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EW GLAUCOMA 84 October 2016 by Vanessa Caceres EyeWorld Contributing Writer Dr. Ritch added. That has helped encourage more interest in these therapies, but at the same time quality information is mixed with a lot of misinformation, and the con- sumer has to be aware of the need to choose the best sites. Eye doctors are naturally skep- tical about non-pharmacological treatments, said Francisco Burgos, OD, Katzen Eye Group, Baltimore. "There are many reasons, such as lack of new research or new studies, not being included in the current medical school curriculum, no stan- dard doses due to lack of research, and lack of private funding for research," he said. Despite skepticism, doctors sense more receptiveness among some of their peers to non-drug therapies for glaucoma. Dr. Ritch, who speaks frequently on the topic, is often asked what he recommends to patients in this realm. Some- times, the receptiveness comes from the doctors trying to ascertain the options themselves. Dr. Burgos uses certain supplements for general health, so he has no problem rec- ommending them to patients when there are no mitigating risk factors. "While no one is going to deviate much from the current treatment modalities, we should not be wearing blinders as to the possi- bilities of adjunctive therapies," Dr. Burgos said. Dr. Ritch is a proponent for supplements such as ginkgo biloba extract, curcumin, omega-3 fatty acids, and citicoline. Dr. Ritch's perspective focuses on supplements that are neuroprotective and that may have a protective effect in other brain diseases, such as Alzheimer's. "Glaucoma is a neurodegenerative disorder and a brain disease," said Dr. Ritch, noting that many neuro- degenerative disorders have similar mechanisms. And it's hard to deny the overall benefit of a healthy diet and exer- cise for general health, even if the link with glaucoma prevention or treatment isn't entirely clear, doc- tors said. "As long as the person is physically capable and there are no contraindications, exercise should be considered or recommended as director, Glaucoma Center of San Francisco, and associate clinical professor of ophthalmology, Univer- sity of California at San Francisco. Dr. Iwach is also a member of the board of the Glaucoma Research Foundation. "Traditional approved interventions have been scientifical- ly tested and validated and usually help. New approaches need to be put in context of available scientific data," he said. With patients relying on the internet for information on these therapies, doctors must often help them distinguish fact from fiction. For example, patients may read about the use of marijuana for glaucoma, Dr. Iwach said. When speaking with such a patient, he will share that although there may be a study that suggests a lowering of IOP with the drug, the associated known and unknown negative side effects, as well as its short duration of ac- tion, lead him not to recommend it as a treatment. "Sometimes it's not what you know, but what you don't know that you have to be especially careful of," he said. At the same time, the internet is filled with information about non-pharmacological therapies, The amount of information available on non-drug therapies for glaucoma and other diseases has in- creased tremendously in the past 20 years as well, Dr. Ritch said. When his interest in the topic began, he could have given a 10-minute over- view; now, he said he could easily spend 30 minutes to address each type of non-pharmacologic therapy that has been studied in glaucoma or other eye diseases. With the increase in interest, how do glaucoma specialists address the topic of non-pharmacological treatments, such as supplements, nutrition, and exercise? Bottom line on scientific proof Scientific evidence—or lack thereof —plays a major role in what doctors will say about non-pharmacological therapy. "At this time, there is no definitive evidence to encourage or discourage the use of exercise, diets rich in antioxidants, acupuncture, or meditation for the treatment of glaucoma," said Joseph Panarelli, MD, associate residency program director, New York Eye and Ear Infir- mary of Mount Sinai. "You can have an open mind, but you have to be critical," said Andrew Iwach, MD, executive Glaucoma-specific evidence is sparse, but eye doctors more open to adjunctive therapies W hen Robert Ritch, MD, Shelley and Steven Einhorn Distinguished Chair, New York Eye and Ear Infirmary of Mount Sinai, New York, first broached the subject of a link between glaucoma and lifestyle and nutrition 20 years ago, people thought he was joking. "Now, there's an enormous increase of interest in the topic," he said. In fact, about 30% of American adults use health care approach- es that go beyond conventional medicine, according to the federal government's National Center for Complementary and Integrative Health. The same organization esti- mated that $30.2 billion was spent in 2012 on complementary health approaches. About 5% to 15% of glaucoma patients use some form of alterna- tive treatment for their condition, the Glaucoma Research Foundation reported. Exploring non-pharmaceutical therapies for glaucoma continued on page 86

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