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New approach to foveal holes: Light, sound, and nutraceuticals

Digital EditionOphthalmology Times: May 2023
Volume 48
Issue 5

Macular hole closure results from this novel treatment.

Light flare. Old film. Weathered overlay. Orange blue white rainbow color glow dust scratches noise on dark black illustration abstract empty space background(Image Credit: AdobeStock/Made)

(Image Credit: AdobeStock/Made)

Reviewed by Roberto Pinelli, MD

A new investigational technique administers a combination of light and sound with nutraceuticals to the retina of a patient with a macular hole.1 This procedure has a remarkable effect on the retinal anatomic architecture affected by the macular hole and ultimately results in hole closure without the need for surgery, according to Roberto Pinelli, MD, founder of the Switzerland Eye Research Institute in Lugano.

Pinelli, in a recent paper, explained that ultrasound and photobiomodulation were applied after a vibrational field to stimulate existing stem cells instead of inserting them into the eye.

Case report

A 79-year-old healthy woman presented for an eye examination in January 2021 and received a diagnosis of idiopathic macular hole. At that time, her uncorrected decimal visual acuity (VA) was 1/10 and the best-corrected VA was 4/10, and she had a slight central metamorphopsia. The idiopathic macular hole was caused by vitreal degeneration with traction on the fovea.

Following a detailed explanation, she consented to a noninvasive treatment with pulsatile stimulation with sound and light (photobiomodulation) with oral intake of phytochemicals.

During and after treatment, she received optical coherence tomography (OCT) imaging to assess the time course of the volume and integrity of the surrounding or inner tissue replacement of the macular hole. Retinal topography calculated the thickness of the various retinal layers and the empty area in the hole. She also underwent subjective visual tests, including the Jaeger Eye Chart test and Snellen Eye Chart test to measure the best corrected VA for near and far, the Amsler Grid Eye Test to detect visual distortion, and the Pelli-Robson Chart test to measure contrast sensitivity, Pinelli said.

While reclining in a chair, the patient underwent a session of low-sound, near-infrasound frequency acoustic stimulation consisting of sound waves in a range of 20 to 174 MHz. The sound waves were applied at progressively increasing frequency up to 174 MHz, at which point the stimulation was continued and the frequency remained steady. The sound stimulation periods lasted 90 seconds.

Pinelli noted that the periodic stimulations were repeated during the same day (7 periods of acoustic stimulation delivered at 30-second intervals with intervals of acoustic silence) for a total of 15 minutes.

The subjective intensity (dB) of the acoustic stimulus depended on the frequency and delivered between 20 and 30 dB through commercial Beats headphones. Two months after the end of the acoustic stimulation, OCT was carried out and the VA measured.

Moreover, Pinelli explained that because partial results were obtained with sound stimulation, he added photobiomodulation in the same single session and also added phytochemicals, which were administered for 6 month as natural nutraceutical waves.1

The anatomic recovery was almost complete at approximately 1 year after the diagnosis and the beginning of treatment. The structural healing of the macular hole was concomitant with a strong VA improvement and resolution of the metamorphopsia.

Treatment rationale

Pinelli explained that there is evidence that specific wavelengths activate the autophagy pathway in the retina, prompting the recovery from traumatic neuronal damage.

“Among numerous biochemical cascades that regulate neuronal integrity in the retina, the autophagy machinery plays a seminal role in maintaining cell survival and sustaining retinal anatomy, including plasticity,’ he said. “This is in line with the involvement of impaired autophagy in producing a variety of retinal disorders.”2-4

Pinelli said he capitalized on those effects that elicit autophagy using light therapy with autophagy-activating phytochemicals to address the foveal damage produced by the vitreal mechanical traction that generated the foveal hole.

Pinelli also explained the study was implemented by pulsatile sound stimulation based on the recent evidence that autophagy and retinal stem cells stimulation induced by light exposure is amplified by acoustic biofeedback therapy.

“In fact, the pulses of sounds of various wavelengths stimulate tissue regeneration, and such an effect is largely grounded on the stimulation of stem cell via upregulation of autophagy,” he concluded.5-8 “Altogether this evidence tempted us to probe the efficacy of a noninvasive multimodal physicochemical approach to promote substance recovery and anatomical reorganization in a case of idiopathic macular hole that was treated according to the trademarked advanced Lugano protocol.”

Roberto Pinelli, MD
E: pinelli@seri-lugano.ch
Roberto Pinelli, MD, is founder of the Switzerland Eye Research Institute in Lugano, Switzerland.
1. Pinelli R, Berti C, Scaffidi E, et al. Combined pulses of light and sound in the retina with nutraceuticals may enhance the recovery of foveal holes. Arch Ital Biol. 2022;160(1-2):1-19. doi:10.12871/000398292022121.
2. Pinelli R, Bertelli M, Scaffidi E, et al. Nutraceuticals for dry age- related macular degeneration: a case report based on novel pathogenic and morphological insights. Arch Ital Biol. 2020;58:24-34. doi:10.12871/00039829202013
3. Pinelli R, Bertelli M, Scaffidi E. The first clinical case of dry age-related macular degeneration treated with photobiomodulation and nutraceuticals: a protocol proposal. CellR4. 2020;8:e2833. doi:10.32113/cellr4_20204_2833
4. Intartaglia D, Giamundo G, Conte I. Autophagy in the retinal pigment epithelium: a new vision and future challenges. FEBS J. 2022;289(22):7199-7212. doi:10.1111/febs.16018.
5. Foglietta F. Canaparo R, Francovich A, et al. Sonodynamic treatment as an innovative bimodal anticancer approach: shock wave-mediated tumor growth inhibition in a syngeneic breast cancer model. Discov Med. 2015;20(110):197-205.
6. Zhou HY, Li Q, Wang JX, et al. Low-intensity pulsed ultrasound repair in mandibular condylar cartilage injury rabbit model. Arch Oral Biol. 2019;104:60-66. doi:10.1016/j.archoralbio.2019.05.018
7. Xia P, Wang Q, Song J, et al. Low-intensity pulsed ultrasound enhances the efficacy of bone marrow-derived MSCs in osteoarthritis cartilage repair by regulating autophagy-mediated exosome release. Cartilage. 2022;13(2):19476035221093060. doi:10.1177/19476035221093060
8. Wang X, Lin Q, Zhang T, et al. Low-intensity pulsed ultrasound promotes chondrogenesis of mesenchymal stem cells via regulation of autophagy. Stem Cell Res Ther. 2019;10(1):41. doi:10.1186/s13287-019-1142-z
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