REVIS ('Restoration of Vision after Stroke'): development of treatment for people with loss of vision
A man sits at a machine called a Humphrey, his head leans on the machine as his finger clicks when he sees a light pulses. He tells us in voiceover to the images we are watching:
"I have glaucoma and I've been clicking for almost 20 years. You can see how the disease is robbing me of my sight."
The man is Joe Lovett and he's made a film, "Going Blind" which in part charts his experience with a revolutionary new treatment at the University of Magdeburg. A programme led by Professor Dr Bernhard Sabel PhD, a Professor of Medical Psychology at the University of Magdeburg. Joe shows us what it's like to walk a few yards in a partially sighted person's shoes. Colours and vision blurs, at night the cars meld into concentric circles which melt and fold and move in front of us. Nothing is clear. It's like, as Lovett remarks, “looking through permanently dirty glasses,” it's disorientating, debilitating and depressing.
Lovett tells us that his ability to see with his left eye is particularly impaired and that no treatment in the US can reverse vision loss or nerve damage. But in Germany, with the help of ERA-NET NEURON funding, the scientists appear to be doing what at first seemed impossible. He goes first to Dr Anton Federov, PhD, a Russian neurologist who is now on Professor Sabel's team in Magdeburg.
Professor Sabel explains that the treatment works on sending a very low alternating current through four electrodes attached around the eyes, through the optic nerve and on to the brain. The theory is that it is not just primary tissue damage which causes loss of vision but also the loss of connecting pathways within the brain. EEGs and scans show that in partially sighted or blind people, the neural pathways are much more limited to the central brain cortex and do not make connections like in a sighted person from the front lobes to the back and vice versa.
This is not really a magic bullet, creating vision where there is none but as Sabel underlines:
"It's these areas of partial function, where vision is not absent but not normal which gives us an opportunity for restoration and repair." The electricity helps to stimulate the brain's ability to interpret the data coming in through the damaged optic nerve and therefore opens up more fields of potential vision.
'Use it or lose it'
The study, published in July 2014 in Neurology, that Michal Bola, Sabel et al. undertook looked at 15 people. Not everyone benefitted from the treatment but the results seem nevertheless impressive. After just 10 days of the electrode treatment, the average showed that 41% of the visual field loss had shrunk. 60% enjoyed better vision in the impaired visual field sector. 70% of patients reported subjective improvement although one third of patients showed no improvement at all.
Just like with exercising muscles or our bodies, the study, which also drew on over 20 years of neurological expertise from the St Petersburg Brain Centre works on the principle of "use it or lose it." Brain synchronization is encouraged through the low level electrical stimulation and once those pathways have been stimulated, it seems the subjects were able to keep on improving. One scan showed that the visual field actually improved 10 days after the end of the treatment and then more than doubled again to 23% by 60 days after the treatment.
The currents applied are individual to each patient and are lower than the kind of current used in a pacemaker. Patients at the SAVIR centre, which administers the treatment, sign up for 10 days, administered twice daily for five days, with a weekend break and then again for a second period of five days. Side effects, according to SAVIR are minimal; mild headaches and temporary sleep disturbances.
The treatment is recommended for people with loss of vision following a stroke, brain trauma, optic nerve or retina diseases, glaucoma, AMD or Amblyopia.
Mr Lovett experienced a significant improvement. He was able to read; he says blurring has reduced and the "smudginess of my vision has been corrected. When I check my glasses to see if they are dirty, they really are. Glare has been greatly diminished especially from oncoming traffic and in airports and my acuity has improved in both eyes."
By the end of the treatment, the black areas in the centre of his vision have moved back slightly given him more central vision, the darker grey areas have lightened or turned white and more spots around his eye seem to experience at least some sight.
Professor Sabel wants this kind of treatment to help "change our thinking about how to treat brain functions." He believes, "we should take advantage of the tremendous plasticity that the brain has. That's why it's great to get together with other collaborating research institutions to work together to shape the future of neurological treatment and therapy." He hopes that will bring even more new treatment options, "which previously hadn't been thought of and which would allow them to help many many patients in the years to come."
The international research projects was funded under the framework of the ERA-NET NEURON.
Story written by Emma Wallis.
Prof. Bernhard Sabel, Otto-.v.-Guericke University of Magdeburg, Germany, funded by the Federal Ministry of Education and Research, Germany
Prof. Paolo M. Rossini, IRCCS S. Raffaele Pisana, Rome, Italy, funded by the Ministero della Salute (Ministry of Health), Italy
Prof. Turgut Tatlisumak, Helsinki University Central Hospital, Helsinki, Finland, funded by Suomen Akatemia (Academy of Finland), Finland
Prof. Wioletta Waleszcyk, Nencki Institute of Exp. Biology, Polish Academy of Science, Warsaw, Poland, funded by Narodowe Centrum Badań i Rozwoju (The National Centre for Research and Development), Poland
- Prof. Bernhard Sabel, Otto-.v.-Guericke University of Magdeburg, Germany, funded by the Federal Ministry of Education and Research, Germany
- Prof. Paolo M. Rossini, IRCCS S. Raffaele Pisana, Rome, Italy, funded by the Ministero della Salute (Ministry of Health), Italy
- Prof. Turgut Tatlisumak, Helsinki University Central Hospital, Helsinki, Finland, funded by Suomen Akatemia (Academy of Finland), Finland
- Prof. Wioletta Waleszcyk, Nencki Institute of Exp. Biology, Polish Academy of Science, Warsaw, Poland, funded by Narodowe Centrum Badań i Rozwoju (The National Centre for Research and Development), Poland
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