Milton Hom, O.D., F.A.A.O.: I’ve been hearing lecturers talk about using homeopathic medicine for their patients. More specifically, there are drops available for conditions, such as allergy and dry eye. From what I gather, the FDA allows homeopathic medicines if they contain at least two ingredients from an approved list (Materia Medicas). Some of the claims are pretty amazing: cataracts, ocular allergy, floaters, AMD, women’s dry eye, etc. I tried looking up studies on clinical outcomes, but could not find specific eyecare clinical studies. All I found were general studies showing positive results.

M.H.: In California, we come across many people preferring non-pharmaceutical treatments. I think if the patient requests it, we prescribe accordingly. What I find amusing is patients will go for an OTC, but not a drug, even if the OTC used to be classified as a drug. An example of this is ketotifen fumarate ophthalmic solution (Zaditor, Alcon). Or we see herbals that perform similar to drugs head-to-head, but patients prefer the herbal because it’s “natural” despite being more expensive. An example is Butterbur used for allergies. OTC and herbals are okay, but drugs are inherently evil in patients’ eyes.

I agree with you about integrative medicine. I think taking the best that traditional and complementary and alternative medicine treatments have to offer is the way to go.

Speaking of herbals, I’ve been getting a lot of requests for marijuana for glaucoma lately.

Ben Gaddie, O.D., F.A.A.O.: Milton, I believe that both eastern and western medicine have their place in the treatment of our patients. There is good evidence from my experience that certain homeopathic treatments work well for ocular surface conditions. There will likely never be peer-reviewed studies on these agents, so it is always going to be difficult to do true, scientific comparisons against prescription therapeutic agents.

Whether homeopathic agents can actually prevent cataracts, AMD or other severe vision issues is yet to be seen, and we will likely never know. As you know, the FDA can approve an over-the counter (OTC) medicine as long as it doesn’t cause harm. This is why some companies can make claims like “it will prevent AMD progression” without real evidence.

B.G.: While requests for medical marijuana are nothing new, I am being asked about it more frequently than ever — and by people who aren’t your typical “potheads,” either. Public perception of medical and recreational marijuana has changed, as evidenced by the recent legislative mandates in Colorado and Washington where recreational marijuana is now legal and 18 states total allowing medical marijuana.

I know that marijuana has some legitimate health benefits, and being a cancer survivor I can respect that notion 100%. However, unless there is data that I am missing, there is very little pragmatic value of medicinal marijuana for eye care and, in particular, glaucoma. The main reason that it isn’t a realistic alternative treatment option is because of its short duration of action (three to four hours). It would have to be smoked every three hours for IOP control.

Not only are the potential side effects obvious, but we also have outstanding efficacy from once daily PGAs that don’t leave you with “the munchies.” OM