Visual information undergoes complex processing before becoming a clear picture. The optic nerve is largely responsible for this process. Unfortunately, it can atrophy due to the various pathological processes. Currently, medicine does not have treatment methods, which can completely cure degenerative diseases of the optic nerve. Stem cell therapy offers a new modern approach, the purpose of which is to restore neurological function partially or completely.
The pathogenetic mechanism of optic atrophy
The optic nerve originates from the retina and conducts video signals between the retina and the cerebral cortex. The damaged optic nerve becomes unable to conduct signals to the brain.
The optic nerve diseases, including optic neuropathy (optic nerve atrophy) are chronic and degenerative pathologies of the optic analyzer, that inevitably lead to vision loss. Most diseases of the optic nerve are caused by apoptosis (programmed death) of retinal nerve cells or other nearby nerve structures.
Such pathologies have complex pathophysiological mechanisms of onset. The causes of their occurrence can be varied:
- Ophthalmic diseases – glaucoma (high intraocular pressure), myopia (nearsightedness), retinitis pigmentosa, infectious eye diseases, pathological processes and retinal injuries, inflammation of the optic nerve (neuritis) and other eye diseases.
- Injuries – traumatic brain injuries, traumatic injuries of eye structures.
- Neoplasms in the orbital cavity – meningioma, osteosarcoma, optic nerve glioma, malignant orbital tumors.
- Pathologies of the central nervous system – arachnoiditis (inflammation of the meninges), brain cancer, pituitary tumors, multiple sclerosis, brain abscesses, meningitis.
- Vascular pathologies – aneurysm, atherosclerotic changes in the optic nerve, blockage of the central artery by a thrombus, increased intracranial pressure due to arterial hypertension, retinopathies of various etiology.
- Genetic disorders – specific DNA mutations, which can be either acquired or congenital.
- Intoxication of the body – poisoning due to the intake of surrogate alcoholic beverages (methyl alcohol), narcotics, nicotine, influence of hazardous chemicals.
- Infections – viral, bacterial or fungal diseases, including influenza.
Optic nerves atrophy (ONA) is characterized by impaired blood flow in the smallest capillaries, a decrease in the size and death of the nerve fibers. The impairment of blood flow in vessels, which supply nerve structures, leads to oxygen deprivation (hypoxia) and unfavourable metabolic changes inside the cells. In turn, the information perceived by the retina reaches the brain in a distorted form. The development of atrophy occurs gradually. In 21% of cases the disease causes irreversible blindness and in 68% of cases it leads to disability.
Types of pathology
Optic nerve atrophy has many classifications, which are necessary for a more accurate diagnosis making.
Depending on the clinical picture, the following classifications are distinguished:
- Primary (simple) atrophy develops as an independent disease. In this case, the optic disc has clear boundaries, although it is pale. This type is often characterized by a narrowing of the retinal vessels.
- Secondary atrophy occurs due to the concomitant disease, leading to the impairment of the optic nerve functions. The optic disc boundaries become blurred.
- Glaucomatous atrophy occurs in glaucoma and is accompanied by elevated intraocular pressure.
Depending on the location:
- Descending – when the optic nerve fibers are affected.
- Ascending – when retinal cells are affected.
Depending on the progression of the pathological process:
- Stable type – nerve lesion reaches a certain degree and remains stable for a long time.
- Progressive type – the pathological process is progressing constantly and is accompanied by rapid vision loss.
Depending on the volume of lesion:
- Partial (initial) atrophy – only a small area of the nerve is affected. The pathology manifests itself by severe visual loss, which cannot be corrected by optic devices (glasses and contact lenses).
- Complete atrophy – lesion of the whole nerve, when a person loses the ability to see completely.
Depending on the severity:
- One-sided – when one eye is affected.
- Bilateral – when both eyes are affected.
The disease can also be congenital and manifest itself in childhood, or be acquired and manifest itself at any age.
What is the cell therapy?
Cell therapy is a promising, modern and rapidly developing medical field. It allows doctors reaching good results in the treatment of various nervous system diseases. The main effects of cell therapy are achieved due to the replacement of dead neurons (nerve cells), improvement of tissue trophicity, formation of new nerve endings and blood vessels, and improvement of immune system function.
Cell therapy involves stem cell treatment. These are special type of cells, which have the ability to specialize in any cells of the human body. Some techniques are still at the stage of clinical trials. Other therapeutic approaches are already successfully applied in many clinics around the world, including German ones.
The benefits of cell therapy:
- Formation of new blood vessels
- Increased circulation in the vessels of the optic nerve and the retina
- Improved supply of nerve fibers
- Ability to repair tissue structures of the visual analyzer
- Secretion of biologically active compounds, due to which scars formation is prevented
- Improvement of immunity and suppression of undesirable immune system activity in the pathological focus
- Resumption of normal tissue metabolism
- Good tolerability
Stem cell therapy has virtually no contraindications and can be performed in patients of any age with various types of atrophy.
Cell therapy for optic nerve repair
Stem cell therapy is widely studied as a treatment of the degenerative eye diseases aimed at replacement of dead neurons and restoration of nerve chains. One of the Swiss clinical trials has demonstrated the high efficiency of stem cells application in nerve lesions. Clinical trials were also carried out in the leading medical centers of Germany, Switzerland and Belgium.
A good therapeutic effect was observed in 70-90% of cases in the form of improved motor and sensory functions. Cell therapy has showed the best results in lesions of brain nerves, degenerative pathologies, infections of the nervous system and pathologies of a hypoxic nature.
The recent data has revealed that stem cell trophic factors protect damaged neurons from death and stimulate formation of new interneuron connections. Moreover, cell therapy significantly slows down further vision loss in patients with advanced conditions. Stem cell therapy in combination with specialized treatments helps to cope with the main symptoms of optic atrophy (loss of central, peripheral and color vision) and contributes to tissue regeneration.
Types of stem cells and their use in ophthalmology
There are three groups of stem cells, which differ depending on their location in the body and potency (the ability to develop in different cell lines). Ophthalmology carries out the researches on all these groups.
- Embryonic stem cells (ESCs) are the cells, which are located in the inner cell mass of an embryo at an early stage of its development. ESCs are pluripotent, which means that they can become any cells in the process of development. They still do not produce specific antigens, which are a common cause of incompatibility between donor tissues and recipient during the transplantation. ESCs can be effective in the treatment of degenerative diseases of the retina, pathologies of retinal pigment epithelium and optical neuropathies. In many countries, ESCs researches are prohibited at the legislative level, since their extraction from the embryo interrupts its further development.
- Fetal stem cells – this group of cells is extracted from the fetus after an abortion or from cord blood. Fetal SCs are pluripotent and have greater functionality than the adult SCs. Such cells demonstrate better photoreceptor recovery rates and are capable of prolonged doubling during the cultivation. However, their use is also connected with ethical issues. In many countries of the world, the researches on fetal cells are prohibited by law.
- Adult stem cells are immobile and non-specialized cells, which are located in mature tissues. Adult SCs perform the function of dead cells replacement with new ones and promote tissue regeneration. Despite this, they create a microenvironment for tissues, protect them from degeneration (destruction), and also have the ability to self-renew and form mature cells. Different types of SCs can differentiate into hematopoietic stem cells, mesenchymal stem cells, and neural stem cells.
For many years, scientists have believed that only specialized structures can be obtained from stem cells, but, as it turned out, mature cells extracted from the adult body can be reprogrammed as well.
Mesenchymal stem cells in optical neuropathies
Mesenchymal stem cells (MSCs) are multipotent and self-renewing stem cells capable of rapid division. Among the various types of stem cells, mesenchymal cells are the most suitable for transplantation in the case of optical neuropathies, as they have strong immunomodulating, neuroprotective and regenerative properties. In addition, mesenchymal stem cells do not have markers of the major histocompatibility complex on their surface that is the complex of antigens associated with transplant rejection. In addition, they do not contain oncogenic factors. MSCs produce several growth factors, which can create a replacement effect, activate body's internal repair mechanisms and contribute to the survival of healthy cells.
Stem and immune properties of mesenchymal cells are more comparable to embryonic than to the other adult cells. Due to the ability to provide the optic nerve with new neurons and glial cells, MSCs play an important role in the treatment of diseases of the optic nerve and retina. In optic nerve atrophy, the vision improvement was observed and such side reactions as an inflammatory or infectious process were absent after the cell therapy. Mesenchymal stem cells are a great alternative to embryonic ones, and their extraction is not connected with any ethical issues.
Sources of mesenchymal stem cells
The bone marrow is the first source of mesenchymal stem cells, followed by cord blood and adipose tissue. Bone marrow is the best source of MSCs, but in some cases its harvesting has such contraindications as limited growth rate, age of the donor, and some inherited risks of tissue sampling. As for extraction of MSCs from the umbilical cord blood, the special protocol is required, and this is not always possible to follow it. Also, it is not always possible to find the source of umbilical cord blood. Mesenchymal cells extracted from adipose tissue have a similar structure and phenotype with bone marrow cells. These cells reproduce better and it is easier to obtain them with the help of liposuction procedures.
How is stem cell therapy carried out in Germany?
Stem cell-based drugs contain millions of viable neural progenitor cells, which form the optic nerve. Cell therapy includes several stages:
- The specialists extract stem cells from the bone marrow by means of puncture of the ilium, or from adipose tissue by means of similar to the liposuction procedure.
- The main features of stem cells, such as the number and viability, as well as the presence of blood infections are assessed.
- If the cellular material meets all the requirements for reimplantation, it undergoes purification. The viability of stem cells should reach 98-99%.
- The required amount of the drug is injected into the subtenon and suprachoroidal spaces of the eye (i.e. in certain areas of the orbit near the optic nerve). This operation is less traumatic and takes little time.
- To consolidate the results of treatment, it is possible to carry out the second session in 1-2 months.
This method of administration ensures drug delivery directly into the pathological focus, which guarantees the most pronounced effect of the procedure. The treatment is easily tolerated by patients and has no side effects. An additional course of reflexotherapy and electrostimulation is prescribed for achieving better results. If necessary, medication therapy is also carried out.
What happens after the procedure?
After the injection, stem cells form a population of the target cells, which constantly multiply, restore the conduction of nerve impulses and are capable of providing the visual analyzer with new neural cells during 1-1.5 years.
A few days after the stem cell therapy session, the immune forces of the body are activated. Their resources are directed at repairing damaged tissues. At this stage, the patient may feel uncomfortable and an exacerbation of the underlying disease occurs. It will decline soon, and after 2 weeks the discomfort disappears.
In a month, the phase of regeneration of the missing nerve fibers and neurons begins. It lasts for 6 months. The patient's condition improves rapidly, depending on the clinical course of optic atrophy, the patient's age, individual characteristics and presence of the concomitant pathologies.
Cell therapy results
Clinical trials of stem cells application in optic neuropathy have been carried out in Germany, China and other developed countries since 2008. The improvement of patients' condition was assessed using quality of life test, related to the vision function. According to the statistics, positive results appear in approximately 3 months after the beginning of therapy and remain stable for 12 months. This can best be seen on the particular examples.
Yuri, 58 years old
At the age of 54, the patient underwent a removal of benign brain tumour, which caused the onset of descending optic atrophy in both eyes. After the injection of his own stem cells, vision improved by 15%. This was followed by a second session in order to consolidate the results, thanks to which he began to discern colours.
Valeria, 24 years old
The patient had bilateral optic atrophy and visual loss up to 20%. Drug therapy in combination with physiotherapy methods did not bring any positive results. After the first procedure of cell therapy, her vision gradually began to improve: she could see with her left eye at a distance of 1 meter, with her right one at a distance of 1.03 meters. During the first week after the procedure, Valeria began to distinguish shades of red and see large objects at a long distance. During the second week, she was able to see with her right eye at a distance of 2.85 meters and with her left eye at a distance of 1.85 meters.
Dmitry, 18 years old
At the age of 18, he got traumatic brain injury in a karate class, after which the optic nerve atrophy in one eye occurred. Vision improved to 90% upon the course of stem cell therapy.
Sergey, 43 years old
The patient had severe unilateral atrophy of the retina and optic nerve, which was accompanied by a significant vision loss. Upon the course of cell therapy, visual acuity and color perception improved. Positive results lasted for 6 months, after which the patient began to undergo the stem cell therapy regularly.
The effectiveness of other treatments for optic atrophy
Several traditional treatment methods are available for patients with optic nerve atrophy. They are aimed at stopping the pathological process, preventing disability and partial restoration of the atrophied areas.
The drug treatment is prescribed for each patient individually. It can include eye drops, pills, and various solutions for injections. The drugs are often delivered to the optic nerve by means of injections into the sub-Tenon's space or by iontophoresis. The choice of drugs depends on the general condition of the body and the structures of the fundus.
Doctors may prescribe the following medications:
- Vasodilators and calcium channel blockers – in elevated intraocular and intracranial pressure
- Vasoconstrictor drugs – to normalize blood supply
- Anticoagulants – to inhibit blood clotting activity and prevent thrombosis
- Antioxidants – to neutralize the oxidation of free radicals and strengthen the walls of blood vessels
- Vitamin complexes
- Detox treatment – to remove dangerous toxins from the body
- Drugs that improve metabolism
- Anti-inflammatory drugs (including hormonal ones) – to eliminate systemic inflammation processes
- Antiviral and antibacterial drugs – to eliminate infections
- Retinoprotectors – to reduce the permeability of blood vessels
- Nootropics – to stimulate metabolism in nerve cells
The disadvantage of drug therapy is its short-term effect and the need for continuous drugs intake. Therefore, such treatment has low efficacy and is not prescribed as an independent method.
Physiotherapy help to improve metabolism and supply of the optic nerve. As a rule, physiotherapeutic procedures are prescribed in combination with drug therapy.
Widespread methods of physiotherapy include:
- Electrical stimulation is a procedure, which is aimed at the restoration of nerve functions and improvement of the nerve endings excitability, which leads to activation of nerve fibers, normalization of blood circulation, and improvement of metabolic processes.
- Magnetotherapy is a procedure, which is aimed at improving speed of biochemical and biophysical processes inside the nerve fibers.
- Laser therapy helps to stimulate and renew neurovascular bundles, normalize blood circulation and remove toxic substances. In addition, laser beams have antibacterial and antiviral properties.
Unfortunately, physiotherapy also brings only a temporary improvement and cannot be prescribed as an independent treatment method.
Surgical treatment is suitable in the case of atrophy of the optic nerve against the background of glaucoma and vascular pathologies. Surgical interventions include the following measures:
- Vasorestructive surgery includes operations for improvement of blood supply of the retina and optic nerve. They are effective at the advanced stages of glaucoma.
- Revascularization of the optic nerve is an operation aimed at restoring the blood supply to the capillaries, which feed the optic nerve. The procedure promotes the formation of new blood vessels.
- Transplantation of biomaterials, including parts of the extraocular muscles, alloprostheses or patient's own adipose tissue.
Surgeries have a large list of contraindications, such as the age over 75 years, diabetes mellitus, complex traumatic brain injuries and acute infectious processes. In addition, the risk of infection, rejection of transplanted biological materials and trauma to the eye structures is also connected with most surgical interventions.
Unfortunately, none of these methods actually cures the loss of optic nerve function. As opposed to them, the stem cell treatment is able to regenerate optic nerve cells, which allows patients with optic atrophy to see better.
Where is it possible to undergo stem cell therapy?
The treatment of optic atrophy is possible in many clinics (for example, S.N. Fyodorov Eye Microsurgery Federal State Institution in Moscow). However, the lack of specially trained personnel, experience, necessary equipment and technologies do not allow all the healthcare facilities to achieve good results. Unfortunately, in the best case, such therapy does not bring any results, and in the worst case, the severe side effects occur.
For this reason, people who want to undergo a course of stem cell therapy look for the specialized hospitals all over the world. Among European countries, Germany has succeeded most in the development of innovative treatment methods for optic atrophy. Here, the specialists have the unique access to the protocols for optic atrophy treatment using stem cells, which allows them to obtain more stem cells, carry out extensive rehabilitation of patients and apply numerous additional treatment methods. This effective combination of the most advanced medical technologies with traditional medicine leads patients to the significant improvements.
In this country, stem cell therapy for optic atrophy is carried out in many clinics, but the Clinic of Advanced Biological Medicine Frankfurt am Main demonstrates the most prominent results. The medical facility specializes in biological and alternative treatment of severe pathologies. The specialists elaborate the individual stem cell treatment regimens, which are complemented by traditional therapy, physiotherapy and other safe methods. The medical staff takes care of the patient's comfortable stay in the clinic until his discharge.
How to undergo cell therapy in Germany?
Patients from all over the world can undergo diagnostics of optic atrophy and receive stem cell therapy in Germany. However, it is very difficult to organize such a trip on your own, because you need to take into account many peculiarities. The Booking Health company can help with organization of therapy in German clinics.
Our specialists provide the following services:
- Selection of the best treatment program based on the annual reports
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- Preparation of all the necessary documents
- Insurance against an increase in the cost of treatment in the case of complications (coverage of 200,000 euro, the insurance will be valid for 4 years)
- Control of invoices and return of unspent funds
- Keeping in touch at all treatment stages
- Buying airline tickets, services of an accompanying interpreter, booking a hotel room
Should you leave a request on the official website bookinghealth.com and our manager will contact you within 24 hours to clarify all the details.
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Author: Alexandra Solovey