Complimentary Therapies in Ophthalmology

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Complimentary Therapies in Ophthalmology

• Nicky Finn
• Lecturer Practitioner
• West of England Eye Unit

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What are CAMs ?

• Diagnosis, treatment and /or prevention which
  complements mainstream medicine by contributing
  to a common whole, by satisfying a demand not met
  by orthodoxy or by diversifying the conceptual
  frameworks of medicine.
• Ernst Cassileth(1998)

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Where do healthcare practitioners stand legally
with regard to CAMs

• They are mostly legal but practitioners are not
  regulated. They can be freely prescribed in the
  UK, but not in all European countries.
• They are considered drugs/treatments and it is
  therefore now viewed as good practice to include
  them in history taking when assessing patients.
• They are not without side effects and contra
  indications and these should be considered when
  carrying out history taking assessment.

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Unconventional treatments of the past.

• Protein shock (milk, serum or vaccine)
• Biogenic stimulation with tissue such as placenta
  injected sub-conjunctivally for a host of
  incurable eye conditions.
• Cobra venom injected for macular degeneration.

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Past physical treatments for eye conditions

• Environmental therapy for the affluent sick.
• Ocular massage.
• Blood letting.
• Thermotherapy.
• Electrotherapy- a faradic current used to create
  an electric eye bath creating a local
  gymnastic effect on the sufferer !

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Pre Christian era

• Illness blamed on malignant spirits,
  devils, superstition and mystic rites.
• Treatment was threw
• Recital of complex incantations.
• Prophylactic measures to prevent the devil
  entering the eye however often more vile than the
  affliction.

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By 7th century BC

• Plants extracts minerals applied as powders
  blown into the eye.
• OR
• Ointment mixed with water, milk, wine or oil.

The role of the priest -magician physician
diverged as therapeutics became more elaborate.
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Dry eye treatment as per Assyrian recipe

• Local application of
• Gall bladder of a freshly disembowelled frog
  mixed with raw onion.

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The modern day approach to CAM in ophthalmology
is holistic

• Diet.
• Nutritional supplements, antioxidants vitamins.
• Physical exercise.

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Treatments used as CAMs in ophthalmology

• Acupuncture
• Faith healing
• Cannabis
• Dietary supplements
• Herbal remedies
• Homeopathy

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Acupuncture

• Acupuncture is described as a Chinese medical
  system which aims to diagnose illness and promote
  health by stimulating the bodys self-healing
  powers.
• 
  Downey (2001)

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Acupuncture

• Used to treat alleviate
• Dry eyes
• Myopia
• Paralytic strabismus
• Retinitis pigmentosa
• Optic atrophy
• Iritis
• Conjunctivitis
• Cataracts

• Designed to correct the imbalance of energy
  flow along specific channels throughout the body.

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Herbal Medicine

• Herbal medicine is described as the use of
  whole plant material by trained practitioners to
  promote recovery from disease and to enable
  healing to take place.
• 
  Busby (2001)

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Cannabis

• Used to try and treat glaucoma
• No scientific evidence.
• Initial studies suggested IOP lower 3-4 hours
  after administration.
• Needs to be used about 5 times a day.
• No effect if used topically.

• Side effects
• Increase heart rate, lower BP this may compromise
  optic nerve perfusion.
• Smoking increased cancer risk with nicotine.
• Euphoria!

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Bilberry

• Pharmacological action
• Antioxidant
• Believed to
• Improve night vision.
• Contra-indications
• Potential to increase anticoagulant action.

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Gingko Biloba

• Pharmacological action
• Inhibits blood clotting
• Improves central peripheral blood flow
• Antioxidant activity.
• Believed to
• Aid mental alertness
• Improve visual acuity in ARMD.
• Contra-indications
• Combined with aspirin maybe hazardous
  associated with pupillary margin haemorrhage.

Comes from the Maidenhair
tree.
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Ginseng

• Potential interaction with other medications
• Increased action of heart medications.
• Increase anti-diabetic effect of anti -diabetic
  medication.
• Increase in plasma levels with oral
  contraception.
• Increasing anticoagulation

• Contains over 20 constituents
• Vitamins A
• B1,B2
• Calcium
• Titanium
• Strontium
• Several steroids
• Believed to
• Provide atmospheric energy to the 5 viscera
• Quieting of animal spirits
• Brightening of the eye
• Improvement of vision
• Suggested therapeutic monitoring of
• Blood glucose

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N-Acetyl Cysteine (NAC)

• This is a specially modified form of the dietary
  amino acid, cysteine.
• This is thought to help loosen the thick crusty
  secretions that block oil-secreting glands if
  taken orally.

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In a study by Yalcin et al(2002)

• This studied the effect of N-Acetyl Cysteine on
  50 patients with chronic posterior blepheritis
  and found significant improvement.
• The limitations of this study are its small size
  and the fact it was not a blind study.
• An interesting study but more research would be
  advisable before it is recommended.

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Other supplements which have been suggested as
helpful in blepheritis

• Flax oil (omega 3 fatty acid)
• Chamomile
• Calendula
• However using herbal remedies in the eye is
  described as risky and not suitable without
  medical supervision by The Natural Pharmacist
  (2003)

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Dietary supplements

• Nutritional supplements in the form of -
• Trace elements
• Antioxidants
• Vitamins
• Antioxidant vitamin and zinc supplementation
• One systematic review found modest evidence
  from one large RCT that, in people with early to
  late age related macular degeneration,
  antioxidant vitamins plus zinc supplements
  reduced the risk of progression and vision loss
  over 6 years compared with placebo.

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Homeopathy

• Homeopathy is described as a 200 year old
  system of medicine based on the Law of Similars
  (let like be cured by like).
• 
  Haehl(1985)

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Homeopathy

• Micro doses of substances like

• Ruta graveolens for eye strain from over use.

Natrum muriaticum for heavy eye lid
headaches
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Euphrasia eyes inflamed watering and unable to
bear light
Pulsatillia - conjunctivitis
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Apis Mel eyelids swollen particularly the lower
eyelids
Argentum Nit conjunctivitis with headaches
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Ernst (2003)

• CAMs should not be treated differently to any
  other area of health care when testing their
  effectiveness, safety and value to the patient

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Nurses must consider the ethical principles

• Autonomy - which allows the patient to make
  choices in treatment.
• Non-maleficence - which means not harming
  patients when providing treatment.
• Beneficence - using safe and effective treatments
  and discussing with patients research about the
  possible harm and benefits.
• Justice - ensuring all patients have equal access
  to treatments.

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References

• Astbury, N.(2001) Alternative eye care. British
  Journal of Ophthalmology. 85,7,767-769.
• Dimond, B.(1998) The legal aspects of
  complementary therapy practice. A guide for
  health care professionals. Churchill
  Livingstone.London.
• Ernst,E Pittler, M Stevenson, C White, A
  (2001) The Desktop Guide to Complementary
  Alternative Medicine an evidence based approach.
  Mosby.
• Ernst, E Cassilith, B. (1998) The prevalence of
  complementary/alternative medicine in cancer a
  systematic review. Cancer. 83,1,32-36.
• Fearon, J. (2001) Complementary therapy. Primary
  Health care.11,10,33-36.
• Haehl, R.(1985) Samuel Hahnemann.His life and
  works.B.Jain, New Delhi, India,2 vol.
• Rhee,DSpaeth,M Myers,JSteinmann,MAugsburger,J
  Shatz,LTerebut,A Ritner,J Katz,L.(2002)
  Prevalence of the use of complementary
  alternative Medicine for glaucoma.Ophthalmology.10
  9,438-443.
• Downey,S and Busby, H. in Rankin-Box, D (2001)
  The nurses handbook of complementary therapies.
  2nd Edition. Bailliere Tindall.
• Internet sites
• http//www.internethealthlibrary.com
• http//www.fihealth.org.uk