Transcript Alternative & Complimentary Medicine in ophthalmology

Complimentary
Therapies in
Ophthalmology
Nicky Finn
Lecturer Practitioner
West of England Eye Unit
What are CAM’s ?
‘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)
Where do healthcare
practitioners stand legally with
regard to CAM’s
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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.
Unconventional
treatments of the past.
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Protein shock (milk,
serum or vaccine)
Biogenic stimulation with
tissue such as placenta
injected subconjunctivally for a host of
incurable eye conditions.
Cobra venom injected for
macular degeneration.
Past physical treatments for
eye conditions
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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 !
Pre Christian era
Illness blamed on malignant spirits, devils,
superstition and mystic rites.
Treatment was threw:
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Recital of complex incantations.
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Prophylactic measures to prevent the devil entering
the eye however often more vile than the affliction.
By
th
7
century BC
Plants extracts &
minerals applied as
powders blown into
the eye.
OR
 Ointment mixed with
water, milk, wine or
oil.
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The role of the priest -magician & physician
diverged as therapeutics became more elaborate.
Dry eye treatment as per
Assyrian recipe
Local application of
Gall bladder of a freshly
disembowelled frog mixed with
raw onion.
The modern day approach
to CAM in ophthalmology
is holistic
Diet.
Nutritional supplements,
antioxidants &
vitamins.
Physical exercise.
Treatments used as
CAM’s 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 body’s selfhealing powers.
Downey (2001)
Acupuncture
Designed to correct
the imbalance of
energy flow along
specific channels
throughout the body.
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Used to treat &
alleviate:
Dry eyes
Myopia
Paralytic strabismus
Retinitis pigmentosa
Optic atrophy
Iritis
Conjunctivitis
Cataracts
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)
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!
Bilberry
Pharmacological
action:
Antioxidant
Believed to:
Improve night vision.
Contra-indications:
Potential to increase
anticoagulant action.
Gingko Biloba
Comes from the
Maidenhair tree.
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.
Ginseng
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
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
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)
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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.
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.
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)
Homeopathy
Micro doses of substances like:
Natrum muriaticum –
for heavy eye lid & headaches
Ruta graveolens –for eye
strain from over use.
Euphrasia – eyes inflamed
watering and unable to bear light
Pulsatillia - conjunctivitis
Apis Mel – eyelids swollen
particularly the lower eyelids
Argentum Nit – conjunctivitis
with headaches
Ernst (2003)
CAM’s should not be treated differently to
any other area of health care when testing
their effectiveness, safety and value to the
patient
Nurses must consider the ethical
principles
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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.
References
Astbury, N.(2001) Alternative eye care. British Journal of Ophthalmology. 85,7,767-769.
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Dimond, B.(1998) The legal aspects of complementary therapy practice. A guide for health care
professionals. Churchill Livingstone.London.
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Ernst,E ; Pittler, M; Stevenson, C & White, A (2001) The Desktop Guide to Complementary &
Alternative Medicine an evidence based approach. Mosby.
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Ernst, E & Cassilith, B. (1998) The prevalence of complementary/alternative medicine in cancer –
a systematic review. Cancer. 83,1,32-36.
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Fearon, J. (2001) Complementary therapy. Primary Health care.11,10,33-36.
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Haehl, R.(1985) Samuel Hahnemann.His life and works.B.Jain, New Delhi, India,2 vol.
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Rhee,D;Spaeth,M; Myers,J;Steinmann,M;Augsburger,J; Shatz,L;Terebut,A Ritner,J &
Katz,L.(2002) Prevalence of the use of complementary & alternative Medicine for
glaucoma.Ophthalmology.109,438-443.
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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
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