Complementary and alternative medicine for glaucoma

Given the recent interest in complementary and alternative medicine (CAM), some patients may seek such treatments to supplement their traditional glau coma management. The prevalence of CAM use for glaucoma is approximately 5% . We reviewed the literature to determine the potential benefit of various alternative treatments. Aside from a temporary osmotic effect from high dos e intravenous ascorbic acid, there is no evidence that megavitamin suppleme ntation has a beneficial effect on glaucoma. During exercise, autoregulatio n in healthy eyes seems to maintain a consistent blood flow rate to the opt ic nerve despite fluctuations in intraocular pressure (IOP). In a glaucomat ous eye, the very modest IOP-lowering that follows exercise may be offset b y the initial elevation in IOP that occurs when one first initiates exercis e. At this time, there is no evidence to encourage or discourage the use of special diets, acupuncture, relaxation techniques, or therapeutic touch sp ecifically for the treatment of glaucoma. Very little research has been don e on the majority of herbal remedies with regard to their treatment of glau coma. Marijuana can cause a profound lowering of IOP, but the high nonrespo nse rate, short half life, and significant toxicity are strong indicators t hat it is not an appropriate therapeutic agent. Ginkgo biloba and some othe r Chinese herbal remedies do not affect IOP, but may improve glaucoma. Thes e agents have blood flow to the optic nerve and, as such, may have a benefi cial effect on recognized toxicities. Although there are some well-designed studies of alternative treatments, many of the recommendations for using a lternative treatments are currently unsupported by the data provided. (Surv Ophthalmol 46:43-55, 2001. (C) 2001 by Elsevier Science Inc. All rights re served.).