PAMITOYLETHANOLAMIDA (PEA). A NEW THERAPEUTIC APPROACH IN GLAUCOMA
Vision could be improved in patients with glaucoma treated with palmitoylethanolamide (PEA). Recently it has been shown that administration of PEA decrease intraocular pressure (IOP) and plays a fundamental role in achieving neuroprotection, improving vision in patients with glaucoma.
Dr Carlos Vergés, Dra Elvira Llevat.
Area Oftalmológica Avanzada
The Pamitoylethanolamida (PEA) is a fatty acid synthesized in the body from palmitic acid and ethanolamide that are ingested with some foods such as meat, milk, cheese and butter. Remember that are saturated fatty acids and not to overindulge in these foods. In cases where it is necessary to provide controlled high levels, as in the treatment of glaucoma, are recommended for administration in tablet, orally, between 300 and 600 mg daily. The tolerance of the EAP is very good and has proved effective in managing chronic pain in rheumatic diseases and various allergic disorders and other immune system diseases (1).
Recent studies show that administration of PEA in glaucoma patients has a double effect, decrease the IOP and neuroprotection. The IOP is the major risk factor in glaucoma, constricts blood vessels and reduces the delivery of oxygen and nutrients to the retina and optic nerve (ON), causing a process of ischemia and cell death (apoptosis).
Visual field with loss of vision in a patient with glaucoma. Black areas indicate with blue arrow.
The second effect of PEA, neuroprtoección, is really new and very important. We know that glaucoma is a neuropathy, an impairment of the nervous tissue, the retina and the ON and one recent findings is that this has a base of inflammatory activity especially in glia (neuroinflammation) and following this it has been shown that treatment, in this case with PEA, has beneficial effects because it is a reducing substantiate this neuroinflammatory process, adding to the effect on IOP (2-4).
The advantage of the PEA is a natural product that is well tolerated by the body and has no side effects of the drugs that we use for glaucoma, which is essential when we consider that most of these patients should be treated for life almost .
The largest study conducted in patients with glaucoma treated with PEA (2), showed an improvement in IOP of 16% compared to baseline and, most important, improved vision, a fundamental fact that because we have always known that in this disease the most you could get was to stop their advance, never improve vision was lost. These studies could demonstrate improved visual field and retinal cell function (ganglion cells analyzed by pattern ERG).
These results open a new pathway of treatment for patients with glaucoma, especially when medical treatment is not fully effective or for whom surgery is contraindicated or in spite of it not able to restrain the disease. We believe that PEA could be very helpful in normotensional glaucoma, where IOP is normal and vision loss persists despite treatment.
A detailed study conducted by a glaucoma expert will distinguish the type of glaucoma, when this treatment is indicated and the appropriate dose of EPA in each case.
1.- G. Guida et al, Dolor 2010;25:035-042
2.- C. Gangliano et al. Invest Ophthalmol Vis Sci, 2011; 9: 6096-6100.
3.- A. Kumar et al. Invest Ophthalmol Vis Sci, 2012; 8: 4416-4425
4.- E. Strobbe et al, Invest Opthalmol Vis Sci, 2013;1: