For incurable maculopathy comes hope from infrared rays and electrical impulses
New interventions are paving the way for new treatment options in its intermediate form, giving more hope to those living with this disease
Key points
Infrared light or mild electric currents on the retina could help curb dry macular degeneration, the most common and widespread form of maculopathy that affects around 1 million people in Italy alone. Infrared rays, capable of stimulating the retina, and mild electric currents, which are released on the surface of the eye and manage to push antioxidant agents into it, are paving the way for new treatment possibilities in its intermediate form, giving hope to those who live with this disease that 'steals' their sight, leaving a progressively larger 'hole' in their central vision. This is demonstrated by three studies recently published in the Nature group's journal Eye, in Current Ophthalmology Reports and in the Journal of Biophotonic. The three papers evaluated the efficacy, safety and tolerability of the therapies, highlighting how these two treatments may pave the way for better management of the disease.
How to slow down the progression of dry maculopathy
The intermediate form of macular degeneration is characterised by the presence of drusen, small deposits that accumulate under the retina. Over time, the disease can evolve towards geographic atrophy, the advanced stage of the dry form, in which irreversible loss of photoreceptors and central vision occurs. Intervening at this earlier stage is crucial for slowing down the evolution towards the advanced forms, and it is precisely at this stage that photobiomodulation and iontophoresis are emerging as promising options for slowing down the progression of dry maculopathy, emphasisesStanislao Rizzo, president of Floretina Icoor, director of the Department of Ophthalmology at the Policlinico A. Gemelli Irccs and full professor of Ophthalmology at the Catholic University of Rome. 'It is a non-invasive treatment,' Rizzo reports, 'that allows us to stimulate retinal function through the use of red and infrared light, to reduce the progression of the disease and promote the reabsorption of characteristic lesions, stimulating the mitochondria, key regulators of inflammation and the oxidative state of retinal cells. Photobiomodulation is performed in an outpatient setting, with the patient sitting in front of a device that uses an LED to illuminate the eye: the light is delivered in a controlled manner for about 4-5 minutes'.
Photobiomodulation as support in the early stages
Recent analyses have highlighted the ability of photobiomodulation to promote retinal cell survival, reduce inflammation and support the repair processes of photoreceptors and retinal pigment epithelium. "The most significant clinical results come from a recent study published in the journal of the Nature group, Eye, conducted on 30 patients treated with photobiomodulation who showed significant short-term improvements in functional and anatomical parameters: the therapy improved visual acuity tests, reduced deposits on the retina as a result of maculopathy, and improved blood flow in the tissues. Furthermore, no adverse effects or signs of toxicity were observed after treatment, confirming the short-term safety of photobiomodulation,' Rizzo points out. The article published in Current Ophthalmology Reports confirms the growing interest in photobiomodulation as a possible support in the early stages of macular degeneration. "Clinical data collected in recent years show mild but significant visual improvements and a reduction in drusen, with a potential protective effect against progression to geographic atrophy. But larger, standardised studies will be needed to precisely define its role in clinical practice,' adds Francesco Faraldi, director of the Ophthalmology Division of the Ordine Mauriziano - Umberto I hospital in Turin.
Iontopheresis is also used to facilitate drug absorption
Alongside photobiomodulation, new evidence is also accumulating in favour of iontophoresis, which, as Rizzo explains, 'also consists of a non-invasive technique that uses a mild electric current to facilitate the absorption of drugs across membranes. It is performed by placing an electrode on the patient's eye and administering a weak electric current'. In the case of macular degeneration, 'iontophoresis is being studied as a method of delivering specific drugs, such as anti-inflammatory agents and antioxidants such as lutein, directly into the macula area, an anatomical region that is traditionally difficult to reach, without the need for eye injections and bypassing the barriers that prevent the absorption of oral supplements,' Rizzo specifies. The electric current, Rizzo points out, 'helps to deliver drugs directly into the retina, improving the effectiveness of the treatment. In fact, it has been found that iontophoresis makes it possible to achieve intraocular concentrations of the active ingredients used, which significantly exceed those obtained with topical administration, reaching high concentration levels in the choroid and retina, which topical administration is unable to achieve. At the same time, side effects are also limited, as the substance delivered acts locally and at low doses, and the weak current does not induce structural changes in the cornea, retina or optic nerve, and does not affect intraocular pressure, confirming the safety profile of this approach'. As reported in the Journal of Biophotonics, ocular iontophoresis is a clinically reliable method for the non-invasive administration of active ingredients and nutraceuticals. 'In the study,' concludes Daniela Bacherini, lecturer at the Eye Clinic of the University of Florence, 'it was shown that after 40 minutes from the brief application of a mild current on the ocular surface, where a lutein solution had been applied, in the treated eyes lutein increased noticeably in the sclera, choroid and peripheral retina, and the macula also reached higher levels, about 1.3 times compared to controls.
