Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N5/0613—Apparatus adapted for a specific treatment
  • A61N5/0616—Skin treatment other than tanning
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N5/0613—Apparatus adapted for a specific treatment
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N5/0601—Apparatus for use inside the body
  • A61N5/0603—Apparatus for use inside the body for treatment of body cavities
  • A61N2005/0605—Ear
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N5/0601—Apparatus for use inside the body
  • A61N5/0603—Apparatus for use inside the body for treatment of body cavities
  • A61N2005/0609—Stomach and/or esophagus
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N2005/065—Light sources therefor
  • A61N2005/0651—Diodes
  • A61N2005/0652—Arrays of diodes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N2005/065—Light sources therefor
  • A61N2005/0651—Diodes
  • A61N2005/0653—Organic light emitting diodes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N2005/065—Light sources therefor
  • A61N2005/0654—Lamps
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N2005/0658—Radiation therapy using light characterised by the wavelength of light used
  • A61N2005/0662—Visible light
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N5/0601—Apparatus for use inside the body
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N5/00—Radiation therapy
  • A61N5/06—Radiation therapy using light
  • A61N5/067—Radiation therapy using light using laser light

Definitions

• the present invention generally relates to systems and methods for treating visual pathway disorders or dysfunctions resulting from, among other things, disease, acute and chronic environmental factors or injuries, and aging.
• the invention may employ low-intensity light therapy to photomodulate retinal pigment epithelial cells to alleviate or reverse or repair disorders including or arising from age- related macular degeneration, diabetic retinopathy, hereditary optic neuropathy, disorders of the visual pathway (optic nerve, retina, retinal artery, cornea, etc.), cataracts, and other disorders of the human vision apparatus.
• Low-level light therapy has become an alternative to many types of treatments previously thought to be best-effected by high-energy methods, such as those using lasers, flashlamps, etc.
• photodynamic therapies, lasers and other high- energy light treatments were believe to be an effective treatment method to reduce or eliminate the skin disorders associated with the activity of sebaceous oil glands, hair growth, wound healing and treating dermatological conditions, such as the reduction of wrinkles and fine lines, scar removal, etc.
• oxidative stress and mitochondrial function or dysfunction are involved in the pathogenesis of numerous retinal, visual pathway, and optic nerve diseases, including age-related macular degeneration, diabetic retinopathy, as well as Leber's hereditary optic neuropathy and many other disorders of the visual pathway.
• Methanol intoxication produces toxic injury to the retina and optic nerve, frequently resulting in blindness.
• a toxic exposure to methanol may result in the development of formic acidosis, metabolic acidosis, visual toxicity, coma, and, in extreme cases, death.
• Visual impairment may develop between 18 and 48 hours after methanol ingestion.
• Symptoms may range from misty or blurred vision to complete blindness. Both acute and chronic methanol exposure have been shown to produce retinal dysfunction and optic nerve damage clinically. Other chemical agents can produce similar disorders
• Formic acid is a toxic metabolite responsible for the retinal and optic nerve toxicity produced in methanol intoxication.
• Formic acid is a known mitochondrial toxin that may inhibit cytochrome c oxidase, the terminal enzyme of the mitochondrial electron transport chain of all eukaryotes. Cytochrome oxidase is an important energy-generating enzyme critical for the proper functioning of almost all cells, especially those of highly oxidative organs, including the retina and brain.
• Photomodulation using narrowband, multi chromatic light using low-energy sources have been shown to accelerate wound healing, improve recovery from ischemic injury in the heart, and improve many skin-related disorders as illustrated in U.S. 6,663,659 (McDaniel) which is hereby incorporated by reference in its entirety.
• LED light-emitting diode
• the use of light at low energy fluences may generate significant biological effects, including cellular proliferation, collagen synthesis, and the release of growth factors from cells, alteration of gene expression and even repair of DNA damage.
• LED photomodulation at 660 nm may stimulate cellular proliferation in cultured cells and significantly improves wound healing.
• mitochondrial cytochromes could act as photoacceptors for light energy; and, further, other receptors may act as mediators for the biological effects of this light.
• the method of this invention may include exposing target cells in a visual pathway to one or more sources of light having at least one dominant emissive wavelength between about 300 nm and about 1600 nm; and delivering an energy fluence to the target cells of less than about 10 J/cm 2 .
• the light source, or sources may each emit a dominant emissive wavelength of from about 400 nm to about 900 nm.
• the energy fluence delivered to the target cells may be from about 1 nanojoule/cm 2 to about 1 joule/cm 2 .
• Suitable light sources according to the present invention may be selected from a light emitting diode, a laser, a laser diode, a dye laser, metal halide lamps, a fiashlamp, a mechanically filtered fluorescent light source, a mechanically filtered incandescent or filamentous light source, or combinations thereof. When multiple light sources are used, they may be of the same or different types.
• two light sources can be used.
• the first source of light emits at a dominant emissive wavelength of about 590 nm and the second source of light emits light at a dominant emissive wavelength of about 870 nm.
• the light sources may deliver energy fluence, as received at the target cells, of from about from about 1 nanojoule/cm 2 to about 1 J/cm 2 ; from about 0.05 J/cm 2 to about 0.15 J/cm 2 , or simply about 0.10 J/cm 2 .
• the light source or sources maybe be operated in a pulsed or in a continuous wave manner. For example, in pulsed mode, the light source or sources emit light according to a pulse code.
• One pulse code might be 250/100/100 - or 250 milliseconds "on", 100 milliseconds "off 5 , and the pulses are repeated 100 times.
• the light sources may be applied to reduce or eliminate oxidative stress, treat inner ear disorders, treat migraine headaches, reduce or eliminate cellulite, or treat the variety of cell disorders and dysfunctions described hereinafter.
• Figure 1 is a chart illustrating various photomodulatory processes and their anticipated effect on cells.
• Figure 2 illustrates various photomodulatory processes and the state of the cell which each process may be applicable to.
• Figure 3 shows a comparison of the efficacy of certain treatments for various factors in human skin.
• Figure 4 shows the relative expression of VEGF in cultured human retinal pigmented epithelial cells subjected to various treatments of the present invention.
• Figure 5 is a graph showing the response of cells that have been exposed to acute UV injury, after being treated with various LILT treatments of the present invention.
• Figure 6 is an illustration of the human auditory system.
• Figure 7 is a photograph of the eyes of a patient suffering from wet macular degeneration prior to treatment according to the present invention.
• Figure 8 is a photograph of the eyes of the patient of Fig. 6 after two weeks of treatment according to the present invention.
• the present invention is directed to a process for treating vision and eye disorders.
• the treatment may be used to photomodulate retinal pigment epithelial cells, and other portions of the visual pathway, to alleviate or reverse disorders including or arising from age-related macular degeneration, diabetic retinopathy, hereditary optic neuropathy, disorders of the visual pathway (optic nerve, retina, retinal artery, cornea, etc.), cataracts, and other disorders of the human vision apparatus.
• RPE retinal pigment epithelial cells
• the treatment of retinal pigment epithelial cells can reduce or reverse the effects of, for example, the damage cause to retinal cells by ultraviolet light, blue light, and oxidative stress caused by free radicals during exposure to stimuli or environmental factors that cause oxidative stress, free radicals, injury, or inflammation, resulting in stress or dysfunction to cells.
• Such damage may lead to macular degeneration, an affliction with affects about 10% of adults and is a leading cause of blindness in developed countries.
• the most common source of light used in such therapy is a narrowband source of multichromatic radiation, such as a light emitting diode.
• Other forms of light can be used, however, such as organic LEDs, flashlamps, lasers, laser diodes, dye lasers, filamentous and fluorescent sources, etc.
• the selection of the light source may be determined by the desired treatment. If, for example, the treatment of the brain is desired, a high energy light source, such as a ⁇ ashlamp, may be used, as it will require a large energy fluence at the light source to penetrate through the skull to deliver a low energy fluence to the cell or target tissue receiving treatment.
• the energy fiuences recited herein refer to the amount of energy (watts x time) perceived by the targeted tissue, cell, or other biological structure being treated.
• loud percussive noises are known to cause temporary hearing loss (which may become permanent after prolonged exposure). Characteristic of this is oxidative stress caused by free radical release in certain cells within the auditory or hearing pathways.
• a personal media player has "ear buds” or small headphones.
• LEDs able to emit an energy fluence capable of administering an effective dosage of light through the ear canal and eardrum to reach cells subject to inflammation and oxidative stress
• personal devices such as MP3 players could be used without the risk of hearing degradation.
• Such a use of the present invention may be expanded to occupation hearing protection devices and other apparatus for protecting hearing when a subject is exposed to high sound volumes for periods of time.
• Such a device could also be used to treat hearing loss from other causes, as well as tinnitus (ringing in the ears) and balance disorders and infections.
• Another example might include the use of low intensity light, in place of or in conjunction with, anti-oxidant drugs to reduce temporary hearing loss or ringing in the ears resulting from prolonged exposure to loud sound.
• the "ringing" or temporary hearing loss is due to oxidative stress in the hair cells or auditory nerve
• delivering a low energy fluence across the eardrum may further reduce or eliminate such oxidative stress by neutralizing free radicals produced when the hair cells or auditory nerve is exposed to high intensity sound waves or other environmental injuries or exposure to toxic agents such as those used in chemotherapy.
• Photomodulation may be used to alter gene expression to reverse, repair or counteract effects of cell damage.
• certain pharmaceutical treatments are known to cause hearing degradation in patients.
• the present invention may be applied to reduce or reverse or protect from the effects of such medications.
• Other medical treatment can include the application of light through the cribiform plate to achieve a small energy fluence direct to the brain; delivery of light via fiber optics or via an endoscope to deliver an energy fluence to internal tissue and organs or coronary arteries; and delivery of light directly to mouth and gums to treat various dental and periodontal conditions.
• Light may also be administered to the nasal passages, or into the sinuses, externally or internally.
• the thyroid gland for various thyroid disorders
• the thymus gland for regulating immune functions, etc. may be treated directly or through the skin.
• visual system we mean to include, but not be limited to, the cornea, iris, lens, retina, optic nerve, optic chiasm, lateral geniculate nucleus, vitreous, retinal artery, superior colliculus, pretectal nucleic, the accessory optic system, the oculomotor system, pulvinar, optic radiations, visual cortex, and associational visual cortical areas.
• Exposure of the visual system may occur by treating with light directed into the eyes, thus irradiating the cornea, lens, iris, retina and optic nerve head.
• the device can be oriented so that the light is directed through the back of the skull or irradiating the visual cortex or through the sides or top of the head thus irradiating the other components of the visual system or brain.
• a much higher energy fluence must be emitted by the source to deliver a very low energy fluence to the target tissue, due. to the amount of skin, bone, etc. that the light must pass through prior to reaching the target, thereby permitting the target to receive a clinically desirable dosage of light, according to the parameter given herein for photomodulatory treatment.
• delivery of the light could be more 'direct', by applying it under the skin or directly through the skull bones into the brain (for example, to slow or stop the growth of benign or malignant tumors).
• Therapeutic endpoints for treatment of corneal abrasion would include absence of fluorescein staining of the cornea.
• therapeutic endpoint measurement would include: (1) fundoscopy or fundus photography which is an assessment of the appearance of the fundus or back of the eye, (note that the retina and optic nerve may be observed by using special lenses); (2) Optical coherence tomography which measures the thickness (cross sectional architecture) of the retina;
• therapeutic endpoint measurement would include the measurement of the visual evoked cortical potential from regions of the LGN or superior colliculus, to which the optic nerves project and the Pupillary Light Reflex test, which tests the integrity of the optic nerve (cranial nerve 2) and the oculomotor nerve (cranial nerve 3).
• Therapeutic endpoints for improvement of visual function preferably involves the use of a battery of tests which serve as standardized assessments for evaluation of the visual functions important in ensuring that visual perceptual processing is accurately completed. These include assessment of visual acuity (distant and reading), contrast sensitivity function, visual field, oculomotor function visual attention and scanning.
• perimetry is the quantitative testing of the side vision.
• Automated (computerized) perimetry employs spots of light that are automatically projected into predetermined areas of the visual field. The test continues until the dimmest light is found that can be seen in each area of the side vision.
• CFF Critical Flicker Fusion Frequency
• Infra-red video pupillography is a way of seeing the pupils clearly in the dark so that a more certain diagnosis can be made. It may also be used to transilluminate the iris to identify local iris causes for pupillary abnormalities.
• Electroretinography is a regular ERG (eletroretinogram) that records the electrical activity of the whole retina in response to light and helps to determine if the rods and cones of the retina are firing in the correct way.
• ERG electroretinogram
• MVG Merge maps about one hundred ERGs at once by illuminating various little bits of the retina sequentially. It uses a computer to sort out the dizzying torrent of information and then it presents a map of the sensitivity of various parts of the retina, based on the electrical activity (in response to light) of all those different regions. If this map matches the map from perimetry, then the problem is in the retina and not in the optic nerve or brain.
• Multi-focal Visual-Evoked Potentials Using a MERG stimulus, information can be picked up from the scalp that tells us if the visual pathways in the brain are damaged.
• Computer controlled infra-red sensitive pupillography is a method that is used to monitor pupillary movements in response to different types of light in order to quantify how much damage there might be in the visual system.
• Computer controlled “Pupil” Perimetry is a method that uses the pupil movement in response to small lights presented in the field of vision as an objective indicator of how well the eye sees the light.
• Computer recording of eye movements can be used for monitoring pupil movements—but it also has the capacity to record the small movements of both eyes at the same time to see if they are tracking together and have normal movements in different directions of gaze.
• Optical Coherence Tomography OCT
• OCT Optical Coherence Tomography
• Ishihara Color Vision Test Cards used for color vision evaluation. A test chart on color dots that appear as identifiable numbers or patterns to individuals who have various types of color vision deficits.
• the retina is a complex sensory organ composed of different cell types arranged in distinct layers.
• the term "retinal function" will be used to refer to (1) activation of these layers by a light stimulus and (2) the processes required for maintenance of the cell.
• Different diseases may affect the retinal layers or cell types in a selective fashion. Congenital stationary night blindness affects transmission of visual signals in the rod-mediated visual pathway whereas achromatopsia affects only the cone pathway. Other diseases may affect both photoreceptor types in a defined location on the retina. Examples are the macular dystrophies, such as Stargardt's and age-related macular degeneration. Other diseases, such as glaucoma or optic neuropathy appear to affect primarily the ganglion cells, located on the surface of the inner retina.
• Certain issues that arise relate to mitochondrial dysfunction and retinal capillary cell death, and oxidative stress.
• oxidative stress is increased in the retinas of diabetic, sometimes resulting in blindness.
• the present treatment may provide an effective alternative to or companion to pharmaceutical treatment for these types of disorders.
• the retina must perform a number of functions in order to convert light entering the eye into an action potential in the visual cortex.
• the activation of the retinal layers by light results in the generation of electric fields in various levels of the visual system that can be recorded non-invasively.
• the light therapy could be beneficial in a wide range of diseases since it appears to affect basic cellular responses to insult such as ATP production and apoptosis.
• ATP production and apoptosis there would be no one test that would be appropriate to assessing all the diseases that might benefit for light therapy.
• an array of LEDs can be used to emit light at one, or more, wavelengths to deliver energy fluence to the affected cells.
• the cells are provided with a clinically effective fluence of energy to initiate photomodulation and/or photoregeneration, but not enough light to cause damage to the cells due to the excessive light exposure that might be cause by higher-energy light sources such as lasers.
• photomodulatory treatment There is photorejuvenation for "energizing" cells.
• Photoregulation controls or sends signals to cells. Photorevitalization may be used to slow, stop, or reverse programmed cells death or, in some case, revive necrotic cells. Photoregeneration may be used to differentiate cells. And photoreregulation may be employed to repair malfunctioning or damaged cells.
• the illustrative array of LEDs may be used to deliver a continuous wave (CW) of light to the affected cells, or may be "pulsed” according to a code determined to provide beneficial treatment.
• a pulse code for example, may be referred Io by the length of each pulse, the time between each pulse, and the number of pulses.
• a pulse code of "250/100/100", for example, would refer to pulses of 250 milliseconds in duration, separated by 100 milliseconds, and repeated 100 times. Such a pulse code may deliver the same energy fiuence as a 25 second continuous wave treatment.
• the LED array may include LED emitters that emit multiple wavelengths, a single wavelength, or the array may include multiple types of emitters, if more than one wavelength is used for treatment. Each LED will generally emit at a dominant emissive wavelength between about 300 nm and 1600 nm.
• the array may include combinations of LEDs that emit in the visible and/or infrared portion of the spectrum.
• the emitters may be configured pulse, emit a continuous wave of light for an extended period of time, and emit simultaneously or in sequence. The total energy fiuence delivered depends on the specific affliction being treated, but will generally be less than about 10 J/cm ⁇ 5 to avoid possible negative effects due to overexposure of the retinal cells.
• the fiuence at the source may be much higher than 10 J/cm 2 , but the fiuence perceived by the source may be very low, due to the absorption and scattering of the light by tissue, bone, or other structures between the light source and the targeted cells.
• a fluence as perceived by the targeted cells may be as small as a few nanojoules and the treatment may still be effective.
• An illustrative embodiment of the invention may include the use of a combination of yellow and IR light, for example 590 nm and 870 nm, emitting at a power of 4.0 mW/cm2 with a pulse code of 250/100/100, or delivering about 0.1
• Pulse codes ranging from 2/1/1 to about 1000/1000/1000 may be employed to deliver a clinically effective amount of treatment light to retinal cells, however pulses with a duration as short of nanoseconds are believed to provide effective treatment in certain circumstances, thus these pulse codes are merely illustrative and not exhaustive of possible codes.
• particularly effective treatment regimen may deliver UVAl light in combination with light of a lower wavelength.
• an energy fluence of 0.1 J/cm 2 may be delivered to the eyes (retinal pigment epithelial cells) of a patient either by pulsing sources according to a 250/100/100 pulse code, or for a continuous exposure of 25 second.
• Either treatment delivers an identical energy fluence to the target cells; however it has been found that certain cells respond differently to pulsed and continuous wave treatment, as illustrated in the figures.
• the time between treatments, as shown in Fig. 3 can affect the efficacy of the procedure.
• combinations of the various modes may be employed as can combinations of light sources within an array for treatment.
• the multiple wavelengths may include combinations of light in the visible spectrum, combinations of visible and infrared or ultraviolet light, or combinations of non- visible light.
• a combination of yellow and infrared light may be used to augment the treatment achieved by 660 nm light with heat produced by light in the infrared region (>700 nm).
• the targeted cells may be exposed to one or more wavelengths of LED emitted from a single LED or an array of LEDS, each of which may emit one or more wavelengths of light in the range of from about 300 nm to about 1600 nm.
• a variety of parameters may be used (including pulse duration, energy, single or multiple pulses, the interval between pulses, the total number of pulses, etc.) to deliver sufficient cumulative energy to interact with the cells. This may result in improved cellular activity, through photomodulatory means, photothermal means, or combinations thereof.
• the ratio of intensity of each source should be selected with respect to each of the other light sources. For example, one illustrative use of the invention may employ three light sources.
• the light sources may have dominant emissive wavelengths of 590 nm, 660 nm, and 870 nm.
• the "pulse code" of the light may result in any number of patterns of simultaneous or sequential use of each source, treatments using the same or different pulse code (or continuous wave) may vary due to difference in operating power of each source.
• each of the light sources may operate at the same or different power. In other instances, the power output of any individual sources may be varied with respect to each of the other light sources.
• Two entirely different lasers, LED, or light beams may be delivered substantially simultaneously through the same optics at different parameters.
• one beam may be delivered primarily to release or to activate, and a second beam primarily to treat.
• Additive or complimentary effects may be achieved by using two beams at the same time, such as the use of red light with a wavelength of approximately 660 nm and another with a wavelength of approximately 880 nm.
• selecting a first wavelength to match the wavelength responded to by mitochondrial cytochromes or DNA and a second wavelength to respond to target receptors may be found beneficial.
• Some examples of possible operating parameters may include the wavelengths of the electromagnetic radiation to the cells to be regenerated, stimulated, inhibited, or destroyed, the duration of pulses (pulse duration) of the electromagnetic radiation, the number of pulses, the duration between pulses, also referred to as repetition rate or interpulse interval. Intervals between treatments can be as long as hours, days, weeks, months, etc.; and the total number of treatments is determined by the response of the individual patient. Further, treatment regimens using a combination of more than one wavelengths either simultaneous or in sequence may be used.
• the energy intensity of the radiation as measured at the living tissue is determined by the nature of the treatment and is further illustrated in the Examples.
• Wavelength ⁇ Each target cell or subcellular component, or molecular bond therein, tends to have at least one unique and characteristic "action spectrum" at which it exhibits certain electromagnetic or light absorption peaks or maxima.
• Figure 3 shows the absorption spectrum of one line of human fibroblast cells in monolayer tissue culture. Different cell lines (of the same cell — for example fibroblasts from 3 different patients) exhibit some differences in their absorption spectra and thus using narrow band multichromatic light (rather than monochromatic light) is also useful in producing the optimal clinical effect.
• narrow band multichromatic light rather than monochromatic light
• the wavelength should roughly correlate with absorption maxima for the target cell or subcellular component or tissue, or exogenous chromophore. In some cases it may be desirable to target more than one maxima — either simultaneously or sequentially on the same or different treatment dates. The presence of multiple maxima action spectra is common for a given cell or subcellular component or exogenous chromophore and different wavelength maxima irradiation may produce different results.
• the laser diodes are also multichromatic with narrow wavelength bands around a dominant band, i.e., they are narrowband multichromatic devices — devices which emit electromagnetic in a narrow band of radiation either symetrically or asymetrically around a dominant wavelength.
• narrowband multichromatic devices devices which emit electromagnetic in a narrow band of radiation either symetrically or asymetrically around a dominant wavelength.
• any device that emits electromagnetic radiation in a bandwidth of +/- less than about 100 nanometers around a dominant wavelength can be considered to be a narrowband, multichromatic emitter.
• LEDs while not monochromatic, emit in such a narrow band as to be considered narrowband multichromatic emitters.
• the narrow band allows photons of slightly different wavelengths to be emitted. This can potentially be beneficial for creating certain desirable multi photon interactions.
• most commercial lasers emit light at a single wavelength of light and are considered monochromatic.
• the use of lasers, according to the prior art, has relied upon the coherent, i.e., monochromatic, nature of their electromagnetic emissions.
• Wavelength may also determine tissue penetration depth. It is important for the desired wavelength to reach the target cell, tissue or organ. Tissue penetration depth for intact skin may be different than the tissue penetration depth for ulcerated or burned skin and may also be different for skin that has been abraded or enzymatically peeled or that has had at least a portion of the stratum corneum removed by any method.
• Pulse duration ⁇ The exposure time for the irradiation is very critical and varies with the desired effect and the target cell , subcellular component, exogenous chromophore tissue or organ.(e.g. 0.5 microseconds to 1 0 min may be effective for human fibroblasts, though greater or lesser may also be used successfully).
• Continuous Wave (CW) vs. pulsed - e.g. the optimal pulse duration is affected by these parameters.
• the energy requirements are different if pulsed mode is used compared to continuous (CW) modes.
• the pulsed mode is preferred for certain treatment regimen and the CW mode for others.
• Duty cycle This is the device light output repetition cycle whereby the irradiation is repeated at periodic intervals, also referred to herein as the interpulse delay (time between pulses when the treatment session comprises a series of pulses).
• a chronic cell disorder may be one that is exhibited after continual exposure to some environmental factor — such as increased incidents of cataracts witnessed in those who are exposed to above-average levels of UV radiation over an extended period of time (fishermen, for example).
• some environmental factor such as increased incidents of cataracts witnessed in those who are exposed to above-average levels of UV radiation over an extended period of time (fishermen, for example).
• the treatment regimen may differ.
• the time intervening between an acute cell injury and the commencement of light treatment may be influential in determining the most effective treatment, as well.
• the present invention also has application to the reduction of cellulite, migraine headaches, strokes, heart attacks, and other medical conditions. Additionally, light therapy may be used in place of or to augment antioxidant compounds used to preserve and prepare harvested organs for transplant.
• adipocyte cells can be photomodulated. Photomodulation increases the local microcirculation in the cellulite and alters the metabolic activity of the cells. Enhanced local microcirculation, metabolism or enzymation activity, or combinations thereof, may be produced by photomodulatory means.
• any of the topical chromophores as previously described can be used or non-chromophoric compositions can be used in conjunction with any of the photomodulatory methods, including low-intensity light therapy.
• Further photothermal means may be used to destroy adipocyte cells alone or in combination with photomodulatory means, with or without the use of exogenous chromophores.
• photolyase helps to restore the original structure and function of the damaged DNA.
• photolyases are activated by light to then act to repair the DNA damaged by ultraviolet light. In the dark it binds to the cyclobutane pyrimidine dimmer created by the UV light and converts it into two adjacent pyrimidines (no dimer connecting these any longer) and thus the DNA damage is repaired. This direct reversal of DNA damage is called "photoreactivation".
• the photolyase upon exposure to blue light absorbs the light energy and uses this energy to 'split' the dimer and thus restore the normal DNA structure. Other mechanisms of DNA repair exist as well.
• the photolyase repair mechanism is not well understood at present, but naturally occurring or synthetic or genetically engineered photolyase from essentially any living organism source can be utilized for other organisms including human and veterinary and plant applications.
• DNA damage produced by factors other than ultraviolet light may also be repaired including, but not limited to, such factors as other environmental damage or toxins, radiation, drugs, diseases, chemotherapy for cancer, cancer, microgravity and space travel related damage, and a myriad of other causes.
• DNA or RNA repair have a wide variety of applications.
• the ability to treat skin damaged by sunlight/ultraviolet light of disease and to repair, reverse, diminish or otherwise reduce the risk of skin cancer could be used either as a therapeutic treatment or as a preventive measure for people with severely sun damaged skin, with precancerous skin lesions, or with skin cancer.
• This principle applies not only to skin cells and skin cancer but to a very broad range of skin and internal disorders, diseases, dysfunctions, genetic disorders, damage and tumors and cancers. In fact potentially any living cells might have beneficial effects from treatment with photolyase or similar proteins in combination with light therapy.
• the light to activate the photolyase typically comes from natural sunlight, essentially any light source, laser and non laser, narrow band or broader bandwidth sources can activate the photolyase if the proper wavelengths and treatment parameters are selected.
• natural sunlight filtered through a selective sunscreen could be used to activate both native and exogenously applied photolyases.
• Another treatment option would be to apply the photolyase and then treat with a controlled light source exposure to the proper wavelength band and parameters.
• a wide variety of light sources could be utilized and the range of these is described elsewhere in this application.
• a low energy microwatt narrow band but multispectral LED light source or array with mixed wavelengths could be utilized.
• Another embodiment is a filtered metal halide light source with a dominant wavelength of 415nm +/- 20nm and an exposure of 1-30 minutes at 1 — 100 milliwatts output can be utilized. Such exposure would occur minutes to days after application of a topical product containing photolyase.
• kin fibroblasts which have been sun damaged are treated with a photolyase and subsequently the photolyase is photomodulated with blue light to set in motion the DNA repair mechanism of photolyase - that is photoreactivation.
• both the photolyase and/or the cofactors described above can be enhanced by utilizing ultrasound to increase skin permeability or to increase transport across the skin barrier and into the skin and underlying tissues. Removal of a portion of the stratum corneum of the skin can also be used, alone or in combination with ultrasound, to enhance penetration and delivery of these topically applied agents. Additionally such methods of removing or altering the stratum corneum can assist in penetration of the light or the efficiency of same or allow use of lower powered light sources including home use devices such as battery powered LED sources.
• photolyases A variety of sources exist for obtaining photolyases. These may include native naturally occurring photolyases, compounds derived from other living organisms (that is one may use for example bacterially derived, or yeast derived, or plankton rederived, or synthetic or genetically engineered, etc., photolyases and use them in human skin for beneficial effects thus not limited to same species derived photolyases.
• One known photolase is derived from Anacystis nidulans while others can be derived from bacteria - yeast in fact protect themselves with a photolyase which can be used in humans, other microorganisms, plants, insects, amphibian and animal sources exist.
• the photolyase enzymes function by light induced electron transfer from a reduced FAD factor to the environmental exposure produced pyrimidine dimers.
• free radical inhibitors or quenchers such as antioxidants can also be used to supplement the photolyase therapy.
• Other light activated chromophores may be utilized with light sources and properly selected parameters to further enhance, stimulate, photomodulate, photoactivate or photoinhibit the target or supporting cells or tissue to promote the most effective treatment.
• wound healing can be accelerated by utilizing a combination of antioxidants, cell growth factors, direct photomodulation (photoactivation) of cells, and photoreactivation through photolyases.
• Topical or systemic therapy with the proper cofactors and replacing any deficiencies of cofactors can further enhance wound healing.
• a chronic leg ulcer wound could be treated with an antioxidant mixture of vitamin E, vitamin C and glutathione, as well as cofactors such as fatty acids and keto acids and low level light therapy using and LED array with parameters selected to photostimulate fibroblasts and epithelial cells could also receive treatment with a photolyase and blue light therapy thus greatly accelerating wound healing and healing wounds or burns that would otherwise not be treatable.
• photolyases and light therapy include: the treatment or repair or reverse nerve damage or diseases including spinal cord injuries and diseases; cancer or cancer treatment related problems including radiation and chemotherapy; cervical dysplasia and esophageal dysplasia (Barrett's esophagus) and other epithelial derived cell or organ disorders such as lung, oral cavity, mucous membranes, etc.; eye related diseases including but not limited to macular degeneration, cataracts, etc.
• blue light photoreceptors such as cryptochrome which photomodulate the molecular clocks of cells and the biological or circadian rhythm clocks of animals and plants — that is the mechanism which regulates organism response to solar day/night rhythms in living organisms.
• protein photoceceptors include vitamin B based crytochromes.
• Humans have two presently identified cryptochrome genes — which can be directly or indirectly photomodulated (that is photoactivated or photoinhibited).
• the clinical applications include treatment of circadian rhythm disorders such as 'jet lag', shift work, etc, but also insomnia, sleep disorders, immune dysfunction disorders, space flight related, prolonged underwater habitation, and other disturbances of circadian rhythm in animals. Circadian issues also exist for many other living organisms including the plant kingdom.
• Warts can be treated using exogenous or endogenous chromophores with either photothermal or non thermal photomodulation techniques — or a combination of both.
• endogenous chromophores include the targeting of the vascular blood supply of the wart with either method.
• Anther preferred embodiment is the use of a topically applied or injected or ultrasonically enhanced delivery of such a chromophore into the wart or its blood supply or supporting tissues with subsequent photomodulation or photothermal activation of the chromophore.
• One such example would be that of a chlorophyll topical formulation similar to those described elsewhere in this application but of higher concentration and vehicle and particle size optimized for wart therapy and the anatomic location of the warts (for example warts on the thicker skin of the hand might be formulated differently than that used for vaginal warts).
• An LED light source could be used for home use with 644nm in a battery powered unit wherein the topical formula was applied daily and treatment of individual warts was performed with the proper parameters until the warts disappeared.
• a cylindrical device with an array of LED arranged and optically diffused such that the entire vaginal cavity could be properly illuminated in a medically performed procedure would represent another embodiment of this therapy.
• a wide range of substances can be utilized either as the primary chiomophore or as adjunctive supporting therapy. These compounds are listed elsewhere in this application.
• an immune stimulator is utilized in conjunction with photomodulation with or without an exogenous chromophore.
• a higher powered light source either narrow or broad band can e utilized with the same chromophore therapy as outlined above, but with parameters selected so that the interaction with the chromophore is non photomodulation, but rather intense photothermal effect so as to damage or destroy the wart but with minimal damage to surrounding uninvolved and non supporting tissues.
• a chlorophyll and carotenoid topical formulation is applied and natural sunlight with or without a selective sunscreen are used to interact with the topical formulation.
• Another embodiment utilizes an injected or ultrasonically enhanced topical delivery of a dye such as indocyanine green which has been used for vascular injections safely in other medical applications.
• Papulosquamous, eczematous and psoriasiform, atopic dermatitis, and related skin disorders can be improved, controlled, reduced or even cleared by the same photomodulation or photothermal interaction with endogenous or exogenous chromophores.
• the process outlined for warts and the other disorders in this application may be used for such therapies.
• the use of ultrasound is particularly useful in the more scaly disorders in this group of diseases as are enzyme peels and other methods with gently remove scaling skin.
• Penetration of light into psoriasis presents for example a major problem with current therapies. Penetration of drugs and topical agents is likewise a major therapeutic challenge.
• psoralens typically cross link DNA and are light activated.
• DNA damage in produced not only by the ultraviolet light itself (like being out in sunlight but primarily ultraviolet A light), but in addition the psoralen drug produced DNA damage- Safety in children in an obvious concern as is use in pregnant or childbearing women.
• a topical light activated exogenous chromophore such as most of the agents listed in this application present no risk of DNA damage and also are generally very safe products - many are natural such as chlorophyll and can be safely used in children and pregnancy and child bearing age women.
• the treatment is only activated where the topical agent is applied — unlike the use of oral psoralen drugs that activate not only the entire skin but also the retina and other tissues.
• the light used for this therapy is not only low in power, but it is for the most part visible or infrared light and is not ultraviolet —producing no DNA damage.
• photomodulation or photothermal activation of exogenous light activated chromophores such as described herein represents a significant advance in safety and efficacy.
• the photolyase embodiments described above also have some application for diseases such as psoriasis.
• diseases such as psoriasis.
• psoriasis are very extensive covering large amounts of the surface area of the body and may be resistant to other known therapies.
• the application of a topical formulation to the areas not being treated — or to all the body areas exposed to the traditional psoriasis phototherapy could receive a post treatment with the photolyase and blue light therapy — think of this as a type of 'antidote' to the ultraviolet psoriasis phototherapy wherein the repair of DNA damage to normal tissue was facilitated immediately following the psoriasis therapy — thus reducing significantly the risk of skin cancer and photoaging in future years.
• Another embodiment involves the use of such a photolyase preparation in the evening after returning from a long day of occupational sun exposure or after an accidental sunburn.
• a spray or lotion containing the photolyase could be applied and then photorepair/photareacitvation of the acutely damaged DNA in the skin could be performed — and this could be performed with a large beam diameter home therapy unit — of by a white light source which contained enough of the desired wavelength at the proper parameters to produce this reaction.
• an antioxidant skin formulation could be also applied to minimize erythema and other undesired effects of the sunburn.
• One such embodiment would be the preparation described earlier with a combination of vitamin C, vitamin E and glutathione and free fatty acids and one or more keto acids.
• a similar formulation could contain these agents but utilize only one or two of the three antioxidants listed.
• an LED light source is used to treat sperm of animals or humans or genetically engineered embryos or subcomponents thereof to enhance fertilization.
• photolyase or other photoreparative or light activated DNA repair proteins or substances combined with photomodulation can be utilized to 'correct' DNA damage in embryonic tissues thus generating a normal or more normal embryo. This can be performed in vitro or in utero (utilizing tiny fiber optic delivery of the proper light parameters — or the light can be delivered from outside the body into the womb without the risk of introducing a fiber optic device.
• stem cells growth and differentiation into tissues or organs or structures or cell cultures for infusion, implantation, etc (and their subsequent growth after such transfer) can be facilitated or enhanced or controlled or inhibited.
• the origin of such stem cells can be from any living tissue or organism.
• stem cells for these embodiments may come from any source in the human body, but typically originate from the bone marrow, blood, embryo, placenta, fetus, umbilical cord or cord blood, and can be either naturally or artificially created either in vivo, ex vivo or in vitro with or without genetic alteration or manipulation or engineering.
• tissue can come from any living source of any origin.
• Stem cells can be photoactivated or photoinhibited by photomodulation, including stem cell differentiation for regeneration of the visual system and specifically the retina and retinal pigment epithelial cells and photoreceptor cells.
• wavelength or bandwidth of wavelengths is one of the critical factors in selective photomodulation. Pulsed or continuous exposure, duration and frequency of pulses (and dark 'off period) and energy are also factors as well as the presence, absence or deficiency of any or all cofactors, enzymes, catalysts, or other building blocks of the process being photomodulated.
• Photomodulation can control or direct the path or pathways of differentiation of stem cells, their proliferation and growth, their motility and ultimately what they produce or secrete and the specific activation or inhibition of such production.
• Photomodulation can up-regulate or down-regulate a gene or group of genes, activate or inactivate enzymes, modulate DNA activity, and other cell regulatory functions.
• wavelength photomodulation is critical as is the bandwidth selected as there may be a very narrow bandwidth for some applications — in essence these are biologically active spectral intervals.
• the photomodulation will target flavins, cytochromes, iron-sulfur complexes, quinines, heme, enzymes, and other transition metal ligand bond structures though not limited to these. These act much like chlorophyll and other pigments in photosynthesis as
• photo acceptor molecules for photo acceptor molecules.
• These photo acceptor sites receive photons from electromagnetic sources such as these described in this application, but also including radio frequency, microwaves, electrical stimulation, magnetic fields, and also may be affected by the state of polarization of light. Combinations of electromagnetic radiation sources may also be used.
• 'energizing the photo acceptor molecules which in turn transfers and may also amplify this energy signal.
• An 'electron shuttle' transports this to ultimately produce ATP (or inhibit) the mitochondria thus energizing the cell (for proliferation or secretory activities for example).
• This can be broad or very specific in the cellular response produced.
• the health of the cells and their environment can greatly affect the response to the photo modulation. Examples include hypoxia, excess or lack or ration of proper cofactors or growth factors, drug exposure (e.g. reduced ubiquinone from certain anticholesterol drugs) or antioxidant status, diseases, etc.
• the as yet unknown mechanism, which establishes 'priorities' within living cells, can be photomodulated. This can include even the differentiation of early embryos or stem cell population. Exogenous light activated chromophores may also be used alone or in combination with exogenous chromophores. Genetically altered or engineered stem cells or stem cells which have an inborn genetic error or defect or uncommon but desirable or beneficial trait may require a different 'combination' of parameters than their analogous 'normal' stem cells or may produce different cellular response if use the same combination of parameters. Using various methods of photomodulation or other techniques known in the art more specific cellular effects may be produced by 'blocking' some 'channels' that are photomodulated.
• buttons For example, consider an old fashioned juke box, if one selects the proper buttons one will set in motion a series of events resulting in the playing of a very specific and unique record or song. If however one were given a broom to push the buttons one would have to block all but the desired button to be selective. Likewise pushing an immediately adjacent button will not produce the desired outcome.
• the magnitude of effects on cells may also be very dependent on the wavelength (when other parameters are the same).
• One such example is the contrast between irradiating chemical bonds in DNA with 302nm light versus 365nm light — the 302nm light produces approximately 5000 times greater DNA pyrimidine dimers than the 365nm only a short distance up the spectrum. Changing the wavelength can also convert the ratio or type of these dimers.
• photomodulation or photochemical reaction parameters can produce very large and very significant differences in cellular effects — even at the subcellular level or with
• photo modulation parameters can be much like a "morse code” to communicate specific 'instructions' to stem cells. This has enormous potential in practical terms such as guiding or directing the type of cells, tissues or organs that stem cells develop or differentiate into as well as stimulating, enhancing or accelerating their growth (or keeping them undifferentiated).
• Cellulite is a common condition which represents a certain outward appearance of the skin in certain anatomic areas — most commonly on the upper legs and hips which is widely regarded as cosmetically undesirable.
• Cellulite is the result of a certain anatomic configuration of the skin and underlying soft tissues and fat which may involve abnormalities of circulation or microcirculation or metabolic abnormalities — predominantly in the fat and supporting tissues.
• Photomodulation or photothermal treatments of the adipocytes (fat cells) or their surrounding supporting structures and blood supply alone or in combination can reduce the appearance of cellulite and/or normalize the structure and function of the tissues involved with the cellulite.
• Photomodulation of adipocytes can be performed using endogenous chxomophores suche as the adipocytes themselves, their mitochondria or other targets within the adipocyte electron transport system or respiratory chain or other subcellular components.
• Exogenous light or electromagnetically activated chromophores can also be photomodulated (photoactivated or photoinhibited) or photothermal interactions can also occur. Examples of such chromophores are listed elsewhere in this application and can be topically or systemically introduced into the target tissues or adipocytes or surrounding blood vessels.
• the use of externally or internally applied ultrasound can be utilized either to enhance delivery of the chromophore or to alter local circulation or to provide thermal effect or to provide destructive effect or any combination of these actions.
• the chromophore is delivered into the fat layer under the skin on the thigh using external ultrasound to enhance skin permeability and also enhance transport.
• the alteration of the stratum corneum alone or in combination with the ultrasound can further enhance delivery of the chromophore.
• External massage therapy from various techniques can be used to enhance the treatment process.
• chromophore is injected into the fat layer prior o treatment with light. Some light therapy with or without ultrasound may be used to photomodulate or photothermally or ultrasonically increase or otherwise alter the circulation or microcirculation or local metabolic processes in the areas affected by cellulite or other tissues. The proper light parameters are selected for the target adipocytes, blood vessels, exogenous chromophores, etc.
• Additional topical agents for inhibiting hair growth include inhibitors of ornithine decarboxylase, inhibitors of vascular endothelial growth factor (VEGF), inhibitors of phospholipase A2, inhibitors of S — adenosylmethionine.
• VEGF vascular endothelial growth factor
• Specific examples of these, but not limited to, include licorice, licochalone A 3 genestein, soy isofiavones, phtyoestrogens, vitamin D and derivatives, analogs, conjugates, natural or synthetic versions or genetically engineered or altered or immunologic conjugates with these agents.
• topical agents exogenous light activated chromophores and treatments described fro cellulite above also are hereby incorporated into methods for reducing the growth of hair.
• Increasing the circulation or microcirculation of the hair bearing skin may also be accomplished by simply producing vasodilation by any method know to those skilled in this art.
• topical agents which might be used to create such vasodilation include, but are not limited to: capsicum, ginseng, niacinamide, minoxidil, etc.
• compositions that may be administered topically or systemically, in accordance with any embodiment of the invention disclosed here may include Vitamin C, Vitamin E, Vitamin A, Vitamin K, Vitamin F, Retin A (Tretinoin),
• a team of blinded expert graders viewing before and after photos of patients subjected to the non-ablative LILT ("Low Intensity Light Therapy") of the present invention score the global improvement of visible acne prominent in the facial area.
• the treatment includes subjecting the target area of the patient's skin that has been treated with the topical composition to a filtered fluorescent light operated continuously and providing full-face coverage, i.e., the entire face of the patient is subjected to the light from the light source.
• a filtered fluorescent light operated continuously and providing full-face coverage, i.e., the entire face of the patient is subjected to the light from the light source.
• Thermal injury is produced with blood vessels included among the target chromophores (but no skin wound care is needed).
• the average reduction in acne is shown in Table 1.
• the light source has a dominant emissive wavelength in the range of 410 nm to 420 run and is centered at 415 nm.
• a team of blinded expert graders viewing before and after photos of patients subjected to the non-ablative LILT ("Low Intensity Light Therapy") of the present invention score the global improvement of visible acne on the facial area.
• the laser diode treatment includes subjecting the target area of the patient's skin that has been treated with the topical composition to a laser diode light having a pulse width of 800 msec and a pulse frequency of 1 hz (1 pulse per second). Three pulses are administered. Six treatments over 12 weeks to the entire face with 400 nm laser diode with a 10cm beam diameter at an intensity ranging 2500 milliwatts/cm2. The average reduction in acne is shown in Table 2.
• the topical treatment includes applying the carotenoid composition containing about 5% carotenoids in a liposome carrier (alternatively, microsponges can be used having an average diameter of 5 microns) to the skin of the facial area and allowing it to penetrate the stratum corneum for approximately 15-20 minutes prior to beginning treatment.
• the first step in the treatment process is to expose the facial area to a continuous wave from a filtered metal halide lamp having a dominant emissive wavelength, i.e., an emission peak, at about 415nm +/- 5nm and an energy output of lOOmW/cm 2 for approximately 10 minutes.
• the patient's facial area is then exposed to a pulsed LED treatment includes subjecting the target chromophore fibroblasts and subcellular components thereof to LED light having a pulse width of 250 msec and a pulse spacing of 250 msec for 90 pulses.
• this dual-source treatment method employs the metal-halide light source to treat the active acne and the LED source to reduce or eliminate the visibility of acne scars.
• a team of blinded expert graders viewing before and after photos of patients subjected to the non-ablative LILT ("Low Intensity Light Therapy") of the present invention score the global improvement of visible acne scarring.
• the LED treatment includes subjecting the patient's skin to a LED light having a pulse width of 250 msec and a pulse spacing of 250 msec for a period of 90 pulses. Eight treatments over 16 weeks to the entire face with 590 nm multichromatic LED at an intensity ranging from 1.0 - 2.0 ⁇ Watts. Having a bandwidth of +/- 5-15nm, the LED therefore produces light in the wavelength range of from 575nm to 605nm. Further, the treatment maintains a skin temperature below the threshold of thermal injury. The average reduction in visible acne scarring is shown in Table 4.
• a method for treating acne by a combination of photothermal and photomodulatory treatment is used to reduce the presence of acne bacteria, resulting in a substantial reduction in the existence of acne on the facial area.
• dual chromophores are targeted a native, naturally occurring porphyrin in acne and an exogenous chromophor.
• Pretreatment is performed using a topically applied chromophore.
• the topical chromophor is an aqueous solution of Na Cu Chlorophyllin and carotenoids is applied to the skin.
• the skin is first cleansed with a low residue cleansing solution and then a pH adjusting astringent lotion is applied by a 5-10 minute application of an enzyme mask for removing skin debris and a portion of the stratum corneum.
• the topical chromophore is applied and delivery of the chromophore is enhanced with a 3 megahertz ultrasound emitter using a duty cycle of 25% and 1.5 watts output using a massage-like motion to cover the entire face for 5 minutes and the shoulders for 5 minutes. Any excess lotion is then removed.
• the cleansing solution used for this example should include at least 40% of an acetone, ethyl acetate, or ethyl/isopropyl alcohol solvent, from about 1% to about 4% salicylic acid as a penetrate enhancer, and about 5% glycerin, included as a moisturizer.
• a filtered fluorescent light source having a dominant emission at 420nm is set to emit continuously for 20 minutes at an intensity of 10 Joules/cm 2 .
• the entire face and upper back of the patient is treated with minimal overlap during each of 6 treatment sessions, each spaced two week apart. Approximately an 85% reduction in acne is observed.
• Example 5 The treatment method of Example 5 is carried out.
• the patient continues the treatment at home using a home-use device comprising a hand-held LED device, a lotion containing an aqueous solution of about 2%, by weight, chlorophyll and about
• the patient applies a chlorophyll-containing topical solution to the areas previously treated for acne scarring once per day, preferably but not necessarily in the morning.
• a sunscreen typical of those known in the art except that it is formulated to permit the passage of radiation having a wavelength in the range of about 400nm to about 420nm and 600nm to about 660nm to allow natural sunlight to further aid the treatment process.
• the carotenoids provide protection to the skin against damage from ultraviolet radiation received from sunlight.
• the patient uses the hand-held LED device 1-2 times per day.
• the LED device emits radiation having a dominant emission at about 644nm +/- 5nm at an energy output of approximately 20 microwatts in a continuous wave.
• Each treatment session covers active acne lesions for acne lesions for approximately 2 minutes. A further reduction in the visibility of acne scarring is observed. Additional improvement in acne scar reduction can be achieved using a 590 nm multichromatic LED at an intensity ranging from 1.0 - 2.0 ⁇ Watts as described in prior examples.
• An LED array includes both blue LEDs having a dominant emission at 415 nm to treat active acne and yellow LEDs having a dominant emission at 590 nm to treat acne scarring.
• the skin is pretreated in the same manner as described in Example 5.
• the LED array is then positioned to cover the entire facial area of the patient with a 20 minute continuous wave of blue light (415 nm) and an exposure of yellow (590 nm) light pulsed on for 250 millseconds and off for 250 milliseconds. Approximately 100 pulses are delivered.
• Female skin exhibiting active acne rosacea and numerous sebaceoushyperplasia lesions is treated with a metal halide light source having a dominant emission centered at 415nm 47- 5nm and an energy output of lOOmW/cm 2 for approximately 10 minutes after having been treated with a topically applied composition containing chlorophyll and carotenoids as the active ingredients.
• a topically applied composition containing chlorophyll and carotenoids as the active ingredients.
• a mixture of 2.0% chlorophyll a and b, 6.0% carotenoids (carotenses and xanthophylls) and 1.5% phycobilin is used. All percentages are by weight.
• Three treatments are administered at two-week intervals. Visual inspection shows a reduction in sebaceous gland size of 40%-60%.
• An LED array includes both blue LEDs having a dominant emission at 415 nm to treat active acne and yellow LEDs having a dominant emission at 590 nm to treat acne scarring.
• the skin is pretreated in the same manner as described in Example 5.
• the LED array is then positioned to cover the entire facial area of the patient with a 20 minute continuous wave of blue light (415 nm) and an exposure of yellow (590 nm) light pulsed on for 250 millseconds and off for 250 milliseconds. Approximately 100 pulses are delivered.
• Figure 5 illustrated the result of an experiment to determine the response of cells that have been injured by UVAl light exposure (360 nm to 400 run). Cells exposed to UVAl light and receiving an energy fluence of 1.4 J/cm2 suffered a death rate of approximately 52%. Eight minutes after exposure to the UVAl light, cells treated with a dual wavelength pulsed treatment according to the present invention at
• Figures 7 and 8 illustrate the effects of treatment of wet macular degeneration according to the present invention.
• the treatment was performed on an elderly woman and employed a dual wavelength pulsed, treatment according to the present invention at 590 nm and 870 nm (simultaneously) using a 250/100/100 pulse code.
• Fig. 8 illustrates changes in the eyes of the subject, taken two weeks after the photographs of Fig. 7. Treatment was administered twice weekly and, afterward, the subject reported improvement in visual recognition and perception.

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