What’s up, doc? Can a dietary supplement reverse patient cataracts?

Roughly 58% of the U.S. adult population (ages 20 and older) reported having used a dietary supplement in the past month, according to recent data by the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey. With heavy marketing, bold claims and peer recommendations from friends and family, it’s no wonder why supplements have become a popular alternative to more formal treatments among patients.

The question for doctors of optometry: Should supplements be used as an alternative therapy to reverse cataracts in patients? 

A new case study from the AOA Ethics and Values Committee, titled “This Supplement Can Reverse My Cataracts, Doc!” addresses if and how over-the-counter medications, vitamins and minerals and herbal supplements work in the overall treatment of cataracts and other conditions.

The case study looked at the example of a 78-year-old female who did not qualify for a driver’s license in her state due to her vision level in part due to cataracts. A neighbor told her about a supplement that helped her 85-year-old brother “get 20/20 vision back.” As a result, she declined cataract surgery and asked her doctor of optometry to use a dietary supplement to combat her cataracts instead.

How should her doctor of optometry, and others in similar situations, navigate treatment options for other patients requesting alternative therapies? 

Satya Verma, O.D., co-author of the case study, states "As health care providers, we have an ethical responsibility to give the best advice to our patients that is based on scientifically proven treatment modalities and not be swayed by sales pitches that focus more on profits." Dr. Verma continues, “If we dispense dietary supplements or other nutraceutical products in our practice, we must make sure that the product has been proven to be effective for the condition being dispensed and is not based on sales pitches and advertisements alone.”

As the paraoptometric and doctor of optometry are compiling a complete medication list during the patient’s appointment, they should determine what prescription medications the patient has been prescribed, as well as what over-the-counter medications, vitamins and minerals, and herbal supplements the patient may be taking. Shared decision-making, especially with supplements related to eye health conditions, is important in determining the best treatment plan available. 

“When discussing treatment options with a patient who has suggested using a certain dietary supplement, we as providers need to listen to the patient to hear why they think such a treatment might be helpful. Then it's up to us to use our training, experience and use of accepted standards of care to counsel the patient to options and what might be the recommended course of care,” shares Douglas Totten, O.D., co-author of this case study. “My experience is that the majority of patients seek our care, as they truly want our guidance and recommendations to the best course of care for their eye health. One of the joys of practice to me is to develop a specific plan of treatment for that unique patient.”

In the case of the 78-year-old female example, the doctor of optometry did, in fact, openly discuss the potential use of a dietary supplement as an alternative treatment in this case. The doctor of optometry found that the most prudent course of action would be to state that surgery would likely be the best course of treatment. Or, if the patient declines the surgery option at this time, they should be informed that vision will likely continue to worsen and the cataracts will advance until surgery happens. The patient would need to accept the compromise of not qualifying for the vision requirement to drive and knowing that general safety is reduced having blurred vision.

If an herbal supplement or alternative treatment appears safe and might have some efficacy for the desired result, a possible compromise may be reached to try the supplement for a period of time with follow up to evaluate the status of the cataracts and then to move forward with a possible surgical referral if the vision is not improving. This would be an example of shared decision-making.

Dr. Verma concludes: "Education is the most important tool to serve our patients and a well-informed patient gets the best care."

Have questions on an ethical debate?

The AOA Ethics and Values Committee routinely produces hypothetical case studies concerning ethical challenges and how best to approach such situations based on the AOA Standards of Professional Conduct, AOA Code of Ethics and the Optometric Oath. Members may access these ethical case studies through the AOA’s centralized education portal, EyeLearn Professional Development Hub.

Have an ethical challenge or question you wish to share? Submit your idea or a case description to legal@aoa.org. The case description may be reviewed by the AOA Ethics and Values Committee and featured in future Ethics Forum discussions.