Physicians must learn about alternative therapies to counsel patients

KOLOA, Hawaii — Use of alternative therapies is becoming more common, and physicians should educate themselves about the good and bad effects of these products so that they can intelligently counsel patients, said a speaker here.

“There is a vast amount of information on alternative therapies and lifestyle modifications available to patients, but very little of it has substantial evidence behind it,” said Robert J. Noecker, MD, here at Hawaii 2004: the Royal Hawaiian Eye Meeting. “We have to understand what they are doing to themselves and keep them out of trouble.”

Dr. Noecker outlined some of what is known about alternative therapies and lifestyle modifications in relation to glaucoma. He said some lifestyle modifications may be beneficial for glaucoma patients. Regular daily exercise, for instance, has been shown to lower IOP by about 5 mm Hg. Yoga, on the other hand, has no proven benefit on IOP, and in fact inverted positions such as the headstand can increase IOP.

Vitamins, while they may have other health benefits, mostly have no effect on IOP, Dr. Noecker said. Vitamin C has been shown to lower IOP, but only with megadoses that can have systemic side effects. Vitamin E might be a beneficial adjunct to filtering surgery, he said, but this must be balanced against an increased risk of excessive bleeding.

Some herbs may have an effect on glaucoma, but caution is necessary with their use, Dr. Noecker said. Ginkgo biloba may increase blood flow and may have some neuroprotective effect, but it also has an effect on bleeding and should be avoided in patients on Coumadin (warfarin, DuPont Pharmaceuticals) and some other drugs.

Marijuana has been shown to have an IOP-lowering effect in 60% to 65% of patients, but its effect is short-lived, he said.

“Some patients who ask about it kind of brighten up when you tell them they would have to take it every 3 to 4 hours to have a continued effect,” Dr. Noecker joked. The systemic side effects of marijuana and the health effects of chronic smoking are enough evidence to recommend against its use, in addition to the fact that it is illegal, he said.

There are, however, ongoing efforts to develop topical cannabinoids — compounds related to THC but without the euphoric effects — that are showing promise, he said.