treatment plan
Getting Familiar with CAM
BY LEO SEMES, OD, FAAO

The acronym CAM stands for complementary and alternative medicine. CAM involves treating conditions with vitamins, minerals, herbs and other alternatives. A growing science surrounding alternative treatment strategies exists, and we should become familiar with the general concept as well as with some specifics.

CAM for Macular Degeneration

Researchers have closely studied vitamin and mineral supplements for treating macular degeneration for fewer than 20 years. A small, uncontrolled study from about 15 years ago showed that zinc may stabilize the condition.

Most recently, the National Eye Institute-sponsored Age-Related Eye Disease Study (AREDS), a well-designed and placebo-controlled study, showed modest benefit from a vitamin and mineral supplement combination among patients who had moderately advanced, nonneovascular age-related macular degeneration (AMD). Table 1 shows the components that comprised the study formula (now Ocuvite PreserVision, Bausch & Lomb). Note that it at least fulfills the recommended daily allowance (RDA) values for each item.

Some clinicians have criticized AREDS for not including lutein. At the time of the study's design and inception, lutein didn't have scientific standing. Since then, lutein has emerged along with other macular proteins (zeaxanthine and lycopene) as potential agents for treating nonneovascular AMD. Stay tuned.

A recent review of bilberry (Canter PH, Earnst E, 2004) was unable to demonstrate a beneficial effect on night vision. The basis for bilberry's apparent action may stem from its antioxidant properties. Alternative antioxidants may include those found in grapeseed oil (vitus vinifera), which are also found in grape juice and wine.

CAM for Glaucoma

Many glaucoma patients use CAM supplementary treatments (Rhee et al, 2001), most frequently megavitamin and herbal remedies including multivitamin and mineral supplements, bilberry, gingko biloba and eyebright. Other supplements include everything from cayenne to yohimbe.

Is CAM Safe?

Whether these alternative treatments are effective remains inconclusive. Whether they're safe to recommend to patients is a question of immediate importance. Sufficient evidence exists that beta-carotene may potentiate lung cancer in smokers (even in reformed smokers). Information about a controversial smokers' multivitamin formula is available at http://www.smokersvitamin.com.

Become more aware of the efficacy and especially the safety profiles and potential complications of alternative therapies for your patients' different conditions. Herbs, minerals and other nutritional supplements may cause reactions ranging from allergic conjunctivitis to transient vision loss. Take detailed histories to determine and document consumption of vitamins, minerals, and herbs.

Keep in mind that nutritional supplements (vitamins, minerals, herbs, etc.) aren't FDA-approved. You can view the FDA's new proposal for reviewing "botanical" drugs at: http://www.fda.gov/cder/guidance/1221dft.htm.

For references, please visit http://www.clspectrum.com/references.asp and click on document #106.

Dr. Semes is an associate professor at the University of Alabama at Birmingham School of Optometry.