.
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  SPEAKER_00: Thus, modest repletion aimed at normalizing levels 20 to 40 nanograms per millius poses minimal danger.
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  SPEAKER_00: Take home and testing recommendations.
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  SPEAKER_00: Put simply, vitamin D deficiency is treatable and may help after glaucoma surgery.
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  SPEAKER_00: To be practical, test when indicated.
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  SPEAKER_00: Patients with risk factors, older age, limited sun exposure, malabsorption, osteoporosis history should have their 25OH vitamin D measured.
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  SPEAKER_00: The Endocrine Society defines deficiency as 20 nanogrammili and insufficiency 20 to 30 nanograms per milliliter.
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  SPEAKER_00: If levels are low, plan repletion 59.
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  SPEAKER_00: Routine screening of every patient is not mandated by guidelines, but reasonable clinical judgment can apply.
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  SPEAKER_00: Treat if low.
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  SPEAKER_00: For someone just after trabeculectomy who is deficient, one can use a supervised loading regimen, as above, in the weeks after surgery, then downshift to a maintenance dose.
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  SPEAKER_00: For example, a common course is 50,000 IU once weekly for two months, then 1000-2000 IU daily thereafter, 59.
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  SPEAKER_00: Alternatively, modest daily dosing, e.g., 5,000 IU day for one month, then 2000 IU day works.
• 8:52
  SPEAKER_00: The goal is to raise blood 25OHD into at least the 30 to 50 nargs per milliliter range, some specialists aim 30 narrams per milliliter, and keep it there.
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  SPEAKER_00: Monitor.
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  SPEAKER_00: Recheck vitamin D after a few months to confirm the level is up.
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  SPEAKER_00: Also monitor calcium if there are risk factors, kidney disease, thiazide use, hyperparathyroidism.
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  SPEAKER_00: Individualize.
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  SPEAKER_00: Elderly or those on interacting meds, thiazides, digoxin, etc., may need smaller doses and closer follow-up.
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  SPEAKER_00: Weight and body fat can affect dosing.
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  SPEAKER_00: Obese patients sometimes need higher doses.
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  SPEAKER_00: Work with your doctor or nutritionist to tailor the dose.
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  SPEAKER_00: Conclusion.
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  SPEAKER_00: While no definitive clinical trials yet show that fixing vitamin D levels will speed trabeculectomy healing or prevent glaucoma worsening, the potential benefits and low risks support at least considering it.
• 9:42
  SPEAKER_00: Vitamin D deficiency is common in older adults, especially those with less sun exposure.
• 9:48
  SPEAKER_00: Given its role in immune regulation, tissue repair, and ocular surface health 25-17, optimizing vitamin D status makes sense as part of comprehensive glaucoma care.
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  SPEAKER_00: In practice, we suggest test or estimate vitamin D status, and if low, start a sensible repletion plan about two weeks after surgery.
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  SPEAKER_00: Keep doses in a safe range and watch calcium levels if any risk factors are present.
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  SPEAKER_00: This individualized approach, guided by office labs and patient factors, balances maximal support for healing against any small risk of overshoot.
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  SPEAKER_00: Tags vitamin D, glaucoma, trabeculectomy, wound healing, immune modulation, dry eye, hypercalcemia, calcium supplements, thiazide diuretics, ocular surgery.
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  SPEAKER_00: All links to sources are available in the text version of this article.
• 10:37
  SPEAKER_00: You can find the full article at visualfieldtest.com.
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  SPEAKER_00: Thanks for listening.
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  SPEAKER_00: To check your visual field, click the link at the bottom of this article or visit visualfieldtest.com.