bates method-review of optometry

7/28/2019 Bates Method-Review of Optometry

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Patient C a r e

A W a lk o nT h e w a d S id ePatients who use non-traditional medicine may not tell you about it.Here's what they migh t be using. By Brian Chou, O.D.N o doubt, you're w onderingabout the bright orange con-traption shown above. Didyou miss the announcementabout a revolutionary new productto treat vision problems?Actually, what you see here is theNeu-Vita Oculizer from England, adevice that was once believed toimprove vision in the early 1900s.Its crank-and-puUey system rotatestwo soft rubber eyecups. The otherend of the instrument is fitted withhard ru bber eyecups with a con-cave-faced plunger to poke the eyewhen the rubber bulbs aresqueezed. Vacuum can also beapplied by covering an air hole andreleasing the bulb.

According to its accompanyinginstructional pamphlet, the Oculizershould be applied either at night ormorning (for a few minutes only) asprescribed. "The eyeballs are thusgently massaged and the nerve cen-tre strengthened, conditionsabsolutely necessary for good eye-sight."Toda y, the O culizer is obsolete,except as a collectors' item.

Looking at this contraption, youmay wonder how people oncebelieved it could improve theirvision. Most likely, the availableinformation convinced them it waseffective.As your patients read about non-traditional eye treatments availableon the market today, they may askyou abou t their merit. They'lldepend on you for answers aboutwhich treatments are safe and effec-tive.Questionable Treatments

Even to day, questionable eyetreatments abound. Whiie thesemight be easy for eye-care profes-sionals to spot, they may not be asobvious to our patients.

A case in poin t: the See ClearlyMethod (Vision ImprovementTechnologies, LLC, now defunct).The so-called "natural" visionimprovement kit included manuals,charts, videotapes and audiotapesthat demonstrated various eye exer-

cises that could improve visionwithout the need for glasses, con-tact lenses or refractive surgery.Much of the See Clearly Methodwas based on the techniques thatWilliam Horatio Bates, M.D.,described in his best-selling 1920book, "Perfect Sight WithoutGlasses."

Members of the scientific com-munity have since discredited Dr.Bates' eye exercises by dem onstrat-ing tha t these exercises are ineffec-tive and conflict with knownfacts.'- Eor example. Dr. Bates rec-ommended "sunning" (staring atthe sun with the eyes wide open) torelax the eye. In reality, this canpermanently damage vision due tosolar retinopathy.'

The See Clearly Method was soldnationwide since 2001 with anadvertising cam paign of radio , tele-vision, print ads and a Web site.W ith celebrity endorsem ent, testi-monials, seemingly valid scientificreferences and a "risk-free" call toP ic tured above )s the Ne u-Vl ta Ocu l izer , cour tesy Rober t Green span , M.D. ,w w w . C o l lec tMe d I ca I A n t i q u es , c o m .


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Patient C a r eact ion, the company sold up to10,000 ki ts per month a t approxi-mately $350 apiece.

The See Clearly ki ts were takenoff the market per a fraud lawsuitand result ing court order inDecember 2006.^just like those hopeful folks whopurchased the Neu-Vita Oculizerdecades ago, people who boughtthe See Clearly Method apparent lybelieved i t was valid, tha n ks in pa rtto modern adver t i sing .

The See Clearly Method, now off the mar-ket, promised to Improve vision withoutthe need for glasses, contact lenses orrefractive surgery.

They 're no t a lone . Today, as anincreasing number of consumersembrace a "do-i t-yourself" a t t i tudetoward the i r own hea l th care ,employing complementa ry anda l t e rna t ive t rea tments . And, thosewho use alternat ive therapies oftendo not share this informat ion withtheir health-care providers. 'Diverse PracticesThe Na t iona l Cen te r forComplementa ry and Alt e rna t iveMedic ine def ines complementa ryand a l t e rna t ive medic ine (CAM) as"a group of diverse medical andhealth-care systems, pract ices andproducts tha t a re no t presen t ly con-sidered to be part of convent ional

medic ine ." The t e rm, "complemen -tary" describes trea tments used asan adjunct to t radi t ional pract ice."Alt e rna t ive" t rea tments replaceconven t iona l ones .Between 1990 and 1997, con-sumers increasingly used theseforms of treatments.^ By 2002,3 6% of adults in the Un i ted Sta tesused some form of CAM, accordingto a survey by the Nat ional Inst i -tutes of Health.*

CAM increasingly has becomepart of eye care. For example , theprevalence of CAM use for glau-coma is approximately 5%.^Another study of 89 pat ientswith inflammatory eye diseasefound that 37 (42%) reportedusing CAM to improve theireye condition.**Despite these figures,most optometric programsdo not appear to offer aformal curriculum dis-cussing non-tradi t ional eye

care t rea tments . In January2007,1 conducted an informal e-mail survey of dean s and presidentsof the 17 U.S. schools an d collegesof optometry. Only four out of 11responden ts , or 36% , report ed tha ttheir curriculum covered nontradi-t ional eye care.Compare this to three previouslypublished surveys of 125 schoolstha t offer a medical doctor degree,19 schools tha t offer a docto r of

osteopathy degree and 585 schoolsthat offer a nursing degree. Sixtypercent of the medical schools,9 5 % of the osteopathic medicalschools and 85% of nursing schoolsdiscussed some form of comple-men ta ry and a l t e rna t ive medicine i ntheir curriculum.Dietary SupplementsOf part icular interest in eye careis the use of vi tamin s to preven t eyedisease. Again, however, our

pat ien ts will depen d on us for m^an swers . And i t ' s here where we Jwmust dist inguish market ing cla ims^jfrom large-scale clinical studies, ,;Ssuch as the Age-Related Eye DiseaseStudy (ARFDS). ' ^

Nutraceuticals became an esti-'mate d $21 bill ion in dustry in the Uni ted Sta tes in 2006, according tO "MarketResearch.com. This is part lydue to less str ingen t labelingrequi rements .More specifically, vitamins, min-erals, herbs and other botanicals,amino acids, various extracts, andcombinat ions qualify as "die tarysuppleme nts" a ccord ing to theDie t a ry Supplemen t He a l th an dEducat ion Act (DSHEA). Congresspassed the DSHEA in 1994 follow-ing intensive lobbying by manufac^turers, and former President Bill 'Clinton signed i t in to law.As a result, the FDA regulatesthese substan ces as foods ra therthan drugs. Tha t mean s man ufac-

turers are not required to submitsafety or efficacy data to the FDAbefore market ing die tary supple-ments. Although DSHEA prohibi tsmanufacturers from cla iming thatthey preven t , t rea t or cure a specificdisease, i t a llows them to makelabeling sta tements that describetheir supplement's alleged effects onthe "structure and funct ion" orgeneral "well-being" of the body, aslong as they bear this disclaimer:"This s t a t eme nt has no t been eva lu-ated by the Food and Drug Admin-istra t ion. This product is notin t ended to d iagnose , t rea t , cure , orpreven t a ny d isease ."

For exam ple, wi th this dis-claimer, a bottle of bilberry extractcould have labeling tha t says that i thas t radi t ionally been used toreduce eyestra in and support visualfunctions, despite a lack of rigorousscient i f ic evidence to substant ia tesuch labeling."


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IQUIX(levorioxac in opiitlialm ic; solutio n) 1.5%

BRIEF SUMMARYINDICATIONS AND USAGE

lOUIX* solut ion IS indicated lor ihe trealment ot corneal u lcer caused bv sjscepl ib le s lra ins ot thefol lowing bacter ia 'GRAM-POSITIVE BACTERIA: GRAM-NEGATIVE BACTERIA:Corynebacienum spscJes' Pseudomonas aerugmosaStaphylococcus aureiis Ssfralia marcescens'Staphylococcus epidermidisStreptococcus pneumomeVifidans group s t rap tococc i ''Etf icaty tor th is organism was studied in tewer than 10 intect ions.

CONTRAINDICATIONSIQU IX* solut ion is contraindicaied in pat ients with a history ot hypersensit iv i ty to levot loxacin, to olhetauinalones. or to any ot t t ie components in th is medicat ion.

WARNINGSNOT FOR INJC TIO\ .lOUiX solut ion should not t>e in iected subconiunct lvai ly, nor should I t be introduced Directly into theanterior cham&er ot the e/e.in pal ients receiving systemic quinolones. sef ious and occasional iy latal hypersensit iv i ty (anaphylact ic)reacl ions have been reported, some tol lowing the f i rst dose. Some react ions were accompanied bycardiovascular col lapse, loss of consciousness, angioedema (Inciuding iaryngeai, pharyngeal or taciaiedema), atrway obstruct ion, dyspnea, urt icar ia, and i tching. \t an ailergic reaction to ievofloxaclnoccurs, d isconi inue the drug Serious acute hypersensit iv i ty react ions may requi ie im mediateemergency treatmerl. Oxygen and airway management should be administered as cl in ical ly indicated.

PRECAUTIDNSGenera l :As with other ant i- intect ives, prolangad use may result in overgrowtt i of non-suscepl ib ie organisms,including fungi. I f superintect icn occurs, d iscontinue use and inst i tute aiternattve therapy. Whenevercl in ical [ i idgmenl dictates, the pat ient should he examined with the aid of magnif icat ion, such assl i t - iamp biomicroscopy, and, where appropriate, t iuorescein staining.Patients shouid be advised not to wear contact lenses t f thay have signs and symp toms of comeal ulcer,In lo rmat lon lo r Pa l ien is :Avoid contaminating the appl icator t ip with materla i from the eye. f ingers or other source.Systemic qumolones have been associated with hypers en si t iv i ly react ions, even fol lo wing a singledose Discontinue use imme diately and contact your physic ian at t l ie t i rst s ign ot a rash or ai iergicreact ion.Dn iq In te rac t ions :Specif ic drug inteiacf ion studies have not been conducted with IQUiX^. However, the systemicadministrat ion Of some qumolones has been shown to elevate plasma concentrat ions of theophyl i ine.intertere with the metabotism of caffeine, and enhance the effects Of ihe orai anticoaguiant wariarinand Its derivatives, and has been associated with transient elevations in serum crea^nine in patientsreceiving systemic cyclcspcrine concomitant ly.CarGinDgana tU. Mu lagenas ls , impa i rmen t o l Fe r t i l l l y :in a long term carcinogenici ty study in rats, levof loxacin exhibited no carcinogenic or lumorigenicpotentia i fo i lowing dai ly dietary administral ion lor 2 years; the highest dose (100 mg/kg/day) was100 t imes the highest recommended human ophthalmic dose.Levolloxacm was noi mutagen ic in the tollowing assays Ames Bacterial muta tion assay (S. typhimuiiumand E coh), CHOfflGPRT forward mutat ion assay, mouse m icranucleus test, rrouse dom inant lethal test.rat unscheduled DNA synthesis assay, and the in wvo mou se sister chromatic) exchange assay It waspositive m the in vitro chromosomal aberrat ion (CHL cei l i ine) and m viiro sister chromatid exchange(CHMU cel l l ine) assays.Levofioxacin caused no impairment of fert i l i ty or reproduction in rats at oral doses as high as360 mg/kg/day, corresponding to 400 t imes the highest recommended human ophthalmic dose.Pragnancy: TeralngBnic Elfects. Pregnancy Calegory C:Levofloxacinat oral doses of 810 mg/kg/day in rats, which corresponds to approximately 1000 t imesthe highest recommended human ophthalmic dose, caused decreased fetai body weight and increasedfetal mortality.No teratogenic effect was observed when rabbits were dosed orai iy as high as 50 mg/kg/day. wfi ichcorresponds to approximsteiy 60 t imes the highest recommended maximum human ophthalmic dose.Of when dosed miravenoi is ly as high as 25 mg/kg/day, corresponding to approximately 30 t imes thehighest recommended human ophthalmic doseThere are, however, no adequate and wel l-control led studies in pregnant w omen. Levofioxacin shouidbe used during pregnancy only il the potentiai beneirt justifies the potentiai risk lo the fefus.Nura ing Mathers :Levofioxacin has not heen measured in human milk. Based upon data from of ioxacin. i t can bepresumed that levoi loxacln is excreied in human milk. Caution should be exercised when IQUIX* isadministered to a nursing mother.Ped ia t r i c Uts :Safety and effectiveness in children beiow the age of six years have not been established. Oraladnnnistralton of systemic Quinolones has been shown to cause arihropalhy in immature animals.There is no evidence thai the ophthalmic administrat ion of levot loxacin t iaB any effect on wei j jhtSearing pn tsGsrialr jc Use:No overal l d i f ferences in safety or effect iveness have been otserved between elderly and other adultpat ients.

ADVERSE REACTIONSThe most frequently reported adverse events in the overal l study populat ion were headache and a tastedisturbance fol lowing inst i l la l ion Tbese events occurred in approximately B-10% of paf ients.Adveise events occurr ing in approximately 1-2% of pat ients included decreased/blurred vis ion,diarrhea, dyspepsia, fever, intect ion, inst i l lat ion si te irr i tat ion/discomfort, ocuiar infect ion, nausea,ocuiar pain/discomfort, and throat i rr i tat ion.Other reported ocular react ions occurr ing in less than 1% of pat ients included chemosis, c omsalerosion, corneal u icer, d ip iopia, f loafers, i iyperemia. l id edema, and l id erythema.Rx OnlyManu lac lu rsd by :Santen Oy, P.O. Box 33, FIN-33721 Tampere, Rniand

Marke lad by ;VISTAKON * Pharmaceu tica ls , U CJacksonvi l le. FL 32256 USA

Licensed from:Daiichi Sankyo Co., L td.. Tokyo, Japan

U.S. PAT, MO 5.053,407Apri l 2007 Version

P a t i e n t C a r e

A taste of honey is worse thannone at all? No studies provethat honey drops treat cataract.

CAM for CataractsThe definitive and accepted treatment for cataract issurgical extraction followed by intraocular lensimplan tation, yet an Internet search for "catarac tcure" produces a plethora of interesting remedies. OneWeb site claims that unprocessed honey is an effectivetreatment for cataract:"A few drops of thishoney should be put inthe eyes. This is anancient Egyptian remedywhich has benefitted[sic\ many patients," theauthors claim.'" A litera-ture search showed ageneral absence of datasupporting honey as aneffective treatment forcataract., aside from oneRussian study."

The same Web pagepromotes garlic asanother effective homeremedy for cataract."Two or three clovesshould be eaten rawdaily," the site says. "They should be chewed slowly.Garlic helps to clean the crystalline lens of the eye." Aliterature search also showed an absence of supportfor consuming garlic as an effective treatment forcataract. However, one study did find that one of themajor organosulfides in garlic oil, diallyl disulfide, pre-vented the development of cataracts of acetam ino-phen-induced cataracts in mice.' '

Yet another Web site stated that it is "essential"that patients with cataract use Cineraria Cataract EyeDrops, described as "the traditional homeopathic rem-edy found in the Ophthalmology section of thePhysicians Desk Reference for over 25 years as a treat-ment for cataracts.""

Hom eopathy is based on the medically dispu tedpremise that infinitesimally small amounts of poisonswill relieve the same symptoms they would produce inlarger amounts.'^ A literature search in PubMed forCineraria for treating catara cts came up w ith only a1981 paper from hidia, which noted its inconclusivebenefit when used in goat lens cultures.''IAntioxidants for Cataracts

It sounds reasonable that antioxidants might retardthe development of age-related cataract. Several such


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nutraceuticals are marketed on theInternet as "nat ural " ways to pre-vent and treat cataracts, suggestingthat cataract surgery is unnecessar-ily risky. Yet at best, little legitimateevidence exists to suggest antioxi-dants have a significant role inpre-venting age-related cataract.ARF.DS evaluated 4,757 partici-pants, of which some used a high-dose antioxidant formulation(vitamin C, 500mg; vitamin E,400IU; beta carotene, 15mg; zincoxide, 80m g; cupric oxide, 2mg}and some were given placebodaily.'" In one portion oft he study,the researchers found that thepatients at high risk of developingadvanced AMD lowered their riskhy about 25% and their risk ofvision loss caused by advancedAMD by about 19% . In thecataract portion of the study, how-ever, researchers found that thesame nutrients had no significant

effect on the development orpro-gression of age-related cataract.In another clinical trial of 1,193eligible subjects, vitamin E (500IUdaily) used for four years did notreduce the incidence or progressionof nuclear, cortical, or posteriorsubcapsular cataracts.'" The authorsconcluded that their findings didnot support "the use of vitamin Eto prevent the development or to

slow the progression of age-relatedcataracts."Another study, the CollaborativeItalian-American Clinical Trial ofNutritional Supplements and Age-related Cataract (CTNS), is cur-rently looking at whether a vitaminand mineral supplement [Centrum,Wyeth Consumer Healthcare) con-taining recommended daily allow-ances can prevent age-related

cataract ordelay its progression.Results are expected inMarch

VISION EXPO EAST 20SYNEMED iEP-900 SERIEAU TOM ATED PERIMETMkJU BOOTH #FULL-FIELD CAPABILITFASTEST TEST TIM E

IND U STR Y STAND AR D PR INTOUEASY 2 BUTTON OPERATIPATIENT ACCEPTANCFULLY REIMBURSABAD VANC ED M ETH OD OL OGEASILY UPGRADAB100% F IXATION M ONITOR IRESULTS ANALY SIS PR OGR ANTY & FREE OASER PR IN


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P a t i e n t C a r ein the United Statespirenoxineand glutathioneare a standardtreatment for cataracts in Japan.The annual domestic sales of thesedrops in Japan are approximately18 billion yen ($176 million).'^ Thedrops are routinely prescribed bytheir doctors and are also coveredby their national health insurance.'^Nevertheless, evidenced-basedguidelines from the Japanese gov-ernment show that that pirenoxine(sold as Catalin) and glutathioneeye drops lack effectiveness fortreating cataracts.'"*

Although Japanese doctors mayknow that pirenoxine and glutath-ione offer questionable benefit forcataracts, it is possible that theycontinue to prescribe them as aneasy way to satisfy their patients.This would be similar to doctorscontinuing to prescribe antibioticsfor viral upper-respiratory infec-tions, so that patients don't feelthey're leaving the office visitempty-handed.^" Regretfully, thispractice doesn't encourage the pub-lic to embrace evidence-basedapproaches to their own healthcare.Another antioxidant touted onthe Internet for cataracts is N -acetyl-carnosine (NAC ). The major-ity of the scientific literature aboutNAC for cataracts is authored byMark Babizhayev, Ph.D., a Russianresearch scientist who serves as the

executive director of InnovativeVision Products (IVP), based inDelaware. IVP markets their NACeye drop under the name Can-C.IVP claims that NAC "is effectivein reducing, reversing and slowingthe occurrence of senile cataract."''In a randomized, placebo-con-trolled study sponsored by IVP of49 subjects (76 cataractous eyes),

9 0 % of NAC-treated eyes showedimproved best-corrected visual acu-ity after six months." The authors

Topical N-acetyl-carnosine mightactually work, but it probably won'treplace cataract surgery any time soon.concluded that topical NAC showspotential for treating and prevent-ing cataracts.Corroborating these results, anindependent study of topical NACfor cataracts in dogs showed some

marginal reduction in lens opacifi-cation in a substantial num ber ofcases.'' While it is unlikely thatNAC will usurp traditional surgeryfor treating cataracts, NAC maybold some clinical benefit forselected cataract patients in whichsurgery is not desirable. The com-pany says it may also provide bene-ficial results for such conditions aspresbyopia, primary open-angleglaucoma, dry eye syndrome andretinal disease.Acupuncture for EyesAcupuncture has existed as a cen-tral part of health care in China formore than 4,500 years. Acupunc-turists believe that their treatmentunblocks invisible life energy (called"chi") along specific pathways ofthe body. Acupuncture stimulationcan alter neurotransmitter release,regulate blood flow and release opi-

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oid peptides to provide analge-sia."-^'Acupuncture has been used to

treat and alleviate various ocularconditions, including dry eye,myopia, paralytic strabism us, retini-tis pigmentosa, optic atrop hy, iritis,conjunctivitis and cataract."One device that attempts to capi-talize on acupuncture for eyes is theEye-Max magnetic acupressure eyemassager (Endless Eorest Inc.). TheWeb site for Eye-Max suggests thatthis product is appropriate for thosewh o experience eyestrain, blood-

shot eyes, dry eyes, double visionand headaches.^^ The homepageproclaims, "Benefit could beGreat!"As with many other forms ofCAM, there is an absence of largescale, random ized, con trolled triaisof acupuncture to validate its roleas an ophthalmic treatment.

Without this data, the merits ofacupuncture in optometry and oph-thalmology are unlikely to gainwidespread acceptance. Meanwhile,acupuncture should not supplantestablished ophthalmic treatment.However, it may be an alternativefor refractory cases or as an adjunctto established therapy.^"

This article doesn't com e close toreviewing all the available CAMtreatments because the field is sim-ply too vast. You can appreciate thediversity of CAM for eye care bysearching the Internet, just like8 0% of Americans who use it tolook up health information.-'*

While there are many exagger-ated claims made by people withdubious credentials, O.D.s shouldremain open-minded about emerg-ing treatments, especially those vali-dated by evidence-based method s.

'Benefi t couid he Great! ' say the makersof the Eye-Max magnetic eye massager.

There likely are non-traditionaltreatments out there, albeit not yetcharacterized, with the potential tohelp our patients. Dr. Chou is in group practice atCarmel Mountain Vision Care in

San Diego. Approximately W yearsago, his efforts led the OhioAttorney General's Office and

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P a t i e n t C a r eFederal Trade Commission toinvestigate the publisher of"Hidden Secrets to Better Vision,"a book that recommended unsafeand unproven eye treatment.Fischer Publishing Corp. closedshortly thereafter.1 . M a r g i E . " F l a s h e s " of c le a r v i s io n a n d n e g a t iv e a c c o m m o -d a t i o n w i t h t e l e r e n c e t o I h e B a t e s m e l h o d of v i s u a l t r a i n i n g .A m J O p t o m A r c h A m A c a d O p t o m 1 9 5 2 A p r ; 2 9 {4 ) : 1 6 7 - 8 4 .2 . G a r d n e r M . F a d s a n d l a l i a c i e s in t h e n a m e o t s c ie n c e ,M i n e o l a , N Y : D o v e r P u b l ic a t i o n s ; 1 9 5 7 .3 . S t o k k e r m a n s T J , D u n h a r M T . S o l a r re t i n o p a t h y i n a t i o s p i -t a !- b a s e d p r i m a r y c a t e d i m e . J A m O p t om esoc19980 c t ; 6 9 ( 1 0 ) : 6 2 5 - 3 64 . I o w a c o u r t o l t hE a t t o r n e y g e n e r a l . C o u r t o r d e r s v i s i o ni m p r o v e m e n t t e c t i n o i o g i e s t o e n d s a lE S o l " S e e C l e a r l yM e t h o d " i < it . A v a i i a b i e a l: w w w . 5 t a t e . i a . u s / g o v e r n m e i j l / 3 0 /l a te s t n e w s / re l e a s e s / n o v 2 Q [ ) 6 A / i T . h t m | . [ A c c e s s e dF e b r u a r y 2 0 0 8 )5 . E i s e n b e r g D M , D a v i s R B , E t tn e r S L , e t a l. T r e n d s in a l t e r -n a t i v e m e d i c i n e u s e in t h e U n i t e d S t a t e s , 1 9 9 0 - 1 9 9 7 : r e s u l t so t a f o i lo w - u p n a t i o n a l su r v e y . J A M A 1 9 9 8 N o v 1 1 ; 2 8 0 ( 1 8 ) :1 5 6 9 - 7 5 ,6 . B a i n e s P , P o w e l l- G r i fi e r E , M c F a n n K, N a h i n R , C D CA d v a n c e D a t a R e p o r t # 3 4 3 . C o m p l e m e n t a r y a n d a l t e r n a t i v em e d i c in e u s e a m o n g a d u l ts : U n i t e d S ta t e s , 2 0 0 2 . M a y 2 7 .2 0 0 47 . R h e e O J . K a t z L J , S p a e t h G L , e t a l. C o m p l e m e n t a r y a n da l t e r n a t i v e m e d i c i n e to r g l a u c o m a . S u r v O p h t h a l m o l 2 0 0 1

J u i - A u g ; 4 6 ( 1 ) : 4 3 - 5 5 .8 . S m i t h J R , S p u r r ie r N J , M a r t i n J T , e t a l. P r e v a l e n t u s e otc o m p l e m e n t a r y a n d a l t e r n a t iv e m e d i c i n e by p a t i e n t s w i t hi n t ia m m a l o ry e y e d i s e a s e . O c u l Im m u n o i I n t la m m 2 0 0 4S e p ; 1 2 ( 3 ) : 2 0 3 - 1 4 .9 . C a n t e r P H , E rn s t E. A n t h o c y a n o s i d e s o t V a c c i n iu m m y r -t i l l u s ( b i l b e r r y ) orn i g t i l v i s i o n a s y s t e m a t ic r e v ie w o fp l a c e b o - c o n t ro l le d t r ia l s . S u r v O p h t h a lm o l 2 0 0 4 J a n -F e b : 4 9 ( 1 ) : 3 8 - 5 0 .1 0 . H o m e - r e m e d i e s - t o r- y o u . c o m . C a t a ra c t s y m p t o m s ,c a t a r a c t tr e a t m e n t , c a ta r a c t c u r e . A v a i l a b l e a t ' w w w . h o m & -r e m e d i e s - l a r - v o u . c o m / r e m e d y / C a t a f a c t . t i l m i . ( A c c e s s e dF e b r u a r y 2 0 0 8 . )1 1 . G o l y c h e v V N , U s e o l h o n e y in c o n s e r v a t i v e t r e a t m e n t ots e n i le c a t a r a c ts . V e s t n O t ta l m o l 1 9 9 0 N o v - D e c ; 1 0 6 ( 6 ) :5 9 - 6 2 .1 2 . Z h a o C , S h i c t i H . P r e v e n t io n o l a c e t a m i n o p h e n - in d u c e dc a t a r a c t b y a c o m b i n a t i o n o t d i a l l y l d i s u l l i d e a n d N - a c e t y l -c y s t e i n e . J O c u l P h a r m a c o i T t i e ra 1 9 9 8 A u g ; 1 4 ( 4 ) :3 4 5 - 5 5 .1 3 . N a t u r a l E ye H e a l t h . C a t a ra c t c u r e a n d p r e v e n t i o n .w w w . n a t u r a i e v e c a r e . g o m / ( J is e a s e s . a s p ? d n u m ^ 2 . ( A c c e s s e dF e b r u a r y 2 0 0 8 . )1 4 . B a r i e t t S . H o m e o p a t h y : Is it m e d i c i n e ? In : T h e H e a l t hR o b b e r s : A C l o s e L o o k a t O u a c k e r y i n A m e r i c a . B u t l a l o , N Y :P r o m e t h e u s B o o k s ; 1 9 9 3 . 1 9 1 - 2 0 2 .1 5 . A l b a i M V , C h a n d o r k a r A G . B ii ta k h P M . E v a l u a t io n o lc a t a l i n , S u c c u s C i n e ra r ia m a r it im a a n d C a t o b e l l in g o a t l e n sc u i tu r e s . I n d ia n J O p h t h a l m o l 1 9 8 1 O c t ; 2 9 ( 3 ) :1 4 7 - 9 ,1 6 . A g e - R e l a t e d E y e D i s e a s e S t u d y R e s e a r c h G r o u p . A r a n -d o m i z e d , p i a c e b o - c o n t r o l i e d , c l i n i c a l t r i a l o t h i g h - d o s e s u p -p l e m e n t a t i o n w i t h v i ta m i n s C a n d E a n d b e t a c a r o t e n e t o ra g e - i e ia t e d c a t a r a c t a n d v i s i o n l o s s : A R E D S r e p o r t n o . 9.A r c h O p h t h a l m o l 2 0 0 1 O d ; 1 1 9 ( 1 0 ) : 1 4 3 9 - 4 21 7 . M c N e i l J J , R o b m a n L , T i k e l l i s G , e t a l. V i t a m i n E s u p p l e -m e n t a t i o n a n d c a t a r a c t ; r a n d o m i z e d c o n t r o l l e d t r i a l .O p h l h a i m o l o g y 2 0 0 4 J a n ; 1 l 1 ( 1 ) : 7 5 - 8 4

1 8 . M e d M K . c o m . A n n u a l s a le s o t d o m e s t ic p h a r m a c e u t ic a lc o m p a n i e s . A v a i l a b l e a t ; w w w . m e d m k . c o m / m m / a d d /m l a d d . h t m . (A c c e s s e d J u n e 2 0 0 7 . )1 9 . S e k i m o t o M , t m a n a k a Y , K it a n o N , et a l . W h y a r e p l i y s i -c t a n s n o t p e r s u a d e d b y s c i e n t i t i c e v i d e n c e ? A g r o u n d e dt h e o r y i n t e rv i e w s t u d y . B M C H e a l t h S e r v R e s 2 0 0 6 J u i 2 7 ;6 ; 9 2 .2 0 . B u t t e r C C , R o i ln i c k S , P i l l R , e t a l. t J n d e r s t a n d i n g th ec u l t u r e o l p r e s c r i b i n g ; q u a l i t a t iv e s t u d y o t g e n e r a l p r a c t i t i o n -e r s ' a n d p a t i e n t s ' p e r c e p t i o n s o f a n t i b i o t i c s to r s o r e t h r o a t s .B M J 1 9 9 8 : 3 1 7 ; 6 3 7 - 6 4 2 .2 1 . C a n - C c a t a ra c t e y e d r o p s . A v a i la b l e a t ; w w w . c a n - c . n e t ,( A c c e s s e d F e h r u a r y 2 0 0 8 . )2 2 . B a b i z h a y e v M A , D e y e v A l, Y e r m a k o v a V N , et a l. E t f i c a c yo f N - a c e t y l c a r n o s i n e i n t h e t re a t m e n t of c a t a r a c t s . D r u g s R D2 0 0 2 ; 3 ( 2 ) . 8 7 - 1 0 3 ,2 3 . W i ll ia m s D L , M u n d a y P . T h e e t fe c t o l a t o p i c a l a n t i o x i -d a n t t o r m u l a t i o n i n c l u d i n g N-acetyl c a r n o s i n e o n c a n i n ec a t a r a c t ; a p r e l im i n a r y s t u d y . V e t O p h t h a l m o l 2 0 0 6 S e p -G c t ; 9 ( 5 ) : 3 1 1 - 6 .2 4 . N JH C o n s e n s u s C o n t e re n c e . A c u p u n c t u r e , J A M A 1 9 9 8 N o v4 ; 2 8 0 ( 1 7 ) : 1 5 1 8 - 2 4 .2 5 . L e a k e R, B r o d e r i c k J E . T r e a tm e n t e t i ic a c y o l x u p u n c S j r e ; ar e v ie w o f t h e re s e a r c h l i te r a t u r e . I n te g r M e d 1 9 9 8 ; 1.107-115.2 6 . A s t b u r y N , A l t e r n a t iv e e ye c a r e . B r J O p h t h a l m o l 2 0 0 1J u I ; 8 5 | 7 ) ; 7 6 7 - 8 .2 7 . E y e - M a x A v a i la b l e a t : w w v , e y e m a s s a g e . c o m . (A c c e s s e dF e b r u a r y 2 0 0 8 . )2 8 . A m e r i c a n A c a d e m y o t O p h t h a l m o l o g y C o m p l e m e n t a r yT T ie r a p y T a s k F o r c e : A c u p u n c t u r e t o r C c u l a r C o n d i t i o n s a n dH e a d x h e s . A p r i i 2 0 0 3 . A v a i la b l e a t : w w w . a a o . o r g /e y e c a r e /t r e a t m e n t / a l t e r n a t i v e - t t i e r a o i e s / a c u D u n l u r e - o c u l a r . c f m .( A c c e s s e d F e b r u a ry 2 0 0 8 . )2 9 . F o x S . O n l in e H e a l th S e a r c h 2 0 0 6 . W a s h i n g t o n D C ; P E WI n t e r n e t & A m e r ic a n L i te P r o je c t : 2 0 0 6 M 2 9 : 2 .

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