Ergebnisse eines systematischen Reviews zu Einsatz und berichtetem therapeutischem Nutzen komplementärmedizinischer Methoden in der Augenheilkunde

Zusammenfassung

Fragestellung Für die Indikationen Glaukom, Katarakt und altersabhängige Makuladegeneration (AMD) wurde eine systematische Literaturrecherche des Zeitraums 1990 bis 2013 erstellt zu Anwendungen und therapeutischen Ergebnissen komplementärmedizinischer Verfahren als Addenda zu bestehenden augenheilkundlichen Versorgungsstrategien resp. als eigenständige Therapieansätze.

Material und Methoden Für den Zeitraum 1990 bis 2013 wurde entlang der Datenbanken PubMed, Cochrane Library, EMBASE, CAMbase und AMED eine systematische Recherche zum Einsatz komplementärmedizinischer Methoden vorgenommen. Es wurden randomisierte wie auch nicht randomisierte prospektive Patientenstudien einbezogen und klassiert in die Segmente „Phytotherapie“, „Akupunktur/Akupressur“, „Biofeedback“ sowie „weitere alternative Heilverfahren“. Die Studien wurden charakterisiert bez. der darin berichteten klinischen Effektmaße resp. der zugehörigen statistischen Signifikanzmaße (p-Werte und/oder Konfidenzintervalle), ferner bez. des implementierten Designs.

Ergebnisse 30 Studienberichte konnten in den Review aufgenommen werden, davon 13 Studien an Glaukom-, 5 an Katarakt- und 12 an AMD-Patienten. Diese Studienberichte basierten auf Gesamtfallzahlen von 6 – 332, 27 – 157 resp. 6 – 328 Patienten. Phytotherapeutische Verfahren wurden in 14 Studien beleuchtet, darunter 6 an Glaukompatienten (alle 6 kontrolliert, darunter 3 mit statistisch signifikantem Mehrnutzen des komplementärmedizinischen Verfahrens), ferner 5 an Kataraktpatienten (3 davon kontrolliert, darunter 2 mit signifikantem Mehrnutzen) sowie 3 an AMD-Patienten (nur 1 davon kontrolliert, diese mit signifikantem Mehrnutzen). Akupunktur/Akupressur wurde in 9 Studien beleuchtet, darunter 5 an Glaukompatienten (3 davon kontrolliert und darunter 1 mit signifikantem Mehrnutzen), in keiner Studie an Kataraktpatienten, jedoch in 4 Studien an AMD-Patienten (keine davon im kontrollierten Design). Biofeedback wurde in 4 Studien an AMD-Patienten untersucht, davon nur 1 kontrolliert und ohne statistische Signifikanz.

Schlussfolgerung Es zeigte sich trotz rigoroser Einschlusskriterien in den Review eine beachtliche Anzahl publizierter Patientenstudien zur Anwendung komplementärmedizinischer Methoden in der Augenheilkunde. Phytotherapeutische Methoden zeigten sich in der Hälfte der kontrollierten Studien als statistisch signifikant wirksam; die Anwendung von Akupunktur/Akupressur konnte für keine der betrachteten Indikationen in den sondierten Studien als mehrheitlich signifikant wirksam belegt werden.

Abstract

Purpose A systematic review was carried out of the reported therapeutic effects of complementary and alternative medicine methods as supplementary or primary treatments for patients suffering from glaucoma, cataract or age-related macular degeneration (AMD).

Material and Methods For the years 1990 to 2013, the following databases were screened for reports of the application of complementary and alternative treatments: PubMed, Cochrane Library, EMBASE, CAMbase and AMED. Both randomised and prospective non-randomised patient trials were included in the review; results were evaluated in the following classes: “phytotherapy”, “acupuncture/acupressure”, “biofeedback” and “other alternative treatments”. The studies were evaluated by measures of clinical effect, statistical significance (p value and/or confidence interval) and the underlying trial design.

Results 30 clinical trials were included, including 13 on glaucoma, 5 on cataract and 12 on AMD patients. These trials were based on patient numbers of 6 – 332, 27 – 157 and 6 – 328 patients, respectively. Phytotherapy was applied in 14 trials, including 6 on glaucoma patients (all 6 with a controlled design, and 3 of which reporting statistically significant results); 5 trials were on cataract patients (3 with a controlled design and 2 with a significant result) and 3 on AMD patients (only 1 with a controlled design, with a significant result). Acupuncture/acupressure was investigated in 9 trials, 5 on glaucoma patients (3 with a controlled design, 1 with a significant result); no acupuncture/acupressure trial was found in cataract patients, but 4 trials in AMD patients (none with a controlled design). Biofeedback was studied in 4 trials, all on AMD patients (only one with a controlled design, without statistically significant findings).

Conclusion Despite its rigorous inclusion criteria, this review identified several clinical trials on complementary and alternative medicine in ophthalmological patients. Phytotherapeutic methods gave significant results in half of the reported controlled trials, whereas there were few significant benefits with acupuncture or acupressure.

Schlüsselwörter

Glaukom - Katarakt - altersabhängige Makuladegeneration - systematischer Review - Komplementärmedizin - Retina

Key words

glaucoma - cataract - macular degeneration - systematic review - complementary medicine - retina

• Literatur

• 1 World Health Organization. WHO Traditional Medicine Strategy: 2014 – 2023. Hong Kong: WHO Library Cataloguing-in-Publication Data; 2013. Im Internet: http://www.who.int/medicines/publications/traditional/trm_strategy14_23/en/ Stand: 10.09. 2014
• 2 Bromfield SG, McGwin G. Use of complementary and alternative medicine for eye-related diseases and conditions. Curr Eye Res 2013; 38: 1283-1287
• 3 Agarwal R, Gupta SK, Srivastava S. et al. Intraocular pressure-lowering activity of topical application of Aegle marmelos fruit extract in experimental animal models. Ophthalmic Res 2009; 42: 112-116
• 4 Bucheli P, Vidal K, Shen L. et al. Goji berry effects on macular characteristics and plasma antioxidant levels. Optom Vis Sci 2011; 88: 257-262
• 5 Baars EW, Kooreman P. A 6-year comparative economic evaluation of healthcare costs and mortality rates of Dutch patients from conventional and CAM GPs. BMJ Open 2014; 4: e005332
• 6 Steinbrook R. The price of sight–ranibizumab, bevacizumab, and the treatment of macular degeneration. N Engl J Med 2006; 355: 1409-1412
• 7 National Center for Complementary and Alternative Medicine. Complementary, Alternative, or Integrative Health: Whatʼs In a Name?. 2013 Im Internet: http://nccam.nih.gov/health/whatiscam Stand: 14.02.2014
• 8 Frank DL, Khorshid L, Kiffer JF. et al. Biofeedback in medicine: who, when, why and how?. Ment Health Fam Med 2010; 7: 85-91
• 9 Tomida I, Azuara-Blanco A, House H. et al. Effect of sublingual application of cannabinoids on intraocular pressure: a pilot study. J Glaucoma 2006; 15: 349-353
• 10 Park JW, Kwon HJ, Chung WS. et al. Short-term effects of Ginkgo biloba extract on peripapillary retinal blood flow in normal tension glaucoma. Korean J Ophthalmol 2011; 25: 323-328
• 11 Ye CH, Jiang YQ. Neuroprotective effect of Erigeron Breviscapus (Vant) Hand-Mazz for patients with glaucoma. Asian J Ophthalmol 2003; 5: 8-12
• 12 Takayama S, Seki T, Nakazawa T. et al. Short-term effects of acupuncture on open-angle glaucoma in retrobulbar circulation: additional therapy to standard medication. Evid Based Complement Alternat Med 2011; 2011: 1-6
• 13 Ikeda N, Hayasaka S, Nagaki Y. et al. Effects of kakkon-to and sairei-to on aqueous flare elevation after complicated cataract surgery. Am J Chin Med 2002; 30: 347-353
• 14 Ikeda N, Hayasaka S, Nagaki Y. et al. Effects of traditional Sino-Japanese herbal medicines on aqueous flare elevation after small-incision cataract surgery. J Ocul Pharmacol Ther 2001; 17: 59-65
• 15 Falsini B, Piccardi M, Minnella A. et al. Influence of saffron supplementation on retinal flicker sensitivity in early age-related macular degeneration. Invest Ophthalmol Vis Sci 2010; 51: 6118-6124
• 16 Barnes PM, Powell-Griner E, McFann K. et al. Complementary and alternative Medicine Use among Adults: United States, 2002. Seminars in Integrative Medicine: Elsevier; 2004: 54-71
• 17 Büssing A, Ostermann T, Heusser P. et al. Usage of alternative medical systems, acupuncture, homeopathy and anthroposophic medicine, by older German adults. Zhong Xi Yi Jie He Xue Bao 2011; 9: 847-856
• 18 Law SK, Li T. Acupuncture for glaucoma. Cochrane Database Syst Rev 2013; (05) CD006030
• 19 Rom E. Sensory stimulation for lowering intraocular pressure, improving blood flow to the optic nerve and neuroprotection in primary open-angle glaucoma. Acupunct Med 2013; 31: 416-421
• 20 Rhee DJ, Katz LJ, Spaeth GL. et al. Complementary and alternative medicine for glaucoma. Surv Ophthalmol 2001; 46: 43-55
• 21 Evans JR. Ginkgo biloba extract for age-related macular degeneration. Cochrane Database Syst Rev 2000; (03) CD001775
• 22 Evans JR. Ginkgo biloba extract for age-related macular degeneration. Cochrane Database Syst Rev 2013; (01) CD001775
• 23 Christen WG, Glynn RJ, Hennekens CH. Antioxidants and age-related eye disease. Current and future perspectives. Ann Epidemiol 1996; 6: 60-66
• 24 Age-Related Eye Disease Study Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthal 2001; 119: 1417-1436
• 25 Shim SH, Kim JM, Choi CY. et al. Ginkgo biloba extract and bilberry anthocyanins improve visual function in patients with normal tension glaucoma. J Med Food 2012; 15: 818-823
• 26 Zhong Y, Xiang M, Ye W. et al. Visual field protective effect of Erigeron breviscapus (vant.) Hand. Mazz. extract on glaucoma with controlled intraocular pressure: a randomized, double-blind, clinical trial. Drugs R D 2010; 10: 75-82
• 27 Quaranta L, Bettelli S, Uva MG. et al. Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma. Ophthalmology 2003; 110: 359-362
• 28 Her JS, Liu PL, Cheng NC. et al. Intraocular pressure-lowering effect of auricular acupressure in patients with glaucoma: a prospective, single-blinded, randomized controlled trial. J Altern Complement Med 2010; 16: 1177-1184
• 29 Kurusu M, Watanabe K, Nakazawa T. et al. Acupuncture for patients with glaucoma. Explore (NY) 2005; 1: 372-376
• 30 Yang H. Dan zhi xiao yao yin combined with auricular-point-pressing for treatment of optic atrophy – a clinical observation of 51 cases. J Tradit Chin Med 2004; 24: 259-262
• 31 Uhrig S, Hummelsberger J, Brinkhaus B. Acupuncture in treatment of glaucoma and ocular hypertension – basic principles of cm and results of a prospective observational study. Forsch Komplementärmed Klass Naturheilkd 2003; 10: 256
• 32 Kaluza G, Strempel I. Training in relaxation and visual imagery with patients who have open-angle glaucoma. Int J Rehabil Health 1995; 1: 261-273
• 33 Kaluza G, Strempel I, Maurer H. Stress reactivity of intraocular pressure after relaxation training in open-angle glaucoma patients. J Behav Med 1996; 19: 587-598
• 34 Woo GC, Halpern GM, Kwong EYM. Effect of TCM-derived extracts on cataract development in the elderly: a pilot study. Prog Nutr 2009; 11: 12-17
• 35 Biswas NR, Beri S, Das GK. et al. Comparative double blind multicentric randomised placebo controlled clinical trial of a herbal preparation of eye drops in some ocular ailments. J Indian Med Assoc 1996; 94: 101-102
• 36 Biswas NR, Gupta SK, Das GK. et al. Evaluation of Ophthacare eye drops – a herbal formulation in the management of various ophthalmic disorders. Phytother Res 2001; 15: 618-620
• 37 Piccardi M, Marangoni D, Minnella AM. et al. A longitudinal follow-up study of saffron supplementation in early age-related macular degeneration: sustained benefits to central retinal function. Evid Based Complement Alternat Med 2012; 2012: 429124
• 38 Fies P, Dienel A. [Ginkgo extract in impaired vision–treatment with special extract EGb 761 of impaired vision due to dry senile macular degeneration]. Wien Med Wochenschr 2002; 152: 423-426
• 39 Krenn H. Acupuncture may improve vision in patients with age-related macular degeneration (AMD): An observational study. Dt Ztschr F Akup 2008; 51: 25-28
• 40 Schürich BM, Gresly D. Augenakupunktur mit Laserneedles. – Die Behandlung der senilen Makuladegeneration. Schweiz Z Ganzheitsmed 2005; 17: 270-271
• 41 Lundgren AC. Medical acupuncture for age-related macular degeneration: a preliminary report. Med Acupunct 2003; 14: 37-39
• 42 Lundgren AC. An acupuncture protocol for treatment of age-related macular degeneration: a second report. Med Acupunct 2005; 16: 33-35
• 43 Vingolo EM, Salvatore S, Limoli PG. MP-1 biofeedback: luminous pattern stimulus versus acoustic biofeedback in age related macular degeneration (AMD). Appl Psychophysiol Biofeedback 2013; 38: 11-16
• 44 Tarita-Nistor L, Gonzalez EG, Markowitz SN. et al. Plasticity of fixation in patients with central vision loss. Vis Neurosci 2009; 26: 487-494
• 45 Vingolo EM, Cavarretta S, Domanico D. et al. Microperimetric biofeedback in AMD patients. Appl Psychophysiol Biofeedback 2007; 32: 185-189
• 46 Giorgi D, Contestabile MT, Pacella E. et al. An instrument for biofeedback applied to vision. Appl Psychophysiol Biofeedback 2005; 30: 389-395
• 47 Beeke E, Kreutzer FJ. Intravenöse Sauerstofftherapie bei trockener altersbedingter Makuladegeneration. Erfahrungsheilkunde 2007; 56: 740-744