Retinitis Pigmentosa Treatment

Treatments for RP in general

Worldwide there are various treatments suggested by the medical world but none scientifically proves any solid results. The general idea amongst ophthalmologists is that there is no cure for Retinitis Pigmentosa. Proposed treatments go from a vitamin based medication to avoiding strong day light, to ozone or electro-stimulation. The truth is that some treatments do actually have certain effects. They tend to slow down the progress of the disease. But there is no real over all treatment for patients. All these treatments are a strain on the patients already hard every day life and in the end bring no solution.

Orfilio PelaezSince the early 50ies the Cuban Doctor Orfilio Pelaez Molina dedicated a life time of medical research to the disease Retinitis Pigmentosa. As a young doctor he was angered when a good friend of his was diagnosed with RP and the local doctor simply said there was nothing he could do: his friend would become gradually blind.

Together with a team of colleague doctors he started to assist RP patients in Cuba during the progress of their disease. All the existing treatments of the time were tried out. A lot of attention went to the psychological aspects of the disease for the patients and their environment. Parallel to the care for the patient, extensive scientific research was performed. All data about the patients were meticulously registered. New treatment methods were tried out on animals in laboratories. The team had a national mission with support on the highest level of the Cuban Ministry of Public Health. This made it possible to gather a high number of patients records, and to do research at the best centres in the country.

Thanks to these decades of care for the Cuban RP patients and the research performed around them Dr Pelaez team started in the 80ies their unique treatment for RP.

First of all we need to explain that the treatment of Dr Pelaez is a combination of a number of treatments. Some parts of the treatments are also recommended by many ophthalmologists world wide. The uniqueness of the treatment is that it is an integral approach of the patient. Unique is also the positive results of the treatment. Many analyses have been done during the years and all statistics point out to a halt in the progress of the visual loss during and after the treatment in a significative majority of the patients. Better results are obtained when treatment is applied in the early stages of the disease when patients are still young of age. There is also a statistically small number of patients that indicated an improvement of the visual field after the treatment.

What is the basis of the treatment? Dr Pelaez considered that the circulation of the ocular tissues through the coriocapillary layer should improve the metabolism of these tissues. On this correct concept the whole treatment is based. The idea is to revitalize the photoreceptors of the eye as far as they are still active. This way the progress of the vision loss is slowed down or stopped.
The method of Revitalization

There are several ways to obtain this revitalization and the combination of all these methods forms the succes of the treatment:

Revitalizing Surgery
The first part of the treatment consists in an operation on both eyes. The surgeons implant fat blood tissues in the upper choroid (a layer around the retina). This will improve the functioning of the photo-receptors of the retina that are still active.
This is a routine operation in the Camilo Cienfuegos Clinic. Patients feel side effects of the operation for a period of maximum 3 days.

Ozone Therapy
The intensity and quantity of ozone administrations is strictly regulated and based on the analysis of each patients physical condition in general and on his or her visual capacities in particular. It is administered either by rectal medication (suppositories) or by injecting it in the veins. An ozone treatment takes around 15 days and needs to be repeated annually once or twice.

Electro-stimulation
To stimulate the electro-ionic balance of the blood circulation in the eye. At the end of the patients stay the doctor explains how to continue with this treatment at home.

Medication
To stimulate the other treatments and to counter certain negative effects of them. Medication is sold in the pharmacy of the C. Cienfuegos Centre.

Other
The best an RP patient can do is live healthy. Don’t smoke as this has negative effects on the blood veins. Perform some phyiscal activity like sports or recreational activities. Eat fruits, vegetables and avoid fat. And also try to protect your eyes against heavy sunlight buy wearing sun glasses.

The Cuban Ministry of Health, Dorsemo SA de CV and Erkamed.

Lasik

Why Choose Marmer Medical Eye Center?
Robert H. Marmer, M.D. has the longest experience performing refractive surgery in the state of Georgia by introducing the first refractive surgical procedure in 1979.
We can serve as your resource for information on LASIK and related procedures. Please call today for your evaluation. Remember, our excellence is from experience

Are You A Candidate for LASIK?

The ideal candidate for LASIK is over 18 years old with normal health and a prescription that has not increased significantly in the last 12 months. People with certain medical conditions or women who are pregnant may not be good candidates for LASIK.

What kind of results can I expect?

Depending on your prescription and how quickly you heal, you may experience the results of LASIK immediately. Most MMEC patients are capable of reading the clock in the laser room moments after their procedure, and usually demonstrate legal driving vision the next day. You can expect your vision to continue to improve over the next few days or weeks, as Dr. Marmer monitors your progress at your regularly scheduled appointments.
For most patients, laser vision correction permanently reshapes the cornea, resulting in excellent vision even many years later. A small percentage of patients treated have required a repeat treatment, or “LASIK enhancement”.

What does the cost of the procedure include?

Your fee covers your LASIK consultation, the pre-operative evaluation, your surgery, all facility fees, medications and a full year of post-operative care. The fee also includes the Lifetime Assurance Plan, which provides LASIK enhancements, if needed, at no additional fee from Dr. Marmer.
Following surgery, Dr. Marmer will closely monitor your progress for a full year. After your year of free follow-up care, you need to be seen on an annual basis in order to maintain eligibility for the Lifetime Assurance Plan.
Is LASIK covered by my insurance plan?

Insurance rarely covers elective procedures like LASIK.

Are there any ways to make LASIK more affordable?

Marmer Medical Eye Center can assist you in obtaining financing through one of several sources, with low monthly payments.
If you have a Medical Flex-Spending Account through your employer, you can use pre-tax earnings to reduce your effective cost by hundred of dollars.
Of course, you also have the option of extending your payment period by using most major credit cards.

Will the procedure hurt?

Anesthetic drops prior to surgery help to numb the surface of the eye, minimizing the chances of discomfort during the procedure. You may experience a dry, scratchy sensation immediately after surgery, but most patients are quite comfortable after taking a short nap. Any mild discomfort after surgery should respond well to the eye lubricant drops provided in your free post-op kit.

Are there any risks?

Yes, but less than 1% of LASIK patients develop complications that can reduce the quality of their corrected vision. Dr. Marmer will attempt to minimize the risk of problems by carefully evaluating your overall eye health and candidacy for LASIK. The appropriate risks, benefits and expectations specific to your case will be addressed at your pre-operative exam and again before you go into surgery.

Does Marmer Medical Eye Center stand behind my results?

Absolutely! MMEC stands behind the results of LASIK Surgery. While we cannot guarantee that you will have perfect distance vision for a lifetime, our Lifetime Assurance Plan is designed to help you maintain excellent vision forever. Most nearsighted patients qualify for the plan, provided they have no significant health problem and are not outside the acceptable prescription range. It is possible that LASIK enhancement may not be the best option. This will be determined after careful evaluation.

What will my recovery be like?

Most LASIK patients are very excited about the quality of their vision the day after their procedure, typically arriving for their one-day visit with legal driving visions! While most patients notice dramatic visual results within the first few days following their procedure, the speed of visual recovery depends on personal healing patterns and the amount of treatment provided. Patients with extremely high prescriptions, for instance, often recover more slowly, but tend to be some of our happiest patients.

How do I get to the Laser Eye Center for the LASIK procedure?

Dr. Marmer performs all LASIK procedures at the TLC Atlanta Laser Eye Center. It is loccated at 4505 Ashford-Dunwoody Rd. NE, Atlanta, GA 30346. Click here for detailed directions.

Hemianopic Patients

Visual rehabilitation therapy widens horizons for patients with visual field loss, proponents say.

How it Works

Launched in the United States in 2003 by NovaVision, VRT is a home-based treatment program designed to expand the visual field of hemianopic patients by stimulating the border zone between the blind and seeing fields, facilitating neuroplasticity. Patients work on a leased VRT device twice each day for approximately 30 minutes per session, 6 days a week. The VRT requires them to fixate their vision on a central point while it stimulates the brain’s visual repair mechanisms, according to the manufacturer. The course of treatment lasts 6 months. The therapy is regularly monitored by the physician, who may recommend further treatment is he or she deems it appropriate.

Dr. Marmer warns that little improvement typically occurs during the first month, so the physician should make an effort to keep patients motivated.

Recent data presented at the American Academy of Neurology 61st Annual Meeting showed functional improvement in reading and trail-making for 39 patients with a homonymous visual field defect who had performed at least 6 months of VRT. Reading speed improved by 21.6% and stimulus detection during visual field testing increased by 10.4%.

NovaVision’s Vision Rehabilitation Therapy. For more information, go to the company’s Web site at www.novavision.com.

A functional magnetic resonance imaging study performed by researchers at Columbia University Medical Center on six chronic right hemianopic patients shows that by performing VRT the patients had an increase in brain activity.2

Patients recover an average of 5% of visual field, reports NovaVision.
Real Life Results

The regimen of “visual workouts” pays off, according to Dr. Marmer, increasing patients’ ability to function in everyday life. They are able to avoid collisions with objects in their environments and read more easily and more quickly.

“We take for granted that you read from left to right, then go back to the left of the next line and start again,” explains Dr. Marmer. But patients with a field defect, particularly on the left, can’t find the beginning of the next line. “So VRT not only helps patients get around without bumping into things, it helps them with reading and anything that requires better visual function,” Dr. Marmer says. “It’s a significant tool to be able to have in your treatment ability, when I couldn’t offer them anything before.”

One of the most exciting things about VRT, Dr. Marmer says, is that the success of the therapy is not time-sensitive relative to the date of injury. “If you had your stroke 3 years ago, or 10 years ago, it’s not too late. Both types of patients seem to get a similar ability to improve,” he says.
Raising Questions

VRT has only recently been launched in ophthalmology, however, and some are skeptical about how much it can do for patients who have lost visual field. Victoria Pelak, M.D., associate professor of Neurology and Ophthalmology at the University of Colorado Denver School of Medicine, does not prescribe the therapy to her patients, though she did examine one patient who had undergone it prior to coming to her. Dr. Pelak reports that the patient believed the therapy had been helpful. Still, she wonders if the benefit might come from a practice effect.

Patients “may show improvement because they have had persistent practice with that manner of testing,” Dr. Pelak explains. “There are eye movements that patients can make that allow them to see areas that they weren’t able initially to see in.”

Eli Peli, M.Sc., O.D., a senior scientist at Schepens Eye Research Institute, professor of ophthalmology at Harvard Medical School, and developer of peripheral prism eyeglasses for hemianopic patients, also has reservations. “Patients get 5 degrees [of visual field expansion] on average, and those with more visual field loss get less, or the patients that have less loss get more,” says Dr. Peli, who has not used VRT. Unfortunately, that means those patients most in need of help will fare worse than milder cases. He also expresses the opinion that 5 degrees of visual field gain “isn’t much — about four fingers at arm’s length.”
Answering the Skeptics

After seeing VRT improve the lives of about a half dozen patients who have undergone the therapy, however, Dr. Marmer disagrees with critics. His career-long interest in retinitis pigmentosa helped him to understand how even a small improvement in visual field could improve a patient’s visual function.

“For someone who has a full visual field, it’s hard to believe that just a tiny bit of improvement is going to make that much more difference,” he says. “Just 5 degrees of improvement is a minimal amount in the overall picture. But for these people, it really is huge. It is a major change in their ability to function. And these patients are generally elderly, so any small improvement is a great help to them.” Even that 5 degrees, Dr. Marmer says, can give patients enough function that they don’t need someone to assist them all the time.

As for the “practice effect” theory, Dr. Marmer points out the NovaVision was able to document increased cortical activity with functional MRI scans.

Yet he says VRT does have its limitations in that visual field improvement cannot be pushed beyond a certain threshold. “Suppose the patient has worked 30 minutes a session, twice a day for 6 days and now have 5 degrees more visual field. Now there’s a whole new border zone, as they call it, between the blind field and the seeing field. Could we refocus our stimulation to that spot and work for another 30 minutes, twice a day, 6 days a week, for another 6 months and get an additional 5 degrees — and keep doing this until you get back your full visual field again? I wish we could do that, but there is eventually a limitation that the brain can’t recover from.”
Patient Selection Tips

Dr. Marmer also cautions that certain patients are not good candidates for VRT. Patients need at least 20/200 vision to participate, as well as mental alertness and the ability to focus for approximately 30 minutes per session.

Additionally, “If they can’t fixate their vision at the very central point, if they have abnormal or uncontrollable eye movement that doesn’t permit them to fixate on one fine point of light, for example, then the treatment may not be successful because they cannot allow the stimulation to the areas that are necessary,” says Dr. Marmer.

A form of epilepsy that is triggered by flashing lights is also a contraindication.

But while there are subsets of visual field loss patients whom VRT cannot help, Dr. Marmer points out that there are many more for whom the therapy is valuable. “It’s a significant tool to have in my treatment arsenal. Before, I couldn’t offer them anything.” OM
Reference

1. Schlueter D, Schulz P, Kenkel S., Romano JG. Functional Improvement after a Visual Rehabilitation Intervention for Patients with Homonymous Visual Field Defects. Presented at: American Academy of Neurology 61st Annual Meeting, Seattle, Apr. 28, 2009.
2. Marshall RS, Ferrera JJ, Barnes A, Zang X, O’Brien KA, Chmayssani M, Hirsch J, Lazar RM. Brain Activity Associated With Stimulation Therapy Of The Visual Border Zone In Hemianopic Stroke Patients. Neuro Rehabilitation Neural Repair. 2008 2, Epub 2007 Aug 14.