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What warnings or recommendations can ophthalmologists give patients about the use of complementary and alternative medicine?
Safety, quality key when advising patients about alternative medicine
 Randall J. Olson |
Complementary and alternative medicine (CAM) hit the big tent when AREDS showed that some minerals and antioxidative vitamins were unquestionably effective in slowing down the risk of visual loss from age-related macular degeneration. Now, AREDS 2 is looking at carotenoids and omega-3 fatty acids in a gold standard randomized clinical trial. So it is hard to argue today that CAM is not a “player” in mainstream medicine. The main argument against CAM is both a valid and invalid complaint: the lack of randomized trials showing efficacy.
The problem is that the effect of CAM by its very nature would be slow (often over decades of use), and CAM affects disease processes that also are slow, so a decent study by the very nature of the disease is going to take a long time and likely be very costly. There would be plenty of resources if this were a patentable drug; however, such is rarely the case for CAM, so the invalid part of the “randomized trial” argument against CAM is that such studies done with any rigor are unlikely to occur today unless an independent body such as the National Institutes of Health steps up with tens of millions of dollars to perform such a study, and how often has that happened?
If our understanding of a disease suggests CAM is potentially effective and there is good epidemiological evidence that CAM is related to a better outcome, then CAM is worthy of our consideration because a randomized clinical trial is unlikely to happen anytime soon. Safety has to enter into the equation, and so known items in our normal food are more likely to be safe, and I would want a good track record to consider herbs. There is little argument that a diet rich in a variety of fruits, vegetables, nuts, whole grains and fish (northern salt water is probably best) with limited red meat provides a lot of what we need and would be good for us. I am concerned about herbs with medicinal qualities because quality has been shown to be all over the map and we know little about their effect; however, I keep an open mind, and some good work is starting to come out.
I take balanced food supplements, and 4,800 mg of fish oil has met Koch’s postulates for me. My meibomian gland dysfunction is consistently symptomatic off them after 3 to 4 weeks and consistently gets better after being on them for 2 to 3 weeks. I have repeated this cycle several times and now consistently take them.
Randall J. Olson, MD, is an OSN Cataract Surgery Board Member.
Inform patients about lack of research into alternative medicine
 Penny A. Asbell |
We often do not have rigorous information on whether or not alternative medicine works. We do not have rigorous information on whether or not there could be potential side effects or interactions with other medications that patients may be taking. Specifically, when you get to dry eye disease, it is very common now to think of taking omega-3, and there is certainly growing evidence that there is perhaps a positive effect on health in general by taking omega-3. Specifically with eye disease, there are really very few peer-reviewed publications on this topic — about six. Those are mainly very small single-site studies with relatively few people — 20 or 30 people, never a number that would lead to a statistically reliable result — and usually very short studies. And some of those have used very different products and very different concentrations and dosings.
What I do with my patients is if they are using nutritional supplements and they feel it is helpful, they can go ahead and use them. In terms of suggesting them as a treatment option, I don’t think the evidence is there to really support them as a treatment.
I am currently funded by the National Eye Institute to evaluate the role of omega-3 in dry eye disease. We have just seen over and over that things that we believe in, that we think are correct, that we think make sense, when we actually study them in a more rigorous manner turn out not to be exactly what we thought they were going to be. I think it behooves us to get real science and real information.
Penny A. Asbell, MD, FACS, MBA, is OSN Contact Lenses Section Editor.