FEDOROV RESTORATION THERAPY

 

INTRODUCTION:

Fedorov Restoration Therapy claims to be a non-invasive and non-surgical way to naturally restore or improve vision, with stable outcomes and without risks of side effects.

https://www.restorevisionclinic.com/

These positive outcomes are accomplished through the application of weak electrical current pulses which stimulate partially-damaged retinal cells and improve the conductivity of signals to the brain. The therapy cannot replace damaged cells or regenerate optic nerves; instead, it increases the functionality of preserved cells on the retina and enhances the activity along optic nerves.

In addition, electrical stimulation therapy influences brain electrophysiology on a network level. This, in turn, affects the sensitization of deafferented regions or the synchronization (entrainment) of neuronal network firing with long-lasting (plasticity) changes.

The application of electrical stimulation therapy (repetitive transorbital alternating current stimulation) is based on the potential of the vision system to adapt to functional and structural changes that can be induced by external influence. For example, by using electrical current impulses. Clinical experience has shown that, if such activation is performed for several weeks, it can cause significant changes (induced plasticity of visual system) in the functional state (activation) of the entire brain-vision system.

Results can be achieved through therapeutic electrical stimulation that activates the retinal ganglion cells, improves the signal conductivity through visual pathways (including the optic nerve), and embodies the visual cortex reserves, resulting in an optimal, functional state of the whole brain and improving the vision system. Treatment by properly adjusted impulses (electric current therapy) focuses on non-invasive electrical activation of retinal neurons using impulses with different shapes and ranges through electrodes located around the eyes (periorbitally).

External electrical signals applied to the retina can cause functional activity in the visual cortex (prestriate area) located deep in the brain.

In a study published in the journal Brain Stimulation, 446 patients with optic nerve lesions received repetitive transorbital alternating current stimulation (rtACS). Current bursts (<1000 μA, 5-20 Hz) were applied to induce phosphenes for one or two 10-day stimulation periods. Efficacy was assessed by monocular measurements of visual acuity and visual field (VF) size. EEG recordings at rest (n = 68) were made before and after treatment and global power spectra changes were analyzed.

The study reported that rtACS improved VF size in the right and left eye by 7.1% and 9.3% (p < 0.001), respectively. VF enlargements were present in 40.4% of right and 49.5% of left eyes. Visual acuity (VA) significantly increased in both eyes (right = 0.02, left = 0.015; p < 0.001). A second 10-day course was conducted 6 months in a subset of 62 patients and resulted in additional significant improvements of VA.

REFERENCE: Fedorov A, Jobke S, Bersnev V, Chibisova A, Chibisova Y, Gall C, Sabel BA. Restoration of vision after optic nerve lesions with noninvasive transorbital alternating current stimulation: a clinical observational study. Brain Stimul. 2011 Oct;4(4):189-201. doi: 10.1016/j.brs.2011.07.007. Epub 2011 Oct 6. PMID: 21981854.

WHEN IS TREATMENT RECOMMENDED?:

Indications for treatment include different forms of vision deterioration marked by a decrease in visual ability, different types of visual field defects, or a combination of the two. We consider each case individually and can discuss with you after reviewing your medical records whether treatment is recommended. The following diseases and consequences respond positively to treatment:

OPTIC NERVE DAMAGE:

• Glaucoma (glaucomatous optic neuropathy)
• Ischemic lesion (anterior arterial and non-arterial ischemic neuropathy)
• Central retinal artery /vien occlusion
• Traumatic injuries (traumatic optic nerve atrophy or traumatic optic neuropathy)
• Brain tumor or non-tumor mass (post-tumor optic neuropathy)
• Hydrocephalus, including Idiopathic Intracranial Hypertension (IIH)
• Neuromyelitis Optica and Neuromyelitis Optica Spectrum Disorders (NMOSD)
• Optic neuritis by Multiple Sclerosis
• Leber Hereditary Optic Neuropathy (LHON)
• Toxic damages of the optic nerve (due to different medicine or methanol poising)
• Congenital optic nerve atrophy including Optic Nerve Hypoplasia (ONH)
• Optic disc drusen (ODD) or optic nerve head drusen (ONHD)
• Radiation neuropathy

DISEASES OF THE RETINA:

• Retinitis pigmentosa
• Stargardt’s macular degeneration
• Other form of rode-cone retinal dystrophies
• Dry type of Age related Macular Degeneration
• Dystrophic chorioretinitis (for myopia)
• Angiopathy, or the initial stage of retinopathy in diabetes

MONO- OR BI-LATERAL AMBLYOPIA

HEMIANOPIA FOLLOWING STROKE, TRAUMA OR BRAIN TUMOR:

• Ischemic stroke
• Cerebral hemorrhage
• Traumatic injuries
• Tumors
• Inflammatory processes

 CONTRA-INDICATIONS:

Fedorov Restoration Therapy is not recommended for vision loss caused by:

• Cataract or pathology of cornea
• Age-related diminished ability to focus on near objects (presbyopia)
• Astigmatism or hyperopia
• Visual impairments caused by retinal bleedings or detachment
• Vision deterioration due to diabetic retinopathy
• Blindness or light perception

REPRODUCTIVE FACTORS AND THE RISK OF OPEN ANGLE GLAUCOMA (OAG) IN WOMEN

 

Reproductive factors have been found to be important risk factors associated with a wide range of chronic diseases such as diabetes and cardiovascular diseases. The reproductive factors such as age at menarche and menopause are all indicators of exposure to endogenous female hormones. There is increasing evidence of the correlation between reproductive factors and OAG.

A meta-analysis to determine the association between reproductive factors including age at menarche, age at menopause, reproductive period, parity, and the risk of OAG in women was performed by Kai and colleagues.

https://journals.lww.com/glaucomajournal/fulltext/2023/11000/reproductive_factors_and_the_risk_of_open_angle.7.aspx

The ages for menarche and menopause were defined as the ages when menstruation started and ended, and the reproductive period was taken as the time from menarche to menopause. Meanwhile, parity was defined as the number of deliveries.

Seven articles, which included 18,618 women, were analyzed in this review.

The pooled results indicated that late age at menarche (≥13 y) was significantly associated with an increased risk of OAG (OR=1.76, 95% CI: 1.28, 2.43).

Early menopause (<45 y) also significantly elevated the risk of OAG (OR=1.89, 95% CI: 1.23, 2.90) in categorical meta-analyses, consistent with the inverse linear relationship between menopausal age and the risk of OAG in dose-response analyses (P=0.002). However, the association turned insignificant among women who experienced menopause between the age of 45 and 49 years (OR=1.13, 95% CI: 0.76, 1.68). Neither long nor short reproductive period was associated with the risk of OAG (<30 vs. ≥35 y: OR=1.53, 95% CI: 0.65, 3.61; 30–34 vs. ≥35 y: OR=1.67, 95% CI: 0.75, 3.70).

In addition, women who had delivered at least 5 children were at significantly higher risk of OAG compared with those who were nulliparous (OR=2.35, 95% CI: 1.02, 5.39), and a J-shape relationship between parity and OAG was observed in dose-response analyses (P<0.001).

The study concluded that late menarche (≥13 y), early menopause (<45 y), and a history of 5 or more parturitions are possible risk factors for OAG. Longitudinal studies are warranted to further examine the relationships between reproductive factors and the risk of OAG.

Lifetime exposure to endogenous estrogen mainly occurs in the reproductive period between menarche and menopause, and thus some speculative theories have centered on estrogen to explain the associations of menarche and menopause with OAG. Estrogen has been proposed to increase the level of nitric oxide and subsequently reduce vascular resistance, which seemed to play a role in the pathogenesis of glaucoma. The estrogen metabolism single-nucleotide polymorphism pathway was previously found to be associated with OAG, which signals the possible impact of genetic factors. In addition, glaucoma is considered an optic neuropathy, while previous studies have reported that estrogen had a protective effect on the optic nerve. Estrogen deficiency may contribute to accelerated aging and greater susceptibility to glaucomatous damage. Therefore, the higher risk of OAG found in women who experienced late menarche or early menopause may be explained by a longer absence of exposure to estrogens.

 

DR. RAVI THOMAS: A TRIBUTE

 

Prof. Ravi Thomas was one of the most colorful and brilliant ophthalmologists of our generation. He had published hundreds of articles, especially related to glaucoma (A PubMed search came up with 173 results). He was also an interesting speaker and was often in the limelight during conferences.

I first came in contact with him in 2001, when he published an article on Automated Perimetry in the Indian Journal of Ophthalmology. There were some points which I could not understand and so I made some drawings on Paint software and emailed him. He replied almost immediately, writing that he was in Korea and would look into the points I mentioned when he returned back to India. He also asked me about the software I had used to make the drawings.

In 2015 I finally had the opportunity to meet him during the World Glaucoma Congress in Hong Kong. 

In 2019 I emailed him regarding my blog and requested him for a post. However, he was busy and we couldn't get any article from him.

His life journey has been cut short suddenly, there was still a lot he could have contributed to ophthalmology in general and glaucoma in particular. 

May his soul rest in peace.

Dr. Syed Shoeb Ahmad

Admin, Glaucoma Specialist Blog: The Glog 

ARTIFICIAL INTELLIGENCE

 

Artificial intelligence (AI) for actual clinical practice in glaucoma is still fraught with numerous limitations. Tae Keun Yoo, from the B&VIIT Eye Center, Seoul, Korea, discusses the role of AI in glaucoma in this correspondence published in the Journal of Medical Artificial Intelligence (JMAI).

https://jmai.amegroups.org/article/view/7990/html

First, the criteria for glaucoma diagnosis should be standardized. As commented by Goldmann et al., there is currently a lack of a standardized “ground truth” definition of glaucoma. The spectrum of glaucoma is wide, and there is a shortage of glaucoma experts worldwide. Therefore, the clinical practice patterns in the management of glaucoma may differ from practitioner to practitioner, and the treatment regimen differ. This problem poses many obstacles to the development and clinical validation of diagnostic devices for glaucoma.

For more accurate performance, it is important to compare and standardize glaucoma diagnostic data at as many centers as possible and train the AI model based on this verified dataset.

Second, it is important to analyze the time-series and multimodal data of patients with glaucoma. The evaluation of glaucoma commonly involves measuring intraocular pressure, fundus photography, optical coherence tomography, and visual field analysis. The progression of functional or structural damage during follow-up is an important factor in the diagnosis and treatment of glaucoma. Each measurement reflects only a few clinical aspects of glaucoma.

In addition, errors often occur in one measurement domain; therefore, other domains must be complemented to evaluate glaucoma. Recently, time-series analyses and multimodal deep-learning models have been studied for glaucoma diagnosis. In the future, large-scale data analyses based on these approaches will succeed in a more accurate glaucoma evaluation.

Third, detailed data on neurodegenerative and systemic metabolic conditions should be collected along with glaucoma data to predict progression. In addition, neurodegenerative diseases have been shown to be predictable by fundus photography, and most are closely related to the optic nerve head and the retinal nerve fiber layer in glaucoma. AI technology based on multimodal deep learning is increasingly used to analyze high-definition images in every area to reveal the relationship between systemic diseases and retinal images in greater detail.

Finally, generative AI techniques should be applied to overcome the lack of pathological data. Data shortages frequently occur because of security or privacy issues. Learning about the imbalanced medical data may result in a biased diagnostic model. Data augmentation techniques are required for accurate diagnosis in the clinical field, and recently developed generative deep learning models such as generative adversarial networks (GAN) provide solutions to this problem. Although still in their infancy, diffusion models, which are newly introduced generation technologies after GAN, can generate fundus photographs. As data quality is increasingly improved based on a large amount of data, realistic generative fundus images will be synthesized based on a large amount of data in the future.

In conclusion, various strategies are required to develop AI for glaucoma diagnosis and treatment. As Goldmann et al. commented, this cannot be solved at once and should be based on the interdisciplinary integration and mutual support of all complementary approaches.