eye-sos.com: Programs of Treatment

Programs of Treatment

TREATMENT

In this section we will examine in more detail the functioning only four (active) of 8 parts incorporated into the treatment programs system.

The principle of determining output parameters and operational modes of the physical therapy virtual instruments of the system is based on the calculation of diagnostic results obtained in the course of testing, i.e. THRESHOLD-LABILITY test and CFFF test.

Basic physical therapy instruments of the system:

1. Neurostimulation (NEURO STUMULATION active program)

2. Laser stimulation (LASER STUMULATION active program)

3. Electrical stimulation (ELECTRO STUMULATION active program)

4. Magnetic stimulation (MAGNETIC STUMULATION active program)

Let’s examine the performance of the data of physical therapy programs which control the operation of external therapeutic tools more specifically.

MAGNETIC STIMULATION

In the last 30 years, our LAMETESK Laboratory accumulated extensive clinical experience of application in ophthalomology of pulsed magnetic fields (hereinafter PMF) with program-adjustable output characteristics.

The treatment is performed using specialized magnetic emitters, which emit pulse or magnetostatic field, and are characterized by low intensity (35-40 mT), specific configuration, and equipped with a programmed change of the polarity of magnetic fields (see

Our long-term practice demonstrated the effectiveness of the application of pulse magnetic fields for treatment of different ophthalmologic diseases. PMF has expressed antipyretic, analgesic and antiedemic effect and contributes to an improvement in trophicity, acceleration of tissue regeneration processes, epithelialization of ulcerous surfaces, and accelerated healing of wounds.

In the hydration phases, the reduction in edema, plasmorrhagia and leukocyte infiltration both in the wound and in the adjacent tissues are distinctly observed. In the proliferating phase, cellular proliferation increases, cicatrical tissue is formed more rapidly and epithelialization is accelerated.

On the basis of clinical experience it is established that PMF contributes to the more intensive resolution of retinal edema and hemorrhages into the retina of the eye. The effect of PMF on the microcirculation and reactivity of vessels has been remarked a long time ago. Under the effect of magnetic field vascular elasticity and tone are normalized, as well as blood velocity, while the diameter of capillaries increases. For example, an increase in the external vascular caliber of the retina and choroid, reduction in the intraocular pressure, decrease of the secretion velocity coefficient are observed in the course of treatment of patients with the open-angle glaucoma.

PMF with the programmed change in the polarity, frequency, pulse form and intensity of magnetic field has definite advantages over the magnetostatic field which can be formulated as follows. In order to achieve more expressed PMF, they are assigned the characteristics with the rates similar to the normal rate of neuro-muscular flows, which is usually disrupted by the pathologic processes. In these cases of strictly rhythmical MR of resonance frequency, superimposition contributes to the normalization of the electro-condition of the affected organs and tissues.

Feasibility and safety of the local application of PMF with intensity up to 40 mT on the area of eye and its appendages, the absence of the damaging action in the membranes and adjacent sections of cerebral tissue is determined. Vasodilating effect was detected as two minutes after the magnetotherapy procedure an increase in the caliber of the retina arteries was observed, and restored to the initial level in twenty-four hours. The tendency towards a decrease in intraocular pressure under the effect of PMF, both under single and course treatment is observed.

Studies also showed that PMF accelerates healing of the cornea wounds. The resolution of edema and the infiltration of stroma are accelerated as well as the regeneration of front and rear epithelium, the activation of stroma cellular elements occurs, which results in accelerated formation of thin and firm cicatrical tissue.

The following parameters of PMF should be considered optimum for treatment of the eye diseases: field intensity of up to 40 mT, magnetic induction increment rate of 2x104 mT/s, at amplitude value of 20 mT and exposure of up to 25 min.

On the basis of the special features of the mechanism of PMF action, magnetotherapy should be prescribed for stopping of inflammation and removal of edema, resolution of infiltrations, exudates and blood, acceleration of metabolic processes, improvement of blood circulation (especially microcirculation), reanimation of trophicity and better healing of corneal wounds.

Magnetotherapy has a number of advantages over other methods of physiotherapy: the procedure does not require the contact of eyeball with the inductor, since PMF effortlessly penetrates the closed eyelids and the gauze bandages; therapy can be started in the first day of the disease or injury; medicinal mixtures can be used for magnetophoresis regardless of their polarity.

Additional interest in magnetotherapy arose in recent years in connection with the publication of a number of researches on the phoretic properties of magnetic fields. A new method of the administration of medicines in the eye tissue under the action of magnetic field is developed, which is called "magnetophoresis".

Researches showed that PMF contributes to an increase in the permeability of cornea and blood-ocular barrier. The penetration of preparations is substantially intensified under the effect of PMF in comparison only with diffusion.

Before the procedure, preparations can be administered in the form of drops, ointments, injections or magnetophoresis using bandage and bath techniques can be performed. The first method is most effective.

Magnetophoresis opens new prospects in the treatment of different pathologic processes, since one procedure combines positive action of both beneficial factors – magnetic field and medicinal substances.

At the same time, while performing magnetophoresis one should consider the fact that in some cases under the action of magnetic field the specific effect of some medicines can weaken, for example, the effect of cholinergic (atropine, acetylcholine, scopolamine, pilocarpine, etc.).

In other cases, under the effect of MR the shift of the pharmacological activity of a number of preparations (including adrenaline, noradrenaline, histamine) is observed, as they acquire unusual properties which can be sometimes dangerous for one’s health. The above information indicates the change of the general body reactivity in PMF and requires the caution in prescription of medications for the magnetophoresis.

The optimum procedures of magnetotherapy for treatment of the eye diseases are developed on the basis of the results of experimental studies and long-term clinical observations.

Indications to the application of PMF in ophthalmology include: lid margin conditions (blepharides, sties), keratitis of different etiology and their consequences, acute keratoconus, post-operational ophthalmologic conditions and post-operative complications, iridocyclite and uveitis of different etiology, tapeto- retinal and other forms of retinal degeneration, myopia and accomodative abnormalities, partial optical nerve atrophy, diseases of the retina vessels, hemorrhage into the membrane and media of the eye, edematic ophthalmoptosis.

The counter-indications include: presence of intraocular foreign bodies (especially magnetic ones), tendency toward the relapsing hemorrhages, hemorrhagic vasculitis, uncompensated glaucoma, convulsive activity.

ELECTRICAL STIMULATION

Electrical stimulation is an integral part of the system of ocular pathology treatment. It is based on the principle of stimulation of the sensory and neuromuscular systems of the eye by weak electric current pulses of specific structure and sequence.

The need for restoring reflex interrelation of the visual analyzer with the elements of central regulation envisages the application of electrical stimulation effects, first of all, for the treatment of diseases caused or accompanied by injuries of neuro-reception and reflex arc.

Such processes include all forms of neurogenic keratitis accompanied by the loss of cornea sensitivity, abiotrophic processes in the retina, and also diseases of neuro-muscular system of the eye of different origin.

The functional induction of excess anabolism, which is manifested in the activation of the reparative processes of intracellular and tissue regeneration, is the principal element of the mechanism of the therapeutic effect of electrical stimulation. In this case an increase in the content and synthesis of protein in the cells, including increase of the mobility, disintegration and renovation of the membrane phospholipids, and intensification of collagen synthesis is observed. At the same time, regional and local blood flows are activated.

It is assumed that the effect of an improvement of sight as a result of electrical stimulation is based on two principal actions: one is at the retina and optical nerve level, when performance efficiency of viable elements that could not transfer visual information is restored as a result of simultaneous excitation of the retina cells and their fibers; and another is at the visual cortex level, in which, as a result of stimulation, the centre of steady erethism (prolonged posttetanic potentiation) is generated, which leads to the restoration of performance of the cells that were previously inactive and to the powerful reverse afferentation to the retina, which improves its performance under this action.

In the clinical experience, electrical optical stimulation has been applied for more than 35 years. Therefore, to date a rather wide spectrum of systematic methods for its practical realization is developed. These methods can be classified into three basic types:

1. Percutaneous electrical stimulation of visual analyzer;

2. Transconjunctival electrical optical stimulation;

3. Implantation electrical optical stimulation.

In the above classification, the types of electrical stimulation are grouped according to the one common feature, i.e. the place of active electrode localization. Thus, during percutaneous electrical stimulation the electrode is localized on the skin in the eye area, during trans-conjunctival electrical stimulation the electrode is placed on the bulbar conjunctiva, and during implantation electrical stimulation the electrode is planted directly on the optical nerve membranes or other bulbar structures (in this case surgery is used to plant the electrode).

Along with neuro, laser and magnetic stimulation, electrical stimulation is the integral part of the system of therapeutic measures.

A few words about the procedure of electrophoresis. Significant interest in electrophoresis is stipulated by the possibility to achieve more prolonged pharmacological effect with the small dose and the considerably smaller concentration of medicinal substance, than with internal or any other methods of medicine administration.

In ophthalmology, electrophoresis is more valuable than in other areas of medicine, which is related to the physiological peculiarities of the eye. The cornea is the ideal semipermeable membrane, through which the ions penetrate the eye, while under the effect of galvanic current the permeability of hemato-ophthalmic barrier increases for the drugs composed of compound complexes and mixtures. As a result of the increase in the permeability of hemato-ophthalmic barrier, more medicinal substances can penetrate in the tissue of the eye. Direct contact of the medicine and abnormal organ contributes to this effect. Rationally selected combinations of drugs, joined under the generality of pharmacodynamic synergism, has considerably greater therapeutic effect in the clinical picture of severe conditions.

Furthermore, it was detected that in case of bath electrophoresis the penetration of medicinal substances increases not only from the appropriate but also from the opposite pole, which makes the simultaneous use of multicomponent solutions with the opposite medicinal ions permissible. It should also be emphasized that after the galvanization of the eye from any pole through the isotonic solution with the low electrical conductivity, the permeability of cornea rises, especially for the anionic substances (after preliminary anodic galvanization).

LASER STIMULATION

Since late 1970-s, a fundamentally new trend in ophthalmology began to form. It was based on the application of low energy laser emission, i.e. laser therapy (laser stimulation).

According to a number of researchers, the mechanism of the low-energy laser emission stimulating effect can be represented as follows: quantum energy of the red coherent light (1,96 eV - (electron of volts)) is too low for destroying the energy connections of the molecule (more than 40 eV), but however is sufficient for the electron excitation. When cellular fotoreceptor molecule absorbs light, photodynamic effect is generated, which is realized by the activation of nuclear apparatus and by intensification of DNA - RNA ribosome activity.

The activation of catalase, superoxide dismutase and cytochrome oxidases plays an important role, along with the transformation of oxygen into one of its active forms –singlet state. The indicated changes in the cell ensure intensification of the regeneration of the damaged organelles, contribute to the formation of phagolysosome, digestion of pathogenic agents and increase in the level of energy processes in the mitochondria. The experiment also revealed that the most prominent stimulating effect of laser emission on the body cells was observed in the ranges of 313 - 460 nm, 600 - 660 nm, and 720 - 910 nm.

Further research in this direction showed that the laser low-intensity radiation intensifies the proliferating activity of cells in the tissue culture, and improves phagocytic and mitotic activity. Cytochemical and radio-autographic studies showed that under similar stimulation of the eye and in case of using energies reduced by 20-30% ("subthreshold" energies), extra-mitotic DNA synthesis is activated in the ganglion and bipolar retina cells.

The first signs of an increase in DNA synthesis were observed a few hours after the radiation, while by the end of the twenty-four hour period extra-mitotic DNA synthesis reached maximum level, during the subsequent days it decreased, reaching initial level by the end of the week. DNA content in the nuclei of the cells increased by 25-30% during this period. The response of the retina cells to the laser radiation was not limited to the activation of DNA synthesis, as RNA synthesis was intensified, too. The response was maximized in 24 - 48 hours after the procedure.

In the described researches, one common special feature is distinguished: both electronic- microscopic and cytochemic changes in the cells were detected at the sufficiently large (4 - 6 mm) distance from the focal spot, i.e. the reaction of the retina cells to the radiation was manifested over the large area, and retina responded as a unified functional structure.

This specific feature of the retina response on the local irradiation was taken as the basis for development and subsequent application in the clinical practice of the laser method of treating some types of macular degeneration and amblyopia.

It should be emphasized that as a result of the indicated researches, maximum permissible levels of laser emission which can not result in injuries of the retina were determined: in the opinion of many researchers, these are power flux densities ranging from 0,5 mW/cm2 to 6,4 mW/cm2.

Researches of early 1990-s were concurrently focusing on the exploration of changes in the retina cells under the effect of laser irradiation and the reaction of other tissues of the eye to this action. As a result, it was established that irradiation of the cornea by the unfocussed laser beams having power density below 0,1 mW/cm2 has stimulating effect on the regeneration processes in the cornea, which are manifested in the acceleration of epithelization in comparison with the control level. Experimental studies allowed adopting the method in the clinic practice.

Improvement in microcirculation is one of the most important properties of irradiation by low-energy lasers. Moreover, the character of the vascular reaction of the eye to the laser stimulation is determined by the initial eyeball vascular tone: in case of collapse the tone improves, in case of spasm dilatation of the vessels is observed, which ultimately results in the improvement in hemodynamics of the eye. Another important aspect of low-energy laser emission is the stimulation of lymph circulation due to the formation of new chorioretinal tracts of microcirculation in the eye, which ultimately leads to an increase in the substance exchange in the retina.

The decrease of the permeability of vascular wall, an increase in the quantity of functioning capillaries and an improvement in the rheological properties of the blood also contribute to the optimization of trophic processes in the eyeball.

The hypotensive effect of laser emission resulting from the increase in the functional possibilities of the endothelial cells of the trabeculas of Schlemm's channel and activation of the liquid diffusion between the retina and the choriod is very important for the ophthalmologic practice.

One should take into consideration the fact that stimulating emission in the near infrared region has larger depth of penetration in comparison with the visible region. Therefore it has more profound effect on the structures like vascular membrane.

It is important to emphasize that in contrast to some other methods of stimulation, for example pharmacological one, when reserve depletion may occur and development of destructive processes can begin as a result of the cells reserves mobilization and in case of prolonged application, in the case of laser stimulation an increase in the functional possibilities of cells, and increase in their viability are observed, that also makes it possible to regard this form of therapy as completely safe.

Presently, the widest application in the clinical practice received low-energy lasers operating in the ranges of 430-450 nm, 620-650 nm, and 720-910 nm.

There are two principal systematic approaches to their application: direct irradiation of the eyeball elements by laser emission and stimulation of neuro-receptor system of the visual analyzer by the reflected beam.

NEUROSTIMULATION

Quantum ophthalmic therapy is a brand new trend in ophthalmology and medicine which is based on the biorhythmic action of light quanta of low intensity energy on the visual organ, (energy intensity corresponds to different wavelengths).

The therapeutic effect of quantum therapy is determined by the regulation of subcortical bioelectric processes, exchange of the neuromediators of the endorphin and immune systems, hormonal activity of the endocrine glands, and also by the improvement in neuro- and hemodynamics, which determines the universal nature of the stimulation, and allows to apply it for the effective treatment of various eye conditions.

The therapeutic application of the method is performed using specific computer program which is the part of the PHOTOSTIMULATION system, and a special tool in the form of eyeglasses with the built-in RGB-emitters (red, green, dark blue: 470nm, 530nm, and 625nm.) which perform colour-pulse action with frequencies from a number of homological senders: from the lowest frequencies, directed towards the cortical divisions of the hemispheres, to high frequencies directed to the organs and body systems.

The procedure is performed by the non-contact method through optical-thalamic- and hypothalamic-pituitary axis. The duration of the procedure is usually 3-10 min.