RO113709B1 - Physiotherapeutical method for the prophylaxis and the non-surgical treatment of cataracts - Google Patents

Abstract

The invention relates to a physiotherapeutical method for the prophylaxis and the treatment of cataracts without surgery or administration of medicaments. The method is based on achieving the original transparency of the crystalline lens in a physiollogical way, by using biochemical mechanisms feed-back activated by the retina and the pineal gland, under the action of the incident light upon the visual organ. The method consists of the serial exposure, in sequences of 2...3 weeks, of the visual organ to natural or artificial light red radiations having a wavelength of 700...750 nm, preferably of 700...720 nm, violet-blue radiations having a wavelength of 400...450 nm, preferably of 420...430 nm and orange-red radiations having a wavelength of 600...700nm, preferably of 680...700 nm, at intensities meant for inducing to patients the minimal visual acuity required for their current vital activity. An exposure of 1...3 months to light radiations in the spectral range of 450...700 nm follows at intensities ensuring the minimal visual comfort required for difficultly carrying on routine or professional activities. The method is also applicable using polarized light, preferably in a linear way, by absorbtion, in this case the removing of cataract generating phenomena, such as brightness and fluorescence, the reduction of the exposure to ultraviolet radiations, the contrast improvement and the adaptation of the light intensity for inducing minimal visual acuities are achieved concomitantly, thereby allowing the use of simpler treatment devices and/or equipment.

Description

RO 113709 Β1

The invention refers to a physiotherapeutic method, for the prophylaxis and treatment of cataracts, without surgical interventions or administration of medicinal products, using light as a therapeutic agent.

Cataract is defined, in the current understanding, as a condition of the visual organ caused by a physico-chemical phenomenon of opacification of the lens - lens with variable diopters that performs the process of visual accommodation, in mammals.

This opacification reduces or totally prevents the light reflected from the surrounding objects to penetrate the photoreceptors on the retina and then, electrically modulated, to reach the optic nerve, to the central processing site, represented by the pineal gland.

The most used cataract treatment methods worldwide are the surgical methods of capsular extraction, corrected postoperatively with glasses or contact lenses, hard pseudofak implant (PMMA) of the anterior or posterior chamber.

These methods present some disadvantages related to intraoperative accidents, such as corneal endothelium damage or postoperative complications such as rejection phenomena, iridocyclitis, secondary cataracts at the level of the posterior capsule, etc.

The advances made in recent years, such as the use of soft implants (poly-HEMA, silicones, etc.), intraoperative enzymatic destruction of the anterior capsular epithelium, phacoemulsification and laser therapy of secondary cataracts, have largely limited these disadvantages.

The major disadvantage of all known surgical methods, namely the induction of visual disability by eliminating the accommodation process, was only solved by using either sets of glasses or bifocals or progressive dioptre glasses, inconvenient solutions for patients.

Following the fundamental and applied research of the last 10-15 years, carried out by universities, companies, foundations, etc., with support from the governments of many countries, notable results have been obtained in the last 2-3 years, especially in the USA and Japan , in the direction of the prophylaxis and medicinal treatment of cataracts. These researches, in addition to the fact that they brought important etiopathogenetic clarifications, eliminated, after long controversies, the prejudice of the irreversibility of crystalline opacifications, the main prerogative of surgical methods. Through the use of various drugs, as therapeutic agents, it was found, on the one hand, an inhibition of the opacification processes and, on the other hand, an activation of biochemical processes, still unexplained, which produce a retransparency of the opacified lens.

Already in medical practice or in various stages of clinical testing, these methods present the disadvantages related to any allopathic therapies, namely adverse reactions, side effects, the relatively low healing index and the frequency of relapses.

For the treatment of congenital cataracts, for which even surgical methods are not effective or recommended, genetic therapies have, for now, made a timid appearance in recent years.

Also known is a method of improving the vision of people affected by cataracts - described in US patent 5235358 - in which light is used as a therapeutic agent. The method aims, first of all, to reduce or stop the evolution of cataracts by eliminating cataractogenic light radiation with wavelengths shorter than 450 nm, i.e. ultraviolet, violet and blue radiation. secondly, the method aims to reduce glare and improve visual contrast by eliminating the phenomenon of light scattering and fluorescence at the level of the lens, also as a result of eliminating light radiation with wavelengths shorter than 450 nm. thirdly, the aim is to increase visual acuity by exposing the visual organ to intense light radiation in the 450...550 nm range, through filters with the highest possible transmission.

RO 113709 Β1

These desiderata are practically achieved either by filtering the light directly before it enters the eye, or by filtering the light before it enters the patient's field of vision. 50 in the first case, light filtering occurs at the level of contact lenses, glasses or "clip" lenses attached to the glasses. in the second case, the daylight that enters the room is filtered in the access area, respectively in the area of windows, skylights and glazed doors. in the case of artificially lit rooms, light filtering is done in the area of the respective lamp itself. It is also possible to filter the light produced by TV screens or monitors right in front of them.

in all these cases, the visual organ is exposed, either to natural light or to artificial light, by means of a filter with a complex composition that ensures, in the 380...450 nm range, a maximum transmission of 20%, preferably 10% or optimally at most 1%. At the same time, the filter used allows exposure of the eye in the 450...550 nm range, with a 60 transmission of at least 40%, preferably at least 60% and optimally at least 70%, and in the 550...780 nm range, transmission is at least 65% and optimally at least 85%. This method results in improved acuity and contrast and postpones the need for surgery or even makes it unnecessary.

Although effective for people with normal vision in poor lighting conditions 65 (fog, clouds, rain, blizzard, etc.), or for some professional categories (drivers, sailors, aviators, athletes, etc.), in the case of people affected by cataracts, this method it presents the disadvantage that it can contribute to the complication or sometimes even the failure of the surgical intervention, as a result of the improvement of vision and the postponement, because of this, of the moment of applying the surgical treatment method. At the same time, this method can accentuate postoperative complications, primarily those related to secondary cataracts. It is known that the practice of artificial lens implant (pseudofak) and, in particular, of the posterior chamber one, requires that, by preserving the anterior capsule, the operation should be performed in an early phase so that the lens extraction can be carried out as quickly as possible. easily, without leaving fragments at the level of the anterior capsular epithelium, generator of black dots and initiator of secondary cataracts 75. Postponing the moment of surgical intervention leads to the production of the phenomenon of maturation, of "baking" of the cataract, with implications on the sclerosing of the capsule, which makes the process of cleaning it difficult, even with special enzyme preparations.

Another shortcoming is the fact that, even in the happy situation, in which the evolution of the cataract stops, the patient is obliged to wear glasses with filters with 80 complex composition for the rest of his life and to live in spaces with uncomfortable visual comfort.

Another disadvantage is the fact that the filters used transmit, practically, the integral light of the visible spectrum, but with a modified composition compared to natural, unfiltered light, in the sense of increasing the weight of radiation in the 450...550 nm range, which ensures the improvement of vision. 85

At the same time, as a result of prolonged exposure of the visual organ to the highest light intensities, fluorescence processes are also accentuated, which have a negative effect on brightness, contrast and visual acuity.

Also, prolonged exposure to high light intensity in the range of wavelengths up to 780 nm, characteristic of red light, presents the risk of retinal detachments 90, as does exposure to ultraviolet radiation in the range of 380 nm.

The present invention solves the problem of retransparency of the lens through physiological processes activated by feed-back mechanisms, homeostatically controlled at the level of the central nervous system (pineal gland) and local (retina), in parallel with the elimination of sources of ambient cataractogenesis, represented by ultraviolet radiation, glare phenomena and 95 visual contrast reduced.

RO 113709 Β1

The physical therapeutic agent used by the method is the physiological physical agent itself involved in the natural circulation of visual information, namely natural and/or artificial light from the visible spectral range.

The physiotherapeutic method for the prophylaxis and non-surgical treatment of cataracts, according to the invention, solves the problem mentioned above, in that the lens retransparency process is carried out by physiological mechanisms induced by the exposure of the visual organ to the very action of the physiological agent carrying the visual information, i.e. natural light and/or artificial, integral or colored, polarized or not, having light intensities adapted to induce, in a first stage of treatment, minimal visual acuities that allow patients to perform only vital, routine activities, and in another stage of treatment, minimum visual acuities that allow patients to carry out current or professional activities with difficulty and normal visual acuities, associated with the elimination of cataractogenic factors - glare, fluorescence - after treatment; in the case of retransparency of the lens with colored light, in the first stage, the visual organ of the patients is exposed to successive sequences of 2-3 weeks with natural and/or artificial red light of 700...750 nm, preferably 700...720 nm , blue-violet in the range 400...450 nm, preferably 420...430 nm and red-orange in the range 600...700 nm, preferably 680...700 nm, and in the second stage it is exposed the visual organ of patients for 1...3 months to light radiation in the spectral range 450...700 nm; in a first version, simpler and more economical, but which takes place over a longer period of time, the method consists in exposing the visual organ in the first stage, for 2...3 months, to full light of 400 ...750 nm, natural or artificial, having a reduced intensity with the help of attenuation filters, at a level that induces the patient a minimum visual acuity necessary to carry out, without an attendant, some vital, routine activities, after which, on measure of the increase in visual acuity, the visual organ is exposed for 5...10 months also to full natural and/or artificial light with a lower intensity than in the first stage, using filters with a higher degree of attenuation, so that the visual acuity is maintained at the initially set value; in another embodiment of the method, the patient's visual organ is exposed to natural, and/or artificial, colored or integral, polarized light, preferably linear by absorption, so that the elimination of ultraviolet radiation, the phenomena of glare and fluorescence, increasing the contrast and adapting the light intensity to the needs of the treatment, is done simultaneously, using polarizers or nicols, preferably made of polaroid material.

By applying the invention, the following advantages are obtained:

- the elimination of surgical interventions, with all their intraoperative (damage to the corneal endothelium) or postoperative complications (rejection phenomena, iridocyclitis, dislocation or subluxation of the lens, secondary cataracts, induction of visual disability through ablation of accommodation, myopia, hypermetropia, strabismus, etc.), rest postoperative recovery (3...4 months), etc.;

- elimination of side effects, adverse and toxic reactions, etc., related to drug therapies;

- allows treatments to be carried out in ambulatory conditions, of normal life, without therapeutic stress;

- does not disrupt, limit or influence in any way any other treatment associated with other ocular or systemic conditions;

- allows treatments during the performance of professional activities and sometimes even related to them (computer operators);

- elimination of cataractogenesis factors such as: glare phenomena, ultraviolet radiation, fluorescence processes, the method thus also acquiring prophylactic qualities;

- simplification of the technical means necessary for the treatment using colored filters, attenuation, usual polarizing elements, etc.;

RO 113709 Β1

- allows the simultaneous treatment of large masses of patients by the same specialist, with closed circuit television systems, intranet or internet;

- it is the ideal method for medical telematics applications;

- has a low cost price.

Next, an example of an embodiment of the invention is presented. 150

The non-surgical treatment of cataract, using the physiotherapeutic method according to the invention, is preceded by an investigation of the patient to determine the minimal or separable visual acuity using, for example, Snellen's optotype, a device in itself known in ophthalmology. At the same time, the doctor also tests other characteristics of the patient's vision, such as visual contrast, color sensitivity, then he will perform the glare test and establish the degree of opacification of the lens and the type of cataract.

next, the ophthalmologist will determine if the patient has other associated eye or systemic conditions. It is important to notice a number of conditions that induce or maintain a cataractogenesis process, such as: the presence of a foreign body in the lens, glaucoma, diabetes, dislocation or subluxation of the lens, conditions of the capsular endothelium, retinal detachment. , macular degeneration, blindness other than lens opacification, etc.

in a first stage of the treatment method, according to the invention, the damaged visual organ of the patient is exposed, for a period of 2-3 weeks, to natural or artificial light from the visible spectrum in the spectral range 700...750 nm, preferably 700...720 nm, at a relatively constant intensity, which induces the patient a minimum visual acuity that allows him to carry out some vital, routine activities.

next, there is an exposure to light from the spectral range 400...450 nm, preferably 420...430 nm, also for 2...3 weeks at the same visual acuity as in the first stage of the treatment. in the third stage, the visual organ is exposed for 2...3 170 weeks to light in the range of 600...700 nm, preferably 680...700 nm at the same visual acuity as in the previous stages, after which a exposure for 1-3 months to light in the range of 450...700 nm, with an intensity that induces the patient a minimum visual acuity necessary to carry out current activities with difficulty, including of a professional nature. 175

The treatment described above is applied continuously, every day, outside of night rest.

The selection of natural light from the prescribed spectral domains is carried out with the help of colored filters, known in themselves, mounted in eyeglass frames or applied to windows, glazed doors, skylights, etc. in the form of foils or even colored windows. in the case of the use of artificial light, the filtering of light is carried out with the help of filters, also known, placed around electric lamps or in front of TV screens or monitors.

Unlike other eye conditions, where the variation in light intensity is not important, in the case of cataracts this light parameter becomes essential, especially when the treatment is carried out with natural light whose intensity varies depending on the season, weather conditions and diurnal changes.

These variations in the intensity of the incident light manifest themselves in changes in the visual acuity of the patient and disrupt the treatment. It should be mentioned that one of the biochemical parameters that are the basis of the treatment method, namely the N-acetyltransferase activity, 190 is disturbed by a variation of the light intensity even for a minute, and then several hours are needed to return to the initial activity. The sensitivity of the cones varies to the light intensity in a few tens of seconds and of the rods in 2...3 minutes.

RO 113709 Β1

For these reasons, it is necessary to use technical means that adapt practically, permanently, to the variation of light intensity, such as heliomat lenses, electrochromic lenses or liquid crystal devices, which are associated with colored filters corresponding to the spectral domains indicated for each specified treatment stage above.

It is obvious that, during the course of the treatment, as a result of the process of gradual retransparency of the lens and the return to normal values of visual acuity, it is necessary to change the intensity of the incident light in order to preserve the visual acuity established at the beginning of the treatment.

This is done by replacing the filters with others with a lower degree of transmission or by using polarizing elements associated with the filters.

It is also possible to use glasses with double frames on which two nicols with two rotating polarizers are mounted, having chromatic shades identical to those of the colored filters for the mentioned spectral domains. By rotating one or both polarizers, manually or automatically, all technical parameters of the therapeutic agent can be achieved, namely color, polarization and light intensity.

The method described above can be applied by exposing the visual organ to artificial light with previously specified parameters, light generated by the TV screen or the monitor of a personal computer, which ensures easy obtaining of the parameters imposed on the therapeutic agent. in the case of TV screens, the chromaticity and intensity can be achieved through manual or automatic adjustments and in the case of monitors, the chromaticity is adjusted by automatic setting and the intensity by potentiometric adjustment or by program.

in both cases, polarizing filters can be mounted in front of the screens. Treatment programs can be used, according to the method, through teletext television systems or through cable programs. The described treatment method can also be applied through computer networks at the level of health, regional, national, etc. units.

The realization of specific programs for setting the monitors to the parameters specific to each stage of treatment can be individualized through the diagnosis or stage evaluation at the level of each patient, by accessing the multimedia facilities of the best specialists in the field, regardless of where they are.

in the case of using personal computers, the treatment programs can be written on the hard drive or on storage units such as floppy disk or C.D.

in a simpler and more economical variant, the method for the treatment of cataracts, according to the invention, consists in exposing the visual organ of the patient to full natural or artificial light, in the spectral range 400...700 nm, in a first stage for 2 ...3 months. The light intensity is reduced, with the help of a set of 4...5 attenuation filters, with different degrees of transmission, so that the patient can detect contours of objects that allow him to carry out vital activities, without a companion.

According to the progressive improvement of the patient's visual acuity, determined by the gradual retransparency of the lens, the filters are replaced with others with a higher degree of attenuation, so that the visual acuity is maintained at the level established at the beginning of the treatment. then, for a period of about 5...10 months, the visual organ is again exposed to natural or artificial light, fully, but at a light intensity that induces visual acuities necessary to carry out, with difficulty, current or professional activities .

Simultaneously with full exposure to light, the visual organ can also be exposed to polarized light, which allows the elimination of glare and improvement of contrast.

The control of the evolution of the treatment is carried out by the ophthalmologist and by the patient himself who, at certain time intervals, will perform specific tests of visual acuity, contrast, etc.

Claims (2)

RO 113709 Β1 Conceptually, the physiotherapeutic method for the non-surgical treatment of cataracts, described above, is based on the Le Chatelier principle, which is the basis of any biological system controlled homeostatically by compensatory dynamic balances. Aggressive external factors or local functional disturbances or homeostatic integration 245 at the level of the visual system, cause the central decision-makers to decide, "in extremis", to sacrifice the lens by turning it into a "filter" for the protection of the photoreceptor elements or for to obtain optoelectronic signals that can be processed by the structures of the visual system. Thus, when the intensity of light incident on the photoreceptors is too high, the pineal gland is the one that intervenes and regulates all the 250 attenuation mechanisms at the level of the pupil, cornea, retina and retinal pigment epithelium. After exhausting all the normal physiological mechanisms to attenuate the intensity of the received signals, the pineal gland finally activates an enzymatic biochemical mechanism that gradually reduces the transparency of the lens, through structural changes that, continuing over time, ultimately lead to the opacification of the lens . The scientific rationale for using 255 in this treatment method light itself - that is, even a cataractogenic agent - in order to restore, as much as possible, the transparency and flexibility of the lens, is that the biochemical processes of modulation by the pineal gland of visual acuity through the intensity of the signals emitted by the photoreceptors of the retina under the action of light, are reversible. consequently, in the situation where the light intensity received by the visual organ is 260 too low, the pineal gland reacts the other way around, causing the activation of biochemical mechanisms in order to gradually cause a retransparency of the lens. The nature or origin of the light used as a therapeutic agent is of no particular importance, as long as its parameters and, above all, the induced effect - visual acuity - are the same. in the application of the method, an important particularity is the use of polarized light, with positive effects, consisting in the prevention or elimination of the glare phenomenon, incriminated as one of the factors of cataractogenesis, as well as the practically complete avoidance of exposure of the eye to ultraviolet radiation. Claims 270 1. Physiotherapy method, for the prophylaxis and non-surgical treatment of cataracts, based on the retransparency of the lens, under the action of a physical agent with specific parameters, made with various known devices, means, equipment or devices, before entering the visual field or the visual organ of patients, characterized by the fact that the process of re-transparency is carried out through physiological mechanisms induced by the exposure of the visual organ to the very action of the physiological agent carrying the visual information, namely natural and/or artificial light, integral or colored, polarized or not, with adapted light intensities to induce, in a first stage of treatment, minimum visual acuities that allow patients to perform only vital, routine activities, and 280 in another stage of treatment, minimum visual acuities that allow patients to carry out current activities with difficulty or professional and normal visual acuities, associated with the elimination of cataractogenic factors - glare, fluorescence - after treatment. 2. Method according to claim 1, characterized in that, in the case of lens retransparency with colored light, in the first stage, the patient's visual organ is exposed to successive sequences of 2-3 weeks with natural and/or artificial red light of 700...750 nm, preferably 700...720 nm, blue-violet in the range 400...450 nm, preferably 420...430 nm and red-orange in the range 600...700 nm, preferably 680...700 nm, and in the second stage the visual organ of the patients is exposed for 1...3 months to light radiation from the spectral range 450...700 nm. 290