Alternative eye care

As ophthalmologists we tend to stick to what we know. We mostly use only four main groups of drugs that act on the eye—anti-infectives, anti-inflammatories, antiglaucoma medications, and lubricants—a limited formulary, but one that is evidence based according to our medical training. But there are alternative therapies which are becoming a growing part of our health care and for which eye conditions present an ideal substrate. In the United States alone an estimated $14 billion a year is spent on alternative treatments and 37 medical schools are starting to devote a small part of their training to this subject. Medline lists 24 main headings under “Alternative medicine” and indexes a number of relevant journals including ones on acupuncture, biofeedback, Chinese medicine, manipulative and physiological therapeutics, and natural products. In his Foundations of Ophthalmology (Vol VII, 1962) Duke-Elder covers a great deal more than pharmacology in his “Ocular therapeutics” section. He describes some unconventional biological and physical treatments which may have had their day but which do not seem so incongruous when compared with the vast array of alternative treatments revealed by searching the world wide web today. In their time many of these treatments represented attempts to treat the untreatable. They demonstrated an inventive ingenuity influenced by the scientific knowledge of the day and were applied with great enthusiasm to unsuspecting patients. Some techniques that have been used include protein shock (milk, serum, or vaccine), biogenic stimulation with tissue such as placenta, injected subconjunctivally for a host of incurable eye conditions, and the injection of cobra venom for macular degeneration. Physical treatments that have been dreamt up over the years include environmental therapy (for the aZuent sick), ocular massage, blood letting, thermotherapy, and electrotherapy—a faradic current was used to create an “electric eye bath” which by all accounts created a “local gymnastic eVect” on the suVerer. Three to four thousand years before the Christian era the cause of disease was blamed on malignant spirits and devils, and superstition and mystical rites dominated the therapeutic scene. The recital of complex incantations was augmented with prophylactic measures to prevent the devil from entering the eyes. These “treatments” were often concocted to be more vile than the demoniacal causes of the aZiction; an Assyrian recipe for dry eyes consisted of a local application of the gall of a freshly disembowelled frog mixed with raw onion. Some treatments, however, were less bizarre and more eVective, and by the 7th century BC the pharmacopoeia contained many plant extracts and minerals. These were applied as powders, which were blown into the eye, or ointments mixed with water, milk, wine, or oil. As these therapeutic measures became more elaborate the roles of the priest-magician and physician diverged but today, five millennia later, the former still retain a significant influence with the practice of “traditional medicine.” Some present day traditional eye treatments are reminiscent of the old recipes—being of plant origin (juice or powder), human origin (breast milk, blood, urine, or semen), or just plain toxic (cleaners, dyes, toothpaste, and kerosene). Despite advances in pharmacology and the eYcacy of proved conventional eye treatments, traditional beliefs and superstitions persist today in the form of apotropaic symbols of fertility used to ward oV the evil eye such as crosses, cowrie shells, fish, or mirrors worn as amulets. The modern use of eye make up and the wearing of earrings and tattoos all having their origins in preventing the entrance of evil spirits. Nowadays, however, most alternative eye treatment does not involve the use of icons or noxious substances but rather seeks to adopt a holistic approach by involving diet, nutritional supplementation, and physical exercise. It often defies rational explanation and lacks scientific proof but enables patients to become more involved with their own treatment and acknowledges the therapeutic importance of the relationship between themselves and the therapist. Many ophthalmologists will be familiar with one of the more outspoken proponents of natural treatment—Harry Benjamin, who as a highly myopic teenager in 1926 was influenced by WH Bates, MD, a New York ophthalmologist and the author of Perfect Sight Without Glasses. Having been told that there was nothing more that could be done and he would have to give up reading, the young Benjamin read Bates’s book, threw up his job and threw out his glasses (−20.0/−3.0 cyl), and adopted a “naturopathic” diet which he claimed enabled him to read and write “quite well,” although he admitted that his distance vision was “not so good”! He himself then wrote Better Sight Without Glasses which is now in its sixth edition and after four decades is still making the health columns of the popular press. With the advent of the internet there is no shortage of advice about eye care without the aid of medicines. Most of this advice involves good sound common sense—plenty of green vegetables, a low fat diet, physical exercise, and nutritional supplements in the form of trace elements, antioxidants, and vitamins. Continuous television watching is discouraged, especially in the dark late at night, and frequent blinking and taking a break during the advertisements is advised. Harry Benjamin goes one step further and suggests as a treatment for cataract a 5 day fast followed by a strict diet (with no bread or bananas), a nightly enema, and a daily dry friction rub. Homeopathy oVers remedies for eye injuries or eye strain based on microdoses of substances such as natrum muriaticum (for heavy eyelids and headaches) or ruta graveolens (for eye strain from overuse). For conjunctivitis with a thick yellow discharge, pulsatilla is recommended and for people who also have swollen glands, oVensive breath, and excessive salivation—mercurius solubilis. Mercury of course has other connotations—namely, in the form of its yellow oxide which was first advocated as a panacea for chronic conditions of the outer eye by Alexander Pagenstecher of Wiesbaden in the middle of 19th century and which generally did more harm than good. An Br J Ophthalmol 2001;85:767–768 767