Complementary and alternative medicine mentions and recommendations in glaucoma guidelines: Systematic review and quality assessment

Introduction: Glaucoma is one of the leading causes of irreversible vision loss and blindness. The global prevalence of glaucoma is 3.54% of the population aged 40-80 years old. Glaucoma and its associated symptoms are often self-medicated using CAM therapies. This study aims to determine the quantity and quality of CAM recommendations within clinical practice guidelines (CPGs) for the treatment and/or management of glaucoma. Methods: MEDLINE, EMBASE and CINAHL were systematically searched from 2009 to April 2020, alongside the Guidelines International Network and the National Center for Complementary and Integrative Health websites. Eligible CPGs containing CAM therapy recommendations were assessed using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Results: From 148 unique search results, 7 eligible CPGs were identified, however, only 1 CPG contained CAM recommendations. This eligible CPG scored high in the scope and purpose, editorial independence, and clarity of presentation domains for both the overall CPG and CAM sections. CAM therapies recommended for use included Dan Zhi Xiaoyaosan; Taohong Siwu decoction and Wuling powder; Wendan Tang; Lycii and Chrysanthemi and Rehmanniae bolus; gingko leaf tablets; Erigeron breviscapus tablets; Wuling capsule; fuming tablets; Mingmu Dihuang Wan; and acupuncture. Conclusion: This review highlights the general lack of CAM recommendations across glaucoma CPGs; this hinders the ability of clinicians to have meaningful discussions surrounding shared-decision making with their patients. Despite the high prevalence of CAM use in glaucoma patients, extremely limited evidence-based CPGs with CAM therapy recommendations are available to guide their safe and effective use.