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Further support for PBM's usefulness in treating AMD patients stems from a prospective interventional case series of 18 eyes of 9 patients with dry AMD carried out by Merry G. , titled "Treatment of dry age-related macular degeneration with photobiomodulation" and presented at the 2012 ARVO Annual Meeting in Fort Lauderdale, FL. The PBM treatment there consisted of irradiation by the LED-based devices Warp 10 (Quantum Devices) at 670 nm, for 88s, delivering 4-7.7 J/cm2 and Gentlewaves (Light Bioscience) at 590 and 790 nm, for 35s, delivering 0.1 J/cm2 per treatment. All 18 eyes were treated sequentially with both devices each time for a total of 18 treatments (3 times per week for 6wk), with no adverse effects. There was statistically significant improvement in VA, by 1.5 lines on average, and in contrast sensitivity, with no changes on their third primary outcome-fixation stability. Finally, a new US-based clinical trial is currently recruiting participants in order to study the potential benefit, tolerability, and safety of FR/NIR light therapy in adults with wet AMD ("Wet AMD Near Infrared Treatment Trial" administered by the New York Eye and Ear Infirmary at Mount Sinai). Hopefully, this trial will be able to address the drawbacks, such as insufficient controls, in prior studies. Diabetic retinopathy After having demonstrated the beneficial effects of PBM in animal models of diabetes, Tang [22] translated the approach to human patients. In their internally controlled consecutive case series, 4 eyes of 4 patients with type 2 diabetes with non-center-involving diabetic macular edema (NCDME) underwent treatment with 670 nm light delivered by Warp 10 through a closed eyelid for 80s twice a day for 2-9mo, with total energy density of 25 J/cm2. The second eye in each patient served as the internal control and was not treated. The treated eyes of all patients demonstrated statistically significant decrease in macular thickness by an average of 20% , while the non-treated eyes featured a slight increase in the thickness by 3% on average. One of the patients experienced sectoral optic nerve hyperemia and edema in their treated eye which was consistent with non-arteritic ischemic optic neuropathy (NAION). However, this occurrence might not have been related to the PBM treatment since prior to the study the patient had risk factors for NAION, including diabetes, hypertension, a small cup-to-disc ratio, a history of proliferative diabetic retinopathy treated with pan-retina photocoagulation 4y prior to study, and CDME treated 3y earlier with focal laser. Tang 's [22] small case series is the first one to demonstrate a benefit of PBM to the patients with NCDME. Further investigations, using larger patient populations, will be necessary to establish the optimal treatment dose and duration, as well as identify and address potential safety concerns. Amblyopia in adolescents and adults A well-known feature of amblyopia is that it becomes untreatable after the "critical period", which ends after the first-decade of life. Fortunately, there is evidence that amblyopia in older patients could benefit from PBM. This was demonstrated by Ivandic and Ivandic[23] in their patient-blinded placebo-controlled trial of adolescent and adult patients (age range of 13-72y and a mean of 46.8y) with pre-treatment BCVA of at most 20/30 (range of 20/30 to 20/400). Among the 231 treated eyes of 178 patients in that study, the cause for amblyopia was ametropia in 110 eyes and strabismus in the remaining 121 eyes. Of these, 20 eyes of 20 patients received mock treatment and served as controls. The other 211 eyes underwent 3-4 treatments over a 2-week period, for 30s each with 780 nm light emitted by a continuous-wave semi-conductor laser diode delivering 0.22 J/cm2 per treatment. While there was no change in the VA among the control patients, the ones treated with PBM experienced a marked improvement. Of the patients with ametropia, 91% had an average increase in VA of 3 lines (range 1-7 lines) and of the patients with strabismus, 89% demonstrated VA improvements of 2.7 lines on average (range 1-7 lines). The beneficial effect was retained during the 6-month follow-up period. Moreover, one of the patients with strabismus and pre-treatment BCVA of 20/100 was followed for a total of 13 years during which 2 re-treatments were necessary to maintain the VA at the 20/25 level. However, it was noted that PBM led to more VA improvement in younger patients (less than 18y of age). Also, the increase in VA correlated with the pre-treatment baseline VA, where patients with severe ocular pathology, such as VA less than 20/200 or eccentric fixation, experienced little-to-no improvement. Overall, the Ivandic and Ivandic [23] study provides strong evidence for the application of PBM to treat amblyopia past the "critical period", with no therapy-related ocular or systemic side effects. In terms of the mechanism through which this treatment operates to improve VA in amblyopic eyes, the authors speculated that it might be similar to those at work in other retinal conditions, such as increase in cellular metabolism. Also, PBM might be stimulating inter- neuronal communication promotion of synaptogenesis. Retinitis pigmentosa It might also be possible to apply PBM to treat RP, which is the most common cause of inherited retinal degeneration with non-syndromic prevalence of approximately 1 in 4000 [55-56]. The evidence for this is currently scarce and consists of a single case report of a 55-year-old patient with advanced bilateral retinitis pigmentosa (RP) whose VA prior to intervention was 20/50 bilaterally, with visual fields reduced to the central 5 degrees[57]. He was treated with transconjunctival illumination of the whole retina with 780 nm light, generated by a continuous- wave laser diode, for 40s for a total of 0.4 J/cm2 per treatment, 陨灶贼 允 韵责澡贼澡葬造皂燥造熏 灾燥造援 9熏 晕燥援 1熏 Jan.18, 圆园16 www. IJO. cn 栽藻造押8629原愿圆圆源缘员苑圆 8629-82210956 耘皂葬蚤造押ijopress岳员远猿援糟燥皂 149PDF Image | Photobiomodulation for the treatment of retinal diseases
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