Unconventional Treatments
Chat Highlights
July 17, 2002

Norma Devine, Editor

On Wednesday, July 17, 2002, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Unconventional Treatments."

Moderator:  Good evening, Dr. Wilson.  The topic tonight is "Unconventional Treatments."  

P:  How might an unconventional treatment differ from a conventional treatment?

Dr. Rick Wilson:  An example would be a treatment that tried to reduce the optic nerve's sensitivity to elevated intraocular pressure (IOP), rather than just lowering the IOP. That treatment could be used together with conventional treatment.

P:  Dr. Rick, how do you feel about unconventional treatments in general?

Dr. Rick Wilson:  I feel good about unconventional treatments that seem to also be helpful systemically like Vitamin E and baby aspirin in older patients.  I don't feel as comfortable with medications or herbs that may have side effects and have not been proven to do any good.

P:  What about THC?

Dr. Rick Wilson:  Wills was the first center in the U.S. to test THC.  We tested it in peanut oil and found that it did not do much to the intraocular pressure and the vehicle was not well tolerated.  If taken systemically, THC does lower IOP (intraocular pressure), but the effect is short lived, so that drops are a more practical approach to IOP lowering.

P:  What's THC?

Dr. Rick Wilson:  Tetrahydrocanabinol, or "pot" to you.

P:  Are there any THC drops on the market today?

Dr. Rick Wilson:  There is a THC drop that is sold in the West Indies.  I think it may be Marinol, or something like that.  I've had patients from Grenada and other Caribbean islands, who had a bottle of the medication.  

P:  Is the THC drop only available in Grenada or is it available in most countries?

Dr. Rick Wilson:  To my knowledge, only in the islands where they have lax controls or no FDA (Food and Drug Administration).

P:  How does THC lower eye pressures?  I am confused about this and using it on a three-year-old child.

Dr. Rick Wilson:  One effect may be the relaxation of the eye muscles on the eye, which lowers the IOP during the period of relaxation.  Clearly, there would have to be serious systemic effects to get to this level of relaxation.  I wouldn't recommend it for a three-year-old child.

Moderator:  A patient wants to know about aqueous chromium.

Dr. Rick Wilson:  That's a new one on me.  

P:  Do you know of any herbs, plants, flowers or roots that are proven, or thought, to help provide neuroprotection of the optic nerve?

Dr. Rick Wilson:  We have tried mega vitamin doses, bilberry juice, and other remedies at Wills without finding one that had a noticeable effect. Several glaucoma doctors talk to their patients about ginkgo biloba, but I haven't seen enough studies to feel comfortable about it.

P:  What would prove them to you?  University studies?

Dr. Rick Wilson:  Placebo-controlled studies, where the patient and the doctor did not know whether the patient was taking the placebo or the agent.  The placebo effect is strong and hard to weed out.

P:  How about Forskolin?

Dr. Rick Wilson:  Back in the Eighties, there was a lot of interest in Forskolin  stimulated by work at Yale with Doctors Sears and Caprioli.  Unfortunately, nothing ever came of it.

Moderator:  What is Forskolin? 

Dr. Rick Wilson:  I'd have to look it up myself.  It's been so long, I've forgotten. [Editor's note:  Forskolin is an extract of the Ayurvedic (used in the traditional medical system of India) herb Coleus forskohlii (root)].  

P:  Melatonin has been shown to reduce the variations of diurnal IOP, so if it's also a possible neuroprotectant, why isn't it being studied more?

Dr. Rick Wilson:  I can't answer that about "more."  I know of one laboratory in England that has been looking at melatonin, and maybe still is.  

P:  What are the most popular unconventional treatments being tested now that hold the most promise?

Dr. Rick Wilson:  The new buzz word is neuroprotection.  Since this is not an accepted IOP lowering medication in many cases, it can be considered unconventional.  Memantine, which has a national trial going, is an example of this type of medication. 

P:  Are you familiar with the Indiana University study showing that ginkgo biloba extract increases ocular blood flow velocity?  The researchers had placebo controls and noted a 23% increase in blood flow velocity.  How easy is it for doctors to get access to these kinds of studies that are not related to pharmaceutical companies' products?

Dr. Rick Wilson:  If it is a reputable study published in a reputable journal, it should be easy to get hold of it.  

P:  How do you feel about acupuncture?

Dr. Rick Wilson:  Acupuncture is an accepted treatment for many things in China, and can be used in lieu of anesthesia for surgery.  I don't know of a study investigating it for use by glaucoma patients.

P:  My ophthalmologist indicated there's nothing in the medical literature supporting the usefulness of dietary supplements for glaucoma.  Is that so?  What about ginkgo biloba, retinol, alpha linolenic and lipoic acids, and B-complex vitamins?  In connection with the latter, I've read that glaucoma patients normally have low levels of thiamin.  Can you comment?

Dr. Rick Wilson:  The medical literature will show that aspirin, vitamin E, and melatonin seem to have neuroprotective effects in the lab, but this has not been proven in glaucoma patients, so it appears to be theoretical.

P:  Can vitamin C help a glaucoma patient?

Dr. Rick Wilson:  Vitamin C was studied by the Italians, as I remember, who used high doses systemically.  These doses, which I think were in excess of 15 grams, caused a short-term decrease in IOP, but that was not practical long term. 

P:  What vitamins might have side effects?

Dr. Rick Wilson:  The fat soluble vitamins -- A, E, and K -- accumulate in the system and can cause toxicity if taken to excess.  

P:  Would you prescribe diet and exercise along with any treatment to help patients fare better over the long haul?

Dr. Rick Wilson:  I prescribe weight control and exercise to all my patients. Both have been proven to help circulation, lessen the risk of heart disease, and diabetes.  Exercise will lower IOP when done for 20 minutes or more four times a week.  

P:  Isn't it risky for people to take advice from, say, vitamin salesmen and laypeople regarding supplements and herbs, because there are so many differing contributing factors to each person's glaucoma situation?

Dr. Rick Wilson:  Absolutely, especially since side effects of these herbs occasionally come to light.  What you say is true for some medications as well; for example, the use of calcium channel blockers in normal-tension glaucoma.  Calcium channel blockers helps spasm of the vessels carrying blood to the optic nerve, but also  lower systemic blood pressure in many instances, which can be detrimental to the health of the glaucomatous eye.

P:  Are there any types of unconventional treatments for infants?

Dr. Rick Wilson:  Not at this time.  Usually the increase in IOP is due to an anatomical, developmental problem that is not amenable even to medication.

P:  My son had speech delays from poor vision until he was almost a year old.  Someone suggested fish oil.  How does that help glaucoma and do you recommend it?

Dr. Rick Wilson:  Fish oil may help rheumatoid arthritis, and the omega 3's in it are helpful to the heart.  I've not heard of it being helpful to glaucoma, especially in the young.

End of highlights for July 17, 2002.

On July 31, Dr. Wilson discussed "Glaucoma and OTC (over-the-counter) Medications" in the chat room. Click here for highlights of that meeting.

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