Are there safe and effective alternatives to conventional AMD treatments?
Are you thinking about trying an alternative therapy to treat age-related macular degeneration (AMD)? Like anyone with a serious illness, you might be tempted to try something that sounds like a miracle cure. But beware.
That said, not all alternative therapies are too good to be true. In fact, at least one has gone on to become the standard of care for the prevention of AMD. Case-inpoint: The use of vitamin supplements is often considered to be an alternativeif not radical wayto treat a disease, but the publication of findings from the Age-Related Eye Disease Study (AREDS) researchers in 2001 demonstrated that a vitamin and mineral supplement containing high doses of vitamins C and E, beta carotene, and zinc successfully slowed the progression of AMD in people with AMD in both eyes or advanced disease in one eye.
Unfortunately, when it comes to alternative therapies for AMD, the AREDS supplement's success seems to be the exception rather than the rule. Here's an update on a few other alternative treatments you might have heard about.
This treatment is based on the traditional Chinese medical theory that pain and disease occur when the body's natural energies (chi) are out of balance. Acupuncture practitioners believe that chi is conducted through the body along pathways called meridians, which intersect at specific points in the body. Stimulating these points using acupuncture needles is meant to correct the improper flow of chi, thereby relieving the problem.
Acupuncture has been used to treat a wide range of conditions, including chronic pain. Studies have shown that biological responses, such as release of pain-relieving opioids, do occur and may be responsible for acupuncture's ability to relieve pain. But much is unknown about its purported mechanism of action for other conditions, such as AMD.
Still, a search of the Internet shows that there are a number of practitioners who offer it for AMD despite the fact that there is virtually no evidence supporting its use. In fact, a check of the English-language medical literature published since 1980 reveals no well-designed scientific studies supporting its use for AMD. Further, a search of the National Institutes of Health's database of more than 90,000 federally and privately supported clinical trials reveals none investigating the use of acupuncture for AMD.
If you're still tempted to try acupuncture for AMD, consider the risks. Although the procedure is generally safe, in studies where the acupuncture needle was placed directly under the globe of the eye, worsening of retinal hemorrhage and periorbital cellulitis (inflammation and infection of the eyelid and skin around the eye) have been reported.
Apheresis involves filtering a patient's blood to extract certain proteins, cells, plasma, or other compounds. Apheresis has been used for years to treat illnesses like Guillain-Barré syndrome, and some researchers believe a form of this technique known as rheopheresis might help reverse the earliest changes associated with AMD. Rheopheresis filters out vitronectin, a large protein that's suspected of playing a role in the development of the drusen that are characteristic of non-neovascular, or dry, AMD.
A few small-scale investigations of rheopheresis showed some possible benefit, which led researchers to begin a randomized, placebo-controlled, double-blind investigation called MIRA-1 (Multicenter Investigation of Rheopheresis for AMD). The results were inconclusive, and the study was consider flawed because nearly 40% of the participants didn't meet the inclusion criteria; a subsequent research effort called Rheo-AMD has been placed on hold by the sponsoring company.
In 2009, German researchers conducted a randomized, controlled trial involving 43 people with dry AMD in one eye and advanced AMD in the other. The people in the treatment group underwent 10 rheopheresis treatments in 17 weeks. The results, which were published in 2009, showed that after the series of treatments, 9 percent of the eyes in the rheopheresis group gained two or more lines on the Early Treatment of Diabetic Retinopathy Study (ETDRS) chart, compared with none in the placebo group. In addition, none of the treated patients lost visual acuity, but 24 percent of those who weren't treated lost one or more lines of vision.
Side effects associated with rheopheresis for AMD included a drop in blood pressure during treatment, nausea, pneumonia, and atrial fibrillation.
Although these results seem somewhat promising, more research, involving larger numbers of patients will need to be completed before it can be determined that rheopheresis is safe and effective for dry AMD.
Microcurrent Stimulation (MCS)
This technique applies a low-voltage dose of electricity to the area around the eyes. Some have theorized that MCS, also known as transcutaneous electrical stimulation of the macula, or TESMAC, will stimulate the flow of blood in the area and improve membrane permeability. However, there is a paucity of published peer-reviewed information about the device's effectiveness for AMD.
Although MCS devices are currently being marketed in other countries for the treatment of AMD, none have been approved by the U.S. Food and Drug Administration (FDA). What's more, the devices are expensive: Home units are advertised for $700 and up, and treatment, either at home or in an office, is not covered by health insurance. Last, but not least, potential risks associated with use of the devices include electrical burns and skin irritation.
The Bottom Line
Scientific evidence supporting the use of most alternative treatments for AMD is limited at best. If you'd like to try an alternative, your best bet is to participate in a clinical trial that is being sponsored by a reputable institution. For more information, ask your doctor or go to clinicaltrials.gov, click on Search for Clinical Trials, and type AMD in the box.