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SYNTONIC PHOTOTHERAPY

Basics and Use in Treatment of Traumatic Brain Injury

Robert Fox, OD, FCSO, FCOVDColorado Vision Summit 2019

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Robert Fox – President

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Disclosure

I have no financial interest in any of the techniques or products discussed

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Course Learning Objectives

1. To learn the history of light therapy and syntonic phototherapy.

2. To learn about light action on the visual system.

3. To learn alpha-omega pupil and functional visual field measurement.

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Course Learning Objectives

4. To become familiar with syntonic syndromes and their treatment.

5. To become familiar with light therapy as a tool in the treatment of the patient with an acquired brain injury.

6. To be able to put this material into immediate use.

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But First…a quick case

MG – 58yo female, TBI/MVA one year ago– Eyes feel “loose” in socket

– Right eye not working with the left

– Was an avid reader, NV now very tiresome

– Drops/skips letters with NV

– Feels Sx are getting worse

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Some Findings

20/30 VAs, mild CHA

Uses +3.00 OTC readers

Near phoria = 4 exo

Near BO = 6/-2

King-Devick I = 32.6 secs.

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Six Weeks Later

Great reduction is all symptoms

Patient is very happy

VA is now 20/25 uncorrected

Near BO = 16/8

King-Devick I = 23.7 secs

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History of Light Therapy

1876 – General Augustus PleasantonBlue and Sun-Lights

blue light increased plant growthand stimulated glands of the body

At this time it was also found that UV light could kill bacteria

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History of Light Therapy

1877 – Dr. Seth Pancoast

Blue and Red Lights

he used sunlight through red or blue glass to accelerate or relax the nervous system

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History of Light Therapy

1878 – Dr. Edwin BabbittThe Principles of Light and Color

he made the ChromoDisk that combined colored filters and placed the light on different parts of the body ( he used all colors)

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History of Light Therapy

1878 – Dr. Edwin Babbitt

The Principles of Light and Color

he used solar charged water and filtered it through colored glass to create an elixir to cure disease

(blue water for a sore throat)

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History of Light Therapy

1890 – sunlight was necessary for the body to produce vitamin D which was necessary for calcium absorption

1903 – Niels Finsen won the Nobel Prize in Medicine for treating lupus vulgaris (a skin form of tuberculosis) with light

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History of Light Therapy

1920- Dinshah GhadialiSpectroChrome program

12 color filter combinations applied to the body

1941- Harry Riley Spitler, DOS, MDThe Syntonic Principle

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History of Syntonic Phototherapy

Harry Riley Spitler, DOS, MD

The Syntonic Principle

Colored light through the eyes

3 body types - Pycnic, Syntonic, and Asthenic

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Syntonic Theory

Dr. Spitler developed 21 principles about the effect of light on the body and mind

• The select application of visible light to the eye

• Frequencies to balance the sensory motor systems

• Reaching the endocrine system via the pituitary, pineal and hypothalamus

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The Autonomic Nervous System

Sympathetic and Parasympathetic

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Sympathetic Actions

• Dilates the pupil

• Increases tearing

• Increases intraocular pressure

• Decreases accommodation

• Turns eye outward

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Sympathetic Actions

• Decreases mucus, saliva and digestion

• Decreases arterial dilation

• Increases pulse rate

• Increases blood pressure

• Increases blood sugar

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Sympathetic Activation

• Thyroid

• Adrenal Medulla

• Pituitary

• Gonads

• Muscles

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Post-Traumatic Vision Syndrome

• Exophoria/exotropia

• Reduced accommodation

• Reduced convergence

• Poor blink rate / poor tearing

• Photophobia

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Parasympathetic Actions

• Pupil constriction

• Decreases tearing

• Decreases intraocular pressure

• Increases accommodation

• Turns eye inward

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Parasympathetic Actions

• Increases mucus, saliva and digestion

• Decreases pulse rate

• Increases arterial dilation

• Decreases blood pressure

• Decreases blood sugar

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Parasympathetic Activation

• Parathyroids

• Adrenal cortex

• Digestive tract

• Liver

• Pancreas

• Spleen

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Light Action on the Visual System

• Light Pathways

• Effect on Autonomic Nervous System

• Frequencies of light and how they affect the visual system

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Light Pathways• Nonvisual photoreceptors of the deep brain, pineal

gland and retina

• Hypothalamus: suprachiasmatic nucleus>pituitary

• Pituitary: ACTH to adrenal gland • >cortisol/stress hormone

• Pineal: melatonin production

• Retina: influences suprachiasmatic nucleus

• Intrinsically photosensitive retinal ganglion cells

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History, History, History!!

• TBI vs. CVA

• Time since injury

• Medications

• Current therapies

• Current glasses / lens styles

• Symptoms

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Autonomic Imbalance

• Alpha Omega Pupil-the inability to sustain constriction under direct light (greater sympathetic activation)

-the faster the dilation, the smaller the field

• Oculomotor imbalance-poorly controlled pursuits and saccades

-head movement vs. eye movement-sign of constricted fields

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Effect on Autonomic Nervous System

• Color Vision-reduced color discrimination on Ishihara plates

-reduced figure/ground perception

• Accommodation and Binocular Dysfunction

• ANS imbalance in head trauma

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Functional Visual Field Measurement

• Reduced Visual Performance in the absence of organic cause

• What you see: • Generalized constriction of form and color• Enlarged blind spot

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The Interpretation of Visual Fields• Motion Field

the extreme periphery of the retina capable of receiving sensations of motion without recognition of contour[motion is first form of vision – R. Melillo]

• Form Fieldrecognition of contours of an objectextent is when the patient can retain the perception of white in a stationary position

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• Color Fields

test green, blue, red (smallest to largest)

there should be no interlacing or overlapping

• Blind Spot

enlarged blind spot – questionable swelling

or new theory of anomalous projection

The Interpretation of Visual Fields

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Red end of spectrum= sympathetic stimulation

Blue end of spectrum= parasympathetic stimulation

Balance Board – general considerations

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Center = gentle, balance

-mu upsilon (blue) and mu delta (red)

Ends = more stimulating

- upsilon omega (blue) and alpha delta (red)

Balance Board

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Red = sensory stimulant

Orange = motor stimulant

Yellow = intense motor stimulant

Green equalizes for physiological balance

Blue = sensory depressant

Indigo = motor depressant

Violet = intense sensory depressant

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Why Red-Orange or Lemon ?

• Sympathetic Activation

• Sensory and Motor Stimulant

• For amblyopia, esotropia

• Stimulates Exo Response

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Alpha Delta – “Amblyopia/Esotropia

Eye Syndrome”

Red-Orange sensory + motor stimulant

Dx: amblyopia, esotropia, poor accommodation, constricted visual field, reduced vergence ranges

Sx: reduced acuity on one eye, head tilt or turn, mmpoor depth judgment, diplopia also slow reading speed and poor handwriting

Tx: stimulate sympathetic especially in long standing strabismus

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Mu Delta – “Chronic Syndrome” Lemon physiologic stabilizer

Dx: convergence excess, esophoria/esotropia alpha omega pupil and poor oculomotor constricted visual field for form or color low recovery on ductions (especially BI)

Sx: toxic or neuroendocrine imbalance chronic health problems or past trauma

Tx: stimulate sympathetic, create exo response

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Treatment Protocol (end at middle of spectrum)

Alpha Delta

Red-Orange +

Mu Delta

Lemon

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Alpha Omega – “Emotional Fatigue”

Ruby pupil, adrenal fatigue, emotional trauma, exhaustion, mood swings

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Alpha Omega – “Emotional Fatigue” Ruby Syndrome

Dx: alpha omega pupil, fatigue exo, low breaks and recoveries (especially BO), adrenal fatigue

Sx: photophobia, transient blurred vision, fatigue, headache

Tx: balance parasympathetic and sympathetic

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Treatment Protocol (end at middle of spectrum)

Alpha Omega

Ruby +

Mu Delta

Lemon

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Why Indigo or Blue-Green ?

• Parasympathetic Activation

• Sensory and Motor Depressant

• For Pain and Spasm

• Stimulates Eso Response

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Mu Upsilon – “Acute Syndrome”

Blue-Green recent head trauma, high fevers, inflammation, swelling, pain, HA, monocular diplopia

Upsilon Omega – “Pain Reliever”

Indigo headaches, asthenopia

(Violet)

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Mu Upsilon – “Acute Syndrome”

Blue-Green recent head trauma, anoxia, stroke

Dx: exophoria, exotropia, convergence insufficiency (PTVS), alpha omega pupil, enlarged blind spot, poor ocm / accommodation

Sx: headache, motion sickness, vertigo, transient blurred vision, diplopia (monocular)

Tx: stimulate parasympathetic

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Upsilon Omega – “Pain Reliever”not a syndrome

Indigo headaches, asthenopia

(Violet)

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Treatment Protocol (end at middle of spectrum)

Upsilon Omega

Indigo +

Mu Upsilon

Blue-Green

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Color Combinations

• Mu Upsilon (alone)

• Upsilon Omega + Mu Upsilon

Always end at the middle of the balance board

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Functional Vision ChangesWhat To Think (brain injury case)

• Visual Acuity LossSx: blurred vision

enlarged blind spot

• Strabismus (exotropia)Sx: double vision, loss of depth perception

hyperarousal of sympathetic

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• Oculomotor DysfunctionSx: skips/rereads lines of print

poorly controlled pursuits and saccades

• Convergence InsufficiencySx: reading difficulty, dizziness/nausea

receded NPC and pulls back from target

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• Accommodative DeficitSx: blur, headaches

reduced amplitude and flexibility

• Decreased Blink Rate

Sx: dry eye, photophobia

reduced TBUT, filamentary keratitis

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Visual Field Constriction

Sx: bumps into things, poor night vision,

spatial disorientation, attention deficit

alpha omega pupil, oculomotor dysfunction, midline shift, information processing disability

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Treatment Protocol

• Frequency of light into the eyemost often indigo and/or blue-green

• 20 minutes per session• Minimum of 4x per week• Progress Evaluation every 8 sessions

repeat history, vision analysis, VF

• Low Risk and Few Side Effects

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Post Treatment• Restoration of Visual Field

• Improved oculomotor and binocular status

• Decreased headaches / asthenopia

• Increased attention, concentration, memory

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Case – Harmony

• 25 yo female

• TBI/MVA – 3 months prior• C1 fracture

• Coma for 2.5 weeks

• DV & NV off

• Feels crossed eyed when reading

• Diplopia

• Frontal headaches

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Harmony’s Findings

• DVA = 20/200, NVA 20/100

• Low myopia -0.75

• CNP 9”/16” and it hurts

• Near ret. +2.00 lag

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What To Do?

-0.50 for DV

Plus for near and

Syntonics– What color should we use?

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One Month Later

Likes the DV Rx

Dislikes NV Rx

VA’s are much better– DV 20/40

– NV 20/20

CNP 3”/6”

Near ret. Now is +0.75 lag

FDT fields are now normal

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Case – DM

55 yo female

MVA / TBI

Emergency call

Very, very photophobic

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Case 2 – DM

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Case 3 – HC

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Pearls to Remember• Enlarged blind spot and general constriction of visual

field

• Light is a primary tool to rebalance the autonomic nervous and endocrine systems

• Mu Upsilon = 90% of TBI cases

• Low risk with with high rate of success

• Successful syntonic cases handle VT much better than those without syntonics boosting overall success rates

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Be Kind You To Your TBI Patients

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