(Reprinted from Living with Glaucoma, Vol. 25, No. 2, Winter, 2011)
We who have lost sight in one or both eyes have longed for a breakthrough in stem cell replacement, but truth to tell, maybe we have been waiting for this simpler method for increasing the vision we already have—of enhancing the window of vision still available to us. That this possibility exists was dynamically demonstrated on October 15, 2011, at the Glaucoma Support Group at NY Eye and Ear Infirmary, by Ronald Siwoff, OD, CEO, of the Siwoff Low Vision Center. Dr. Siwoff is a pioneer in the field of vision enhancement. He and his staff practice methods markedly different from other low vision specialists in a number of ways. The most important and unique approach, however, is that of cognitive vision rehabilitation incorporating a holistic approach.
The eye, as we glaucoma patients well know, does not operate in a vacuum. The act of seeing is intricately connected with the overall health of the body, the oculomotor system, neuroreceptors and visual perceptual processing in the brain.
When in prehistoric times did vision begin? According to what has been established, vision was one of the earliest of the senses to appear in life forms. As many of you may know, the embryo repeats the process of development through various stages, beginning with the combining of spermatozoa and ovum. Dr. Siwoff pointed out that during the embryonic stage, one of the first sensory organs visible are the eyes, an indication of the importance of this sense. Dr. Siwoff also emphasized that we do not see with our eyes but with our brain. The eye itself is simply a conduit for information from the visible world to the visual cortex located in the occipital lobe in the back portion of the brain. Through a series of cellular processes, ganglion nerves (at least 60 identified) this information reaches the brain. The brain is the focus of Dr. Siwoff’s treatment for enhancing sight. We are pleased to report that Dr. Siwoff offers a solution for both macular degeneration as well as glaucoma.
Macular degeneration, the leading cause of blindness in the United States, has been at the center of many new treatments; including Lucentis injections for the wet type of AMD. Another new therapy being tested, is stem cells converted into retinal pigment epithelial cells, which are transplanted under the retina. Dr. Eugene DeJuan invented a surgical technique, called RT Therapy (Retinal Translocation Therapy). The Macula is surgically detached and then re-attached to a healthy area of pigment epithelium. Dr. Siwoff developed a non-invasive treatment that eliminates the risk of surgery, but provides a similar outcome. Dr. Siwoff calls his technique RIT therapy (Retinal Image Translocation) to honor the work of Dr. DeJuan. Dr. Siwoff uses a high-resolution digital retinal camera. He then designs custom prismatic spectacles to locate the healthy retinal tissue from the diseased retina. This therefore restores functional vision.
Patients with RIT spectacles receive a home rehabilitation program and are followed up at six weeks. Typically, patients keep getting better. As they become comfortable with the glasses, they find themselves improving in distance vision as well as near acuities. This gradual improvement continues up to three months and may even longer.
Glaucoma and other eye-debilitating events such as stroke, head injuries and optic nerve disease cannot be helped by RIT therapy because a retinal fundus photo does not show where to move the prism in order to bend light to the area of maximum sensitivity. Dr. Siwoff has invented a technique for these patients, Using a technology called Visually Evoked Potential (VEP). This equipment uses e.e.g.’s to track signals from the eye to the brain. Using information from the VEP, prisms can be very useful tool for correcting vision problems with this new technique. Although prisms have been used by eye doctors for many years, Dr. Siwoff’s applications are new, highly refined and customized for each patient. Preliminary results show that the special eyeglasses provide neuro-stimulation to the visual cortex. VEP results over time show objective improvement.
The new technology will be made available to eye specialists. The specialists will be able to locate the best retinal area of visual response through the use of the VEP. Some of you may recall one of our workshops a few years back when a lecturer described this technique as a possible visual field assessment tool, one that is objective rather than subjective. VEP equipment has been used in other fields for years to determine whether or not a person can see. Pediatricians have used it with newborns for this purpose. Dr. Siwoff’s new technique expands the information we can gather in order to help children and adults with serious visual impairments.
VEP involved placing of electrodes on several places including the occipital lobe, the vision center of the brain. The patient is placed in front of a pattern of visual stimuli (light patterns) with an EEG amplifier, and a computer that separates and highlights visual response.
The use of the prescribed prism lenses has produced larger and more rapid signals to the brain, as well as better vision over time. Patients are given a home-based program of training with their prism glasses. This training is necessary because research has shown that it takes six weeks for the brain to learn alternative visual pathways. Dr. Siwoff has been studying the effects of this therapy for several years. In his original study, of 68 patients for both near and far vision, two patients possessing only hand-motion demonstrated substantial improvement—one patient improved to 20/120 and the other to 20/50. The average gains were less extreme yet almost all were positive.
The importance of this is not only in the application of treating vision loss, but it also tells us more about the plasticity of the human brain. All patients with some degree of instruction and practice can learn new visual skills to read, walk, view TV and computers, drive and just pay attention to their environment. The Siwoff Low Vision Center provides strategies, aids, lessons and homework all geared to increase functional vision for home and community activities of daily living and work.
The low vision exam at Siwoff Low Vision Center involves taking of the medical history and assessment of the medical, physical and visual health of each patient. Dr. Siwoff designs and creates custom low vision aids, spectacles, contact lenses, special tints for lenses, and intervention strategies to enhance vision.
We want to thank Dr. Siwoff for his dynamic presentation offering hope for vision restoration to those of us who have lost some sight. His lecture was inspiring and those who attended were generally moved. We also want to thank Rachel Rose Siwoff, for her support and encouragement. Rachel Rose Siwoff is a licensed professional counselor at Siwoff Low Vision Center. She is responsible for designing strategies for patient education.
The Siwoff Low Vision Center is located at:
385 State Route 24 (E Main St), Suite 2D
Chester, NJ 07930