Nutritional medicine’s role in ophthalmology increasing with evidence to justify its use

Ophthalmologists are finally seeing the scientific evidence that they need to justify their turning to multivitamins and specific nutritional supplements.

Issue: August 1, 2000

Just a few years ago, most ophthalmologists, as well as most in other medical specialties, were lukewarm about vitamins and nutritional supplements.

We were aware of the need for certain vitamins and minerals to maintain good general health and fulfilled our responsibility to our eye patients by prescribing the multivitamin/mineral products that were promoted by companies with which we were familiar.

No one got excited about it and no one criticized the ophthalmologist who dispensed or prescribed to his or her patients any product such as Ocuvite (Bausch & Lomb Pharmaceuticals), I-Caps (CIBA Vision), Theragran (Bristol-Myers Squibb), Centrum (Whitehall-Robins) or any of a number of other vitamin products. Then with the passage of the Dietary Supplement Health and Education Act of 1994, the floodgates opened and everyone and his or her cousin got into the vitamin and supplement business. Suddenly, the doctors who prescribed or dispensed vitamins and other nutritional supplements became the target of critics who waved the “ethics” flag and used the perjurative label “alternative medicine.” Interestingly, it has been pointed out that many of the critics are academics and others who receive “research” grants and subsidies from manufacturers of competing products.

We as ophthalmologists have been spoiled by our own success. Cataract surgery is virtually 99% successful, and we can restore sight to a level that in many cases is better than pre-cataract vision. As a result, we have been penalized by the government and other third-party payers by lowering reimbursement for doing more and better work. As a consequence, we as a body (not just a few) have become “refractive surgeons,” turning to new technology not yet controlled by government regulators to augment our income.

For many of us, the core “raison d’etre” of ophthalmology is still cataracts, glaucoma, macular degeneration and other degenerative conditions of the eyes. The reality is that the government, in its infinite wisdom, has targeted ophthalmology for continuing cuts in reimbursement. So eye doctors, in order to survive, are looking with renewed interest at wellness and prevention rather than just surgery, and are, in a sense, going “back to the future” with nutritional supplements and vitamin therapy.

Promotion of “nutriceuticals”

A growing number of ophthalmologists are becoming involved with the promotion of “nutriceuticals” — nutritional supplements designed to meet the needs of specific degenerative problems such as macular degeneration, cataracts and glaucoma — some through multilevel marketing companies and some through a company (ScienceBased Health, Corte Madera, Calif.) organized by and for doctors for the ethical prescription of the nutritional products through their practices, much as they have done for many years with vitamin products such as Ocuvite, I-Caps, Theragran and others.

The purpose of the doctors involved with companies like ScienceBased Health is to bring nutritional science into mainstream medicine by using only those products that have been peer reviewed and with documented safety and efficacy, and to avoid the questionable marketing tactics of multilevel marketers.

Physicians generally tend to accept the claims of pharmaceutical companies but ignore the evidence of the efficacy of nutriceuticals. They want double-masked studies and Food and Drug Administration (FDA) approval before they will accept anything because they have been conditioned to this in their medical school training (funded by private philanthropies, government grants and “gifts” from pharmaceutical companies).

The fact is that many of the drugs we use every day never had double-masked studies, nor were they approved by the FDA. Commonly used medications such as aspirin, vaccines for smallpox, polio and diphtheria-pertussis-tetanus, digitalis, penicillin, Streptomycin (streptomycin sulfate, Pfizer) and other antibiotics, the sulfonamids, morphine derivatives, ocular steroids and the list goes on and on.

Effectiveness of nutritional supplements

Prior to the “pharmaceutical revolution” (and in many parts of the world today), herbs and other phytochemicals have been investigated and used for medicinal purposes. In a sense, then, modern medicine is “going back to the future” to find ways of preventing or delaying these conditions that have been treated, at least in the past half century, by crisis intervention (that is, diagnose the disease and then treat it with surgery or pharmaceuticals).

When the conversation turns to nutritional supplements (particularly specific antioxidants) for the prevention of disease, I hear doctors say that “there is not enough documentation.” The fact is that there is documentation, but most ophthalmologists do not have the time or the motivation to read the journals that publish articles on nutritional science. They are concerned with new surgical technology for refractive surgery and the latest cataract techniques. They are accustomed to performing “miracles,” not preventing disease.

But there is an increasing interest in vitamin therapy because of a growing body of evidence that the antioxidant vitamins and minerals incorporated into the formulas of some products really are effective in slowing or reversing eye diseases.

We have learned a great deal about vitamins, free radicals and antioxidants over the past 10 years, but still many physicians are reluctant to get involved because they were not trained in this area. Many doctors still are not familiar with the terminology or the science, and many are sensitive to the criticism of others who feel that ophthalmologists should limit themselves to “traditional” treatments of eye problems.

The 1989 Conference on Free Radicals and Vitamins in Public Health concluded that, “Free radical damage is the principal cause of heart disease, cancer, cataracts and ARMD, and the antioxidant micronutrients, particularly vitamins A, C and E, are the principal line of defense.” Now, more than a decade later, we are finally seeing the scientific evidence that we need to justify our turning to multivitamins and specific nutritional supplements to prevent, rather than treat, degenerative diseases of the eyes.

For Your Information:

Spencer P. Thornton, MD is an ophthalmologist in private practice. He can be reached at 5070 Villa Crest Drive, Nashville, TN 37220; (615) 373-1236; fax: (615) 373-0333; e-mail: thornton@eyecareusa.org. Dr. Thornton is a consultant for ScienceBased Health.