Retinitis pigmentosa

Clinical Case Study: Retinitis Pigmentosa and coMra Therapy

This case study details the treatment of a 57-year-old female patient diagnosed with retinitis pigmentosa (RP). The patient, who also has a history of HIV and borderline diabetes, presented with a history of steadily diminishing peripheral vision, significant difficulty with night vision, and challenges adjusting to light changes, which resulted in frequent falls.

Patient History and Initial Presentation

The patient was first seen in 1999 following an arterial venous malformation (AVM) bleed. While she was treated with vision therapy at that time, she was not seen again for several years. In 2008, abnormal retinal pigment epithelium findings were noted, leading to a referral to an ophthalmologist who diagnosed pigmentary degeneration. By March 2014, the patient was formally diagnosed with retinitis pigmentosa by the University of California, San Francisco (UCSF).

Upon returning to the clinic in 2014, the patient reported that her vision was rapidly deteriorating and she had been told by specialists that she would eventually go blind. Her initial objective findings were as follows: * Visual Acuity: Slightly reduced (20/30). * Contrast Sensitivity: Significantly depressed, with no function at high spatial frequencies and impairment at medium and low frequencies. * Color Vision: Moderately impaired. * Depth Perception (Stereopsis): Significantly impaired (200 seconds). * Visual Field (Goldmann): Severely impaired. * OCT (Optical Coherence Tomography): Showed severe loss of outer retinal layers throughout the macula and peripheral retina. * ERG (Electroretinogram): Severely reduced levels, indicating diffuse outer retinal dysfunction affecting both rods and cones.

The patient’s case was considered atypical due to the lack of family history and the late onset of symptoms, as RP typically manifests in the late teens and progresses through the 20s and 30s.

Treatment Protocol: Microcurrent and coMra Therapy

The initial treatment approach utilized Frequency Specific Microcurrent (FSM), as developed by Carol McMakin. The patient received five weekly, 37-minute sessions. Following the fifth session, the patient reported increased confidence in her vision, and re-measurement of her visual fields showed significant improvement.

Encouraged by these results, the treatment plan was expanded to include coMra therapy using the coMra Delta laser. While initial caution was exercised regarding the application of laser therapy to the eye, research into clinical trials – specifically those conducted in Russia by Evonik and others – demonstrated the safety and efficacy of direct application through the closed eyelid for conditions like RP and macular degeneration.

The treatment protocol evolved as the patient’s progress was monitored: * Initial Protocol: Universal 1 (1 minute, lateral aspect, through the closed eyelid). * Intermediate Protocol: Added the Optic Neuritis protocol, involving a scanning motion at the temple and above/below the orbital ridge. * Final Protocol: A combination of Universal 1 (1 minute) and the Optic Neuritis protocol (2 minutes superior/lateral), with all applications utilizing a continuous scanning motion.

Results and Observations

Over the course of 14 sessions combining coMra therapy and FSM, the patient experienced dramatic improvements: * Visual Fields: A massive expansion was documented, with the visual field increasing from approximately 10–15 degrees to 40–50 degrees. * Contrast Sensitivity: Testing showed a return to the normal range, a significant improvement from the initial severely depressed levels. * Depth Perception: Improved from 200 seconds to 63 seconds. * ERG: Follow-up testing at UC Berkeley showed the emergence of responses, particularly to the 30Hz flicker, which had been flatlined initially. * Subjective Feedback: The patient reported increased emotional well-being, improved peripheral vision, better performance on stairs, and greater speed and confidence in daily activities.

Long-term Management

When the treatment frequency was reduced to every two weeks, the patient’s visual fields began to decline. Upon returning to a twice-weekly treatment schedule, the patient regained some of her previous improvements, though she did not fully return to the peak levels observed in August.

This case is highly unusual, as retinitis pigmentosa is a progressive, degenerative condition where improvement is typically not expected. The ophthalmologists at UCSF expressed satisfaction with the patient's response, acknowledging the objective improvements documented through external testing. The current goal of the treatment is to continue supporting the patient’s remaining vision and slowing the progression of the disease.