platelet activating factor

# Ginkgo Biloba and Ocular Perfusion in Glaucoma **Ginkgo biloba** extract (GBE) is a botanical supplement long studied for its circulatory and neuroprotective effects. In glaucoma – especially **normal-tension glaucoma** (NTG) where intraocular pressure is not elevated – vascular dysregulation and poor optic nerve perfusion are thought to contribute to retinal ganglion cell loss. GBE’s flavonoids and terpenoids (e.g. ginkgolides) may improve **microcirculation**, inhibit platelet-activating factor (PAF) and support neuronal health ([pmc.ncbi.nlm.nih.gov](https://pmc.ncbi.nlm.nih.gov/articles/PMC3283204/#:~:text=Glaucoma%20leads%20to%20the%20loss,11)) ([pmc.ncbi.nlm.nih.gov](https://pmc.ncbi.nlm.nih.gov/articles/PMC11828365/#:~:text=The%20rationale%20behind%20using%20GBE,31%2C%2027)). This article reviews GBE’s mechanisms of action, evidence for visual field and blood flow effects in glaucoma, relevant data from cognitive and cerebrovascular aging studies, and addresses safety (bleeding risk, drug interactions). We also outline optimal trial designs to test GBE in glaucoma patients. ## Mechanisms of Action ### Microcirculation and Vasodilation Ginkgo’s polyphenolic flavonoids and terpenoids enhance small-vessel circulation. In vitro and clinical studies show that GBE improves blood rheology: it **increases erythrocyte deformability**, lowers fibrinogen, and reduces blood viscosity and elastic resistance ([pmc.ncbi.nlm.nih.gov](https://pmc.ncbi.nlm.nih.gov/articles/PMC3283204/#:~:text=this%20article%20studied%20the%20hemorheological,improves%20blood%20viscosity%20and%20viscoelasticity)) ([pmc.ncbi.nlm.nih.gov](https://pmc.ncbi.nlm.nih.gov/articles/PMC11828365/#:~:text=The%20rationale%20behind%20using%20GBE,31%2C%2027)). GBE also promotes endothelium-dependent vasodilation. For example, GBE increases nitric oxide (NO) and prostacyclin release, and can lower systemic vascular resistance ([pmc.ncbi.nlm.nih.gov](https://pmc.ncbi.nlm.nih.gov/articles/PMC3178766/#:~:text=Flavonoids%20can%20dilate%20blood%20vessels,therapeutic%20value%20of%20GBE%20in)) ([pmc.ncbi.nlm.nih.gov](https://pmc.ncbi.nlm.nih.gov/articles/PMC11828365/#:~:text=GBE%20has%20been%20shown%20to,a%20confocal%20scanning%20laser%20Doppler)). In healthy elderly adults, intravenous GBE raised coronary artery blood flow and brachial artery flow‐mediated dilation ([pmc.ncbi.nlm.nih.gov](https://pmc.ncbi.nlm.nih.gov/articles/PMC3283204/#:~:text=Ginkgo%20biloba%20increases%20microcirculation%20by,19)). Improved vasodilation and blood fluidity in small vessels could enhance **ocular perfusion pressure** and retinal capillary flow, which are often reduced in NTG ([pmc.ncbi.nlm.nih.gov](https://pmc.ncbi.nlm.nih.gov/articles/PMC3283204/#:~:text=,11)) ([pmc.ncbi.nlm.nih.gov](https://pmc.ncbi.nlm.nih.gov/articles/PMC3178766/#:~:text=After%20GBE%20treatment%2C%20the%20mean,and%20superior%20temporal%20peripapillary%20area)). ### Platelet-Activating Factor (PAF) Antagonism Ginkgolides (B, A

Ginkgo biloba for Ocular Perfusion and Visual Field Preservation: Promise and Precautions

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