Large-scale, prospective, randomized clinical trials are, of course, the gold standard when it comes to vetting a drug, device or other treatment for your patients. These investigations allow clinicians to balance both the desired efficacy of a therapy with an acceptable level of safety.
However, riding shotgun alongside these vetted, “mainstream” therapies are treatments from the wide and varied world of complementary medicine. Some complementary therapies have been around for thousands of years, such as the Ayurveda from India, while others, such as homeopathy pioneered in Germany, are much younger (though still just over 100 years old).1
The approach to healing taken by complementary therapy can be many and varied, which can be helpful to some patients looking for new options, but can be a nightmare for a clinician looking for some sort of rigorous data on results and safety. In homeopathy, for example, treatments can include nutrition, acupuncture, herbal medicine, and soft-tissue manipulation.
Similarly, the Ayurveda offers patients such alternatives as herbs, massage, exposure to sunlight and controlled breathing.1
Though some patients can experience some positive effects from these alternative approaches, vetting such therapies can be vexing for the clinician for, as one review puts it, “Ayurvedic medications have the potential to be toxic. Most Ayurvedic medications consist of combinations of herbs and other medicines, so it can be challenging to know which ones are having an effect and why.”1
Ophthalmology, too, has had some experience with complementary therapies, as evidenced by this month's cover story on glaucoma treatments (p. 30). In addition to the tried-and-true, scientifically proven methods for managing glaucoma, some patients and their physicians may be exploring complementary treatments, running the gamut from ginkgo biloba to nicotinamide and pyruvate. As with any complementary therapy, glaucoma specialists on the front lines say the challenge is separating the good data from the bad, since patients can get their information from any number of sources. “I would hate for these findings to be misinterpreted by patients, who may not have the training and experience to critically evaluate medical literature,” notes one of the clinicians interviewed in the piece.
And, in an interesting twist of fate, selective laser trabeculoplasty, often viewed as a second-line treatment (some might say “complementary”) behind medications may turn the tables and become the primary treatment in some practices, according to physicians interviewed for our SLT feature (p. 39). As one glaucoma specialist puts it, “This tide of not using SLT as a first-line treatment is getting smaller and smaller ...”
Though complementary therapies can be tricky to evaluate and, therefore, recommend, it seems physicians are keeping an open mind, and are willing to look at the data as it evolves.
— Walter Bethke
Editor in Chief
1. Tabish SA. Complementary and alternative healthcare: Is it evidence-based? Int J Health Sci 2008;2:1:5-9.