“RETINAL IMAGE TRANSLOCATION (RIT) THERAPY”
Millions of people who are legally blind as the result of macular degeneration, diabetic retinopathy, retinitis pigmentosa and other retinal diseases can have hope, because of a new form of rehabilitation therapy called RIT (Retinal Image Translocation) therapy. RIT therapy is a nonsurgical noninvasive method of restoring functional vision. The treatment was invented and developed by Ronald Siwoff, OD, FAAO, Director of Siwoff Low Vision Center, PC, in Chester, New Jersey, and formerly Director of Low Vision at St. Barnabas Medical Center in Livingston, and Assistant Professor of Ophthalmology at University of Medicine and Dentistry of New Jersey.
“RIT therapy was not possible until now because it requires a new technology using high resolution digital photography. With these new cameras, we are able to pinpoint healthy areas in otherwise damaged and scarred retinas” said Siwoff. Once these “windows” of peripheral vision are located, custom prismatic lenses can relocate the retinal image to a healthy spot and away from retinal scar tissue. The custom prismatic spectacles give the appearance of restoring central vision. The macular patient, for example, no longer has to turn his head to the side to see, but rather can see more normally out of the center of his eyeglasses.
Many eye doctors have some knowledge of how prisms work, but their training in use of prisms was limited to older failed methods of using them to correct vision loss. Previous methods relied on subjective reports from the patient himself, who was asked to self-align a prism trial lens until the visual image became clearer. What seemed to be a good correction at one time was an undesirable correction at the next exam. There were two problems with this technique: (1) it relied on subjective reports rather than objective findings, and (2) patients’ results were inconsistent and often ephemeral. Because these problems appeared to have no answers, most eye specialists simply abandoned the use of prisms, preferring to teach their patients to “view eccentrically”, i.e., to turn the head. The eccentric viewing method opened up safety issues. For example, a patient who is required to twist his head to one side to see is at greater risk of bumping into things on the other side.
The first problem above, reliance only on the patient’s subjective reports of where to put the prism, relates to the patient’s lack of awareness of his “island of vision”. This is correctable now that the eye specialist can locate the best area of visual response through the new technology.
The second problem is solved by patient education. The patient needs to know that the visual system of the brain just needs time. Siwoff researched a group of 68 patients, encompassing a wide range of ages and conditions. His findings confirm recent research in optic nerve regeneration (Dong Feng Chen et.al., Schepens/Harvard), which gives evidence that adaptation to new neural input takes about six weeks.
RIT therapy is completely different from the old methods of using prisms for vision correction. Patients with RIT spectacles are given a home rehabilitation program and are seen for followup at six weeks. Typically, patients keep getting better. They become comfortable with the glasses, improve in distance and near acuities, and continue to improve up to three months and even longer.
In Siwoff’s original study, both distance and near vision improved an average of 200%. Two patients with only hand motion had even more remarkable outcomes, one improving to 20/120 with the new glasses, the other improving to 20/50!
In summary, thousands of patients have been helped to see better on a long-term basis through the newest low vision technique of RIT therapy. RIT is an innovative treatment that demonstrates the plasticity of the human brain and its ability to reassign central visual function to the peripheral retina.
“VEP-GUIDED RIT THERAPY FOR OPTIC NERVE DISEASE AND OTHER DISORDERS”
VEP-Guided RIT therapy is our newest discovery and treatment. VEP-RIT developed after our success with RIT therapy for macular diseases. RIT’s discoverer, Ronald Siwoff, OD,FAAO, became interested in optic nerve atrophy, which did not lend itself to retinal mapping for prismatic correction. The typical patient, diagnosed with advanced glaucoma, stroke, head injury, and other trauma to the optic nerve, needed more than relocation of the retinal image. Some are infants with retinopathy of prematurity.
These patients, which include those with developmental and communication disorders, have much more devastating diseases than macular degeneration, because they and their caregivers often cannot tell if they can see at all. The optic nerve, the channel from the visual input (eye) to the visual recognition center (brain) is weakened. Even if the retina looks healthy, these patients may be severely visually impaired.
We have had very promising results by combining Visual Evoked Potential (VEP) with Retinal Image Translocation (RIT). VEP involves placing electrodes on the skull in the area of the occipital lobe, the brain’s vision center. The patient is placed in front of a pattern of visual stimuli (light pattern), and visual brain waves are isolated depicted in the same way as other e.e.g. findings. The VEP equipment has been used for years to determine whether or not a person can see. What we are doing that is entirely new is to use the results in combination with RIT therapy. This is an evolved technical application of VEP.
Patients with such difficult eye diseases as those described above are now wearing glasses and enjoying functional vision. Many parents report that their children with developmental difficulties are progressing well. Older patients are able to achieve greater independence because they can do things for themselves again.
Trainings in RIT therapy and VEP-Guided RIT therapy are available to eye specialists in other areas of the country. Contact us today for more information.