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“History teaches us that men and nations behave wisely once they have exhausted all the other alternatives.”Abba Eban, 1915–
As ophthalmologists we tend to stick to what we know. We mostly use only four main groups of drugs that act on the eye—anti-infectives, anti-inflammatories, antiglaucoma medications, and lubricants—a limited formulary, but one that is evidence based according to our medical training. But there are alternative therapies which are becoming a growing part of our health care and for which eye conditions present an ideal substrate. In the United States alone an estimated $14 billion a year is spent on alternative treatments and 37 medical schools are starting to devote a small part of their training to this subject.1 Medline lists 24 main headings under “Alternative medicine” and indexes a number of relevant journals including ones on acupuncture, biofeedback, Chinese medicine, manipulative and physiological therapeutics, and natural products.
In his Foundations of Ophthalmology (Vol VII, 1962) Duke-Elder covers a great deal more than pharmacology in his “Ocular therapeutics” section.2 He describes some unconventional biological and physical treatments which may have had their day but which do not seem so incongruous when compared with the vast array of alternative treatments revealed by searching the world wide web today.
In their time many of these treatments represented attempts to treat the untreatable. They demonstrated an inventive ingenuity influenced by the scientific knowledge of the day and were applied with great enthusiasm to unsuspecting patients. Some techniques that have been used include protein shock (milk, serum, or vaccine), biogenic stimulation with tissue such as placenta, injected subconjunctivally for a host of incurable eye conditions, and the injection of cobra venom for macular degeneration. Physical treatments that have been dreamt up over the years include environmental therapy (for the affluent sick), ocular …