It is hard to know the maximum potential of healing through "Palm Pressure Therapy" (PPT) for each patient, as the patients stop seeing Dr. Athikhomkuchai when their vision has improved to their satisfaction. Other reasons for patient withdrawal are the lack of the funds and transportation. Further study is necessary to learn more of this simple yet effective therapy.
Dr. Athikhomkuchai recommends all patients that seek this alternative treatment to be under the observation of an ophthalmologist who is familiar with the procedure.
In some instances, Dr. Athikhomkuchai may prescribe drugs, perform surgery or laser surgery in combination with "Palm Pressure Therapy." The treatment choice based on the condition of an individual patient.
Dr. Athikhomkuchai welcomes any Ophthalmologists who want to learn this technique.
See the explanation of the terminology used in the Glossary.
Below are examples of the patients treated with Palm Pressure Therapy (PPT).
Treatment for Primary Open Angle Glaucoma (POAG, Chronic Glaucoma)
Case 1 - POAG
Mr.Y., age 82, no systemic condition, has left prosthetic eye and chronic glaucoma (POAG) in a right eye.
Treatment history before visiting Dr. Athikhomkuchai:
The patient received treatment from another ophthalmologist, and the doctor prescribed Duotrav eye drop and Cardiprin (aspirin) 100 mg. Three days before visiting Dr. Athikhomkuchai, the patient had no perception of light in his right eye. The patient described this as "Everything went dark." The former ophthalmologist diagnosed the condition as artery occlusion.
Examination and diagnosis by Dr. Athikhomkulchai:
Patient has no perception of light, and full cupping of the optic nerve head, a sign of chronic glaucoma.
Treatment
After eye examination, Dr. Athikhomkulchai recommended:
Using visual acuity assessment as a guideline to determine the improvement of the vision in each eye:
2 weeks - patient can perform finger count at 1 foot
4 weeks - visual acuity = 5/200 (meaning the biggest letter the patient can read at 5 feet, the normal eye can read at 200 feet)
6 weeks - visual acuity = 15/200, with the pinhole = 20/200
The pinhole test differentiates the source of the problem whether it is a refractive error or pathological diseases. A patient may have blurred vision due to focusing problem that can be corrected by glasses and contact lens, or blurred vision due to the eye diseases.
14 weeks - visual acuity = 17/200, with the pinhole = 20/100-1
Case 2 - POAG
Mrs. Y.D., age 82, has hypertension, a known case of POAG in both eyes.
Treatment history before visiting Dr. Athikhomkulchai:
Mrs. Y.D. was using three different eye drops for many years without any vision improvement. One year before visiting Dr. Athikhomkulchai, she completely lost her vision in her right eye. One month before visiting Dr. Athikhomkulchai, the vision in her left eye began deteriorating. Below is the eye drops prescribed to her:
After the eye examination, Dr. Athikhomkulchai recommended:
Two months after treatment:
Case 19 - POAG
Ms.Sunee S., age 59 with systemic conditions include diabetes and high blood pressure.
Treatment history before visiting Dr. Athikhomkuchai:
The patient received treatment for POAG from the ophthalmologist, and the doctor prescribed Brimonidine and Lumigan. She lost her vision in both eyes while continue to apply Brimonidine and Lumigan.
Examination and diagnosis by Dr. Athikhomkulchai:
First visit: September 2nd, 2015;
Treatment
After eye examination, Dr. Athikhomkulchai recommended:
Using visual acuity assessment as a guideline to determine the improvement of the vision in each eye:
January 4th, 2016
March 7th, 2016
Case 3 - POAG and Multiple Central Serous Retinopathy (MCSR)
Ms. U., age 50, has Asthma.
Treatment history
Treatment history before visiting Dr. Athikhomkulchai Patient experienced:
After the eye examination, Dr. Athikhomkulchai recommended:
Three days after treatment:
Seven weeks after the treatment:
Treatment for Dry Age-related Macular Degeneration (AMD)
Case 4
Ms. S.S., age 58, no systemic condition.
Symptom: blurred vision on right eye 3 days before a visit to the office.
Examination and diagnosis by Dr. Athikhomkulchai:
Treatment
After the eye examination, Dr. Athikhomkulchai recommended:
Three months after treatment: Both eyes have visual acuity of 20/20
Treatment for Optic Atrophy
Case 5
Mrs. SJ., age 43, no systemic condition.
Treatment history
Six months before visiting Dr. Athikhomkulchai, the patient experienced a headache and blurred vision. The clinical assessment showed that the pressure from a brain tumor had caused the swelling of the optic nerve (chronic papilledema) to both eyes. Following the recommendation of the physician, she had the tumor removed. After the removal of the tumor, her vision only improved slightly.
Examination and diagnosis by Dr. Athikhomkulchai:
Treatment
After the eye examination, Dr. Athikhomkulchai recommended:
One month after treatment:
Visual acuity in both eyes = 5/200
Two months after treatment:
Visual acuity in both eyes = 20/200
Four months after treatment:
Visual acuity - right eye = 20/200+1
Visual acuity - left eye = 20/200
Note: This result is great success because there is no conventional treatment for Optic Atrophy.
Treatment for Central Retinal Vein Occlusion (CRVO)
Case 6 - CRVO
Miss. PN., age 13, no systemic condition.
Treatment history before visiting Dr. Athikhomkulchai:
Two weeks before a visit, patient experienced a blurred vision in her left eye. Her diagnosis from the former ophthalmologist was CRVO. She received an intraocular anti-VEGF injection into her left eye. The injection did not improve her vision.
Examination and diagnosis by Dr. Athikhomkulchai:
Treatment
After the eye examination, Dr. Athikhomkulchai recommended:
One week after treatment:
Visual acuity in left eye = 20/70-1, with the pinhole 20/40-2
Three weeks after treatment:
Visual acuity in left eye = 20/40-2, with the pinhole 20/40-1
Five weeks after treatment:
Visual acuity in left eye =20/30-3, with the pinhole 20/30-1
Three months after treatment:
Visual acuity in left eye =20/20
Case 7 - CRVO
Miss. P., age 37, no systemic condition.
Treatment history before visiting Dr. Athikhomkulchai:
Four days before a visit, patient experienced blurred vision in her left eye. Her diagnosis from the former ophthalmologist was CRVO. She refused to have Intraocular anti-VEGF injection that was the treatment of choice.
Examination and diagnosis by Dr. Athikhomkulchai:
Treatment
After the eye examination, Dr. Athikhomkulchai recommended:
One week after treatment:
Visual acuity in left eye =5/200, with the pinhole 20/200-1
Two weeks after treatment:
Visual acuity in left eye =10/200, with the pinhole 20/100
Three weeks after treatment:
Visual acuity in left eye =20/200, with the pinhole 20/50-2
Ten weeks after treatment:
Visual acuity in left eye =20/100, with the pinhole 20/50+1
Three months after treatment:
Visual acuity in left eye =20/70-2, with the pinhole 20/40
Case 18 - CRVO
Ms. Sukanda, Age 26, A student, no systemic condition
Treatment history before visiting Dr. Athikhomkulchai:
Patient experienced blurred vision in her right eye at the end of December 2015. Her diagnosis from the former ophthalmologist at the Eye Hospital in Bangkok was CRVO. The Ophthalmologist told her there was no treatment for her condition.
Examination and diagnosis by Dr. Athikhomkulchai:
After the eye examination, Dr. Athikhomkulchai recommended:
Patient's status after the treatment:
One week after treatment:
Visual acuity in right eye = 20/40-2
Two weeks after treatment:
Visual acuity in right eye = 20/40+2
Dr. Athikhomkuchai recommends all patients that seek this alternative treatment to be under the observation of an ophthalmologist who is familiar with the procedure.
In some instances, Dr. Athikhomkuchai may prescribe drugs, perform surgery or laser surgery in combination with "Palm Pressure Therapy." The treatment choice based on the condition of an individual patient.
Dr. Athikhomkuchai welcomes any Ophthalmologists who want to learn this technique.
See the explanation of the terminology used in the Glossary.
Below are examples of the patients treated with Palm Pressure Therapy (PPT).
Treatment for Primary Open Angle Glaucoma (POAG, Chronic Glaucoma)
Case 1 - POAG
Mr.Y., age 82, no systemic condition, has left prosthetic eye and chronic glaucoma (POAG) in a right eye.
Treatment history before visiting Dr. Athikhomkuchai:
The patient received treatment from another ophthalmologist, and the doctor prescribed Duotrav eye drop and Cardiprin (aspirin) 100 mg. Three days before visiting Dr. Athikhomkuchai, the patient had no perception of light in his right eye. The patient described this as "Everything went dark." The former ophthalmologist diagnosed the condition as artery occlusion.
Examination and diagnosis by Dr. Athikhomkulchai:
Patient has no perception of light, and full cupping of the optic nerve head, a sign of chronic glaucoma.
Treatment
After eye examination, Dr. Athikhomkulchai recommended:
- Baby aspirin
- Steroid
- Palm Pressure Therapy
Using visual acuity assessment as a guideline to determine the improvement of the vision in each eye:
2 weeks - patient can perform finger count at 1 foot
4 weeks - visual acuity = 5/200 (meaning the biggest letter the patient can read at 5 feet, the normal eye can read at 200 feet)
6 weeks - visual acuity = 15/200, with the pinhole = 20/200
The pinhole test differentiates the source of the problem whether it is a refractive error or pathological diseases. A patient may have blurred vision due to focusing problem that can be corrected by glasses and contact lens, or blurred vision due to the eye diseases.
14 weeks - visual acuity = 17/200, with the pinhole = 20/100-1
Case 2 - POAG
Mrs. Y.D., age 82, has hypertension, a known case of POAG in both eyes.
Treatment history before visiting Dr. Athikhomkulchai:
Mrs. Y.D. was using three different eye drops for many years without any vision improvement. One year before visiting Dr. Athikhomkulchai, she completely lost her vision in her right eye. One month before visiting Dr. Athikhomkulchai, the vision in her left eye began deteriorating. Below is the eye drops prescribed to her:
- Travatan eye drop
- Alphagan eye drop
- Timolol eye drop
- Right eye - no perception of light
- IOP =21.0 mm.Hg.
- full optic cupping with pale disc - Left eye - visual acuity = 20/40-2, with the pinhole = 20/30
- IOP =14.8 mm.Hg.
- 0.95 optic nerve head cupping - Diagnosis - POAG
After the eye examination, Dr. Athikhomkulchai recommended:
- Lutein
- Vitamin A
- Palm Pressure Therapy (PPT)
Two months after treatment:
- Right eye - patient can see the light
- Left eye - visual acuity = 20/30+1
- Right eye - visual acuity = 20/100
- Left eye - visual acuity = 20/30+1
- Right eye - visual acuity reading is 20/70-2
- Left eye - visual acuity reading is 20/30+2
Case 19 - POAG
Ms.Sunee S., age 59 with systemic conditions include diabetes and high blood pressure.
Treatment history before visiting Dr. Athikhomkuchai:
The patient received treatment for POAG from the ophthalmologist, and the doctor prescribed Brimonidine and Lumigan. She lost her vision in both eyes while continue to apply Brimonidine and Lumigan.
Examination and diagnosis by Dr. Athikhomkulchai:
First visit: September 2nd, 2015;
- Right eye - visual acuity reading = hand motion, the ocular pressure is 9.4 mm.Hg.
- Left eye - visual acuity reading = hand motion, the ocular pressure is 9.2 mm.Hg.
- Fundus examination - pale and full optic disc cupping
Treatment
After eye examination, Dr. Athikhomkulchai recommended:
- Baby aspirin
- Vitamin A
- Palm Pressure Therapy
Using visual acuity assessment as a guideline to determine the improvement of the vision in each eye:
January 4th, 2016
- Right eye - Visual acuity; no change, the ocular pressure is 8.8 mm.Hg.
- Left eye - Visual acuity; the patient can perform finger count at 3 feet, the ocular pressure is 7.7 mm.Hg.
- Stop application of Brimonidine and Lumigan
March 7th, 2016
- Right eye - Visual acuity; no change, the ocular pressure is 8.4 mm.Hg.
- Left eye - Visual acuity; 20/50-2; the patient can read line 4 on a Snellen chart at 20 feet, the ocular pressure is 7.7 mm.Hg.
Case 3 - POAG and Multiple Central Serous Retinopathy (MCSR)
Ms. U., age 50, has Asthma.
Treatment history
Treatment history before visiting Dr. Athikhomkulchai Patient experienced:
- Poor vision
- The light appears dimmer than before
- Unable to identify facial details, all she can see is a black blob
- Objects appear distorted
- Intraocular pressure (IOP) was 40 mm.Hg.
- Timolol eye drop
- Alphagan eye drop
- Xalatan eye drop
- Diamox tablet 1x4
- Both eyes can perform finger count at 2 feet
- Both eyes - optic disc cupping is 0.4
- IOP level - right eye = 22.8 mm.Hg.
- left eye = 32.3 mm.Hg. - Found multiple cystic edema at macular area
- High tension glaucoma
- Multiple Central Serous Retinopathy
After the eye examination, Dr. Athikhomkulchai recommended:
- 2% Isoptocarpine eye drop
- Low-dose steroid
- Palm Pressure Therapy (PPT)
- Slowly withdraw all the eye drops that the former ophthalmologist prescribed
Three days after treatment:
- Visual acuity - right eye = 20/70+1
- left eye = 20/50 - IOP level - right eye = 7.5 mm.Hg.
- left eye = 9.1 mm.Hg
- Visual acuity - right eye = 20/70+1, with the pinhole =20/50-1
- left eye = 20/30-3 - IOP level - right eye = 8.8 mm.Hg.
- left eye = 7.6 mm.Hg.
- Visual acuity - right eye =20/30-2
- left eye = 20/20-3 - IOP level - right eye = 11.2 mm.Hg.
- left eye = 12.0 mm.Hg.
- Visual acuity - right eye =20/20-2
- left eye = 20/20-1 - IOP level - right eye = 12.4 mm.Hg.
- left eye = 10.5 mm.Hg.
Seven weeks after the treatment:
- Visual acuity - right eye =20/20
- left eye = 20/20 - IOP level - right eye = 12.7 mm.Hg.
- left eye = 11.5 mm.Hg.
Treatment for Dry Age-related Macular Degeneration (AMD)
Case 4
Ms. S.S., age 58, no systemic condition.
Symptom: blurred vision on right eye 3 days before a visit to the office.
Examination and diagnosis by Dr. Athikhomkulchai:
- Visual acuity - right eye =20/50-1, no change with the pinhole
- left eye = 20/20 - Detected drusen (small clumps of debris) in macular
- Sign of macular degeneration
- Diagnosis: Dry AMD (age-related macular degeneration)
Treatment
After the eye examination, Dr. Athikhomkulchai recommended:
- Lutein
- Vitamin A
- Palm Pressure Therapy (PPT)
Three months after treatment: Both eyes have visual acuity of 20/20
Treatment for Optic Atrophy
Case 5
Mrs. SJ., age 43, no systemic condition.
Treatment history
Six months before visiting Dr. Athikhomkulchai, the patient experienced a headache and blurred vision. The clinical assessment showed that the pressure from a brain tumor had caused the swelling of the optic nerve (chronic papilledema) to both eyes. Following the recommendation of the physician, she had the tumor removed. After the removal of the tumor, her vision only improved slightly.
Examination and diagnosis by Dr. Athikhomkulchai:
- Both eyes can perform finger count at 3 feet
- Both eyes have pale optic disc
Treatment
After the eye examination, Dr. Athikhomkulchai recommended:
- Vitamin A
- Palm Pressure Therapy (PPT)
One month after treatment:
Visual acuity in both eyes = 5/200
Two months after treatment:
Visual acuity in both eyes = 20/200
Four months after treatment:
Visual acuity - right eye = 20/200+1
Visual acuity - left eye = 20/200
Note: This result is great success because there is no conventional treatment for Optic Atrophy.
Treatment for Central Retinal Vein Occlusion (CRVO)
Case 6 - CRVO
Miss. PN., age 13, no systemic condition.
Treatment history before visiting Dr. Athikhomkulchai:
Two weeks before a visit, patient experienced a blurred vision in her left eye. Her diagnosis from the former ophthalmologist was CRVO. She received an intraocular anti-VEGF injection into her left eye. The injection did not improve her vision.
Examination and diagnosis by Dr. Athikhomkulchai:
- Visual acuity - right eye =20/20
- left eye = 20/200, with the pinhole = 20/100+1 - Detected retinal vein hemorrhage
- Diagnosis: a severe case of CRVO
Treatment
After the eye examination, Dr. Athikhomkulchai recommended:
- Laser coagulation to seal the rupture and stop hemorrhage
- Steroid
- Palm Pressure Therapy
One week after treatment:
Visual acuity in left eye = 20/70-1, with the pinhole 20/40-2
Three weeks after treatment:
Visual acuity in left eye = 20/40-2, with the pinhole 20/40-1
Five weeks after treatment:
Visual acuity in left eye =20/30-3, with the pinhole 20/30-1
Three months after treatment:
Visual acuity in left eye =20/20
Case 7 - CRVO
Miss. P., age 37, no systemic condition.
Treatment history before visiting Dr. Athikhomkulchai:
Four days before a visit, patient experienced blurred vision in her left eye. Her diagnosis from the former ophthalmologist was CRVO. She refused to have Intraocular anti-VEGF injection that was the treatment of choice.
Examination and diagnosis by Dr. Athikhomkulchai:
- Visual acuity - right eye =20/20
- left eye = finger count at 3 feet - Detected retinal vein dilation, tortuous, rupture, and hemorrhage
- Diagnosis: a severe case of CRVO
Treatment
After the eye examination, Dr. Athikhomkulchai recommended:
- Laser coagulation to seal the rupture and stop hemorrhage
- Steroid
- Palm Pressure Therapy
One week after treatment:
Visual acuity in left eye =5/200, with the pinhole 20/200-1
Two weeks after treatment:
Visual acuity in left eye =10/200, with the pinhole 20/100
Three weeks after treatment:
Visual acuity in left eye =20/200, with the pinhole 20/50-2
Ten weeks after treatment:
Visual acuity in left eye =20/100, with the pinhole 20/50+1
Three months after treatment:
Visual acuity in left eye =20/70-2, with the pinhole 20/40
Case 18 - CRVO
Ms. Sukanda, Age 26, A student, no systemic condition
Treatment history before visiting Dr. Athikhomkulchai:
Patient experienced blurred vision in her right eye at the end of December 2015. Her diagnosis from the former ophthalmologist at the Eye Hospital in Bangkok was CRVO. The Ophthalmologist told her there was no treatment for her condition.
Examination and diagnosis by Dr. Athikhomkulchai:
- Visual acuity - right eye =20/70
- left eye = 20/20 - Fundus examination: Detected retinal vein dilation, tortuous, rupture, and hemorrhage
- Diagnosis: CRVO
After the eye examination, Dr. Athikhomkulchai recommended:
- Palm Pressure Therapy
- Steroid
- Laser Photocoagulation
Patient's status after the treatment:
One week after treatment:
Visual acuity in right eye = 20/40-2
Two weeks after treatment:
Visual acuity in right eye = 20/40+2
One month after treatment:
Visual acuity in right eye =20/30-2
 |
| Before treatment with PPT (taken by the Eye Hospital in Bangkok) |
 |
| After treatment with PPT (taken by Dr. Athikhomkulchai) |
Treatment for Retinitis Pigmentosa (RP)
Case 8 - Retinitis Pigmentosa (RP)
Miss. A.T., age 13, no systemic condition.
Treatment history before visiting Dr. Athikhomkulchai:
Four years before a visit, the eye assessment listed hereditary RP in both eyes. She did not receive any treatment due to no conventional treatment was available.
Examination and diagnosis by Dr. Athikhomkulchai:
- Visual acuity - right eye - finger count at 1 foot
- left eye - hand motion at close-range - Detected retinal degeneration with bone spicule pigment deposit
- Detected degeneration of the macular area with ground glass appearance
- Detected pale optic disc
- Detected retinal blood vessels attenuation
Treatment
After the eye examination, Dr. Athikhomkulchai recommended:
- Vitamin A
- Baby Aspirin
- PPT
Three months after treatment:
Visual acuity - right eye = 8/200
- left eye = 5/200
Seven months after treatment:
Visual acuity - right eye = 10/200
- left eye = 20/200+1
Two years after treatment:
Visual acuity - right eye = 20/200-1
- left eye = 20/100-1
The patient's quality of life has improved tremendously after the treatment.
Treatment for Epiretinal Membrane
Case 9 - Epiretinal Membrane
Patient - Ms. P.L, age 52 with no systemic condition.
Treatment history before visiting Dr. Athikhomkulchai:
Three months before a visit, the patient's left eye became blurred. The former ophthalmologist found the retina covered membrane and recommended the patient to remove it surgically. The patient refused the surgery and had bio-molecular therapy instead. There is no improvement in her vision after the treatment.
 |
| Left eye shows Drusen and Epiretinal membrane |
Examination and diagnosis by Dr. Athikhomkulchai:
- Visual acuity - right eye = 20/20-2
- left eye = 20/50+2 (no change with the pinhole) - Detected membrane in the macular area (see image)
- Diagnosis: Epiretinal Membrane
After the eye examination, Dr. Athikhomkulchai recommended:
- Vitamin A
- Baby aspirin
- Lutein
- Palm Pressure Therapy
One month after treatment:
Visual acuity - right eye = 20/20-2
- left eye = 20/20-2
Two months after treatment:
Visual acuity - both eyes = 20/20-1
Treatment for Central Serous Retinopathy (CSR)
Case 10 - Central Serous Retinopathy
Patient - Ms. G.L., age 37, no systemic condition.
Treatment history before visiting Dr. Athikhomkulchai:
Patient experienced blurred vision and flashes of light for three weeks before seeing the former ophthalmologist. The doctor detected fluid accumulation at the retina but did not recommend any treatment.
Examination and diagnosis by Dr. Athikhomkulchai:
- Visual acuity - right eye = 20/20
- left eye = 20/70-1
- Detected cystic edema at macular of left eye 2 disc diameter (DD)
- Diagnosis: Central Serous Retinopathy (CSR)
Treatment
After the eye examination, Dr. Athikhomkulchai recommended:
- Vitamin A
- Steroid
- Palm Pressure Therapy
One month after treatment:
Visual acuity - left eye = 20/40-1
Two months after treatment:
Visual acuity - left eye = 20/20-3
Five months after treatment:
Visual acuity - left eye = 20/20
This is a great success therapy since there is no conventional treatment for Central Serous Retinopathy at present. Ophthalmologists usually recommend their patients to observe the condition as most cases can resolve themselves without treatment. Recurrences can occur, resulting in macular degeneration. Treatment such as Laser photocoagulation or Intraocular anti-VEGF is futile for CSR.
Case 11 - Central Serous Retinopathy
Patient - Ms. P.D., age 50, hypertension
Treatment history before visiting Dr. Athikhomkulchai:
Patient experienced blurred vision and a grayish layer covering the left eye for one month. The former ophthalmologist did not recommend any treatment.
Examination and diagnosis by Dr. Athikhomkulchai:
- Visual acuity - right eye = 20/20
- left eye = 20/50, same with the pinhole - Small cystic edema at macular region in left eye
- Diagnosis: CSR on left eye
Treatment
After the eye examination, Dr. Athikhomkulchai recommended:
- Vitamin A
- Lutein
- Palm Pressure Therapy
Two weeks after treatment:
Visual acuity - left eye = 20/20-2
Note: PPT proofs to be very successful in improving the patient's vision in CSR while most ophthalmologists prefer to observe the symptom without any treatment for 3-6 months. Some may try to inject anti-VEGF with no success and risk other complications.
Treatment for Exophthalmos from Hyperthyroidism
Case 12
Dr. Athikhomkulchai follows the theory that tissue has an ability to re-model itself. When the correct amount of pressure applies to the eye, the action stimulates the trabecular meshwork to drain aqueous fluid from the eye, resulting in lower intraocular pressure. With repeated palm pressure therapy, the IOP remains lower permanently. Dr. Athikhomkulchai uses this theory to treat exophthalmos patients successfully.
The treatment duration was 1 year of Palm Pressure Therapy (PPT). See before and after picture below:
Treatment for Hereditary Macular Degeneration
Case 13
Patient - Ms. P.S., age 22
Treatment history before visiting Dr. Athikhomkulchai:
The patient noticed a grayish round at the center of the left eye. The former ophthalmologist found macular degeneration in both eyes. No treatment is available.
Dr. Athikhomkulchai follows the theory that tissue has an ability to re-model itself. When the correct amount of pressure applies to the eye, the action stimulates the trabecular meshwork to drain aqueous fluid from the eye, resulting in lower intraocular pressure. With repeated palm pressure therapy, the IOP remains lower permanently. Dr. Athikhomkulchai uses this theory to treat exophthalmos patients successfully.
The treatment duration was 1 year of Palm Pressure Therapy (PPT). See before and after picture below:
 |
| Before the treatment with PPT |
 |
| After the treatment with PPT |
Treatment for Hereditary Macular Degeneration
Case 13
Patient - Ms. P.S., age 22
Treatment history before visiting Dr. Athikhomkulchai:
The patient noticed a grayish round at the center of the left eye. The former ophthalmologist found macular degeneration in both eyes. No treatment is available.
Examination and diagnosis by Dr. Athikhomkulchai:
- Visual acuity - right eye = 20/20-2
- left eye = 20/200, same with the pinhole
- Optic disc cupping - right eye = 0.4
- left eye =0.5 - Macular degeneration is more severe in the left eye than the right eye as shown in image below (click image to enlarge)
- Diagnosis: Hereditary Macular Degeneration (Stargardt's disease)
 |
| Macular Degeneration |
Treatment
After the eye examination, Dr. Athikhomkulchai recommended:
- Lutein 20 mg., 1 tablet a day
- Vitamin A 25000 unit, 1 tablet a day
- Palm Pressure Therapy
One week after treatment:
Visual acuity - right eye = 20/20
- left eye = 20/100, with the pinhole 20/100+1
Two weeks after treatment:
Visual acuity - right eye = 20/20
- left eye = 20/70-1, with the pinhole 20/70+1
Eight weeks after treatment:
Visual acuity - right eye = 20/20
- left eye = 20/50-1, with the pinhole 20/40-2
Treatment for Central Retinal Artery Occlusion (CRAO)
Case 14 - CRAO
Mr. G.N., age 40, has hypertension.
Treatment history before visiting Dr. Athikhomkulchai:
10 days before a visit, the patient had a sudden vision loss in the right eye while watching T.V. The former Ophthalmologist prescribed an anticoagulant drug and the use of Hyperbaric Oxygen Therapy for 7 days. The patient had minimal vision improvement after the treatment.
Examination and diagnosis by Dr. Athikhomkulchai:
- Funduscopy reveals pale and edema of the retina surrounding the Macular area. The appearance described as "Cherry-red spot", a pathognomonic sign of CRAO
- Visual acuity - right eye = finger count at 1 foot
- Diagnosis; CRAO
After the eye examination, Dr. Athikhomkulchai recommended:
- Vitamin A
- Baby Aspirin
- Steroid
- PPT
Two weeks after treatment:
Visual acuity - right eye = finger count 3 feet
- left eye = 20/20-1
Three weeks after treatment:
Visual acuity - right eye = 10/200
- left eye = 20/20-1
Four weeks after treatment:
Visual acuity - right eye = 10/200, with the pinhole 20/200
- left eye = 20/20-1
Three months after treatment:
Visual acuity - right eye = 15/200, with the pinhole 20/200
- left eye = 20/20
Five months after treatment:
Visual acuity - right eye = 20/200, with the pinhole 20/200
- left eye = 20/20
Note: The visual acuity reading in the right eye is stable at 20/200. The patient has regained sufficient visual field in the right eye that the combined left and right eye vision make it possible to live a normal life again.
Case 17 - CRAO with Cilioretinal artery sparing
Ms. JP, age 56, no other medical condition
Treatment history before visiting Dr. Athikhomkulchai:
three days before a visit, the patient had a sudden vision loss in the right eye after prolong using a computer right before bedtime. The patient's vision on her right eye limited to a small window at the center. Patient woke up the next day without any improvement. The general ophthalmologist she visited diagnosed the condition as CRAO and referred her to the retina specialist for further assessment. Her doctor warned her that there was no treatment for her condition.
Examination and diagnosis by Dr. Athikhomkulchai:
After the eye examination, Dr. Athikhomkulchai recommended:
One week after treatment:
Visual acuity - right eye = 20/30-2
Two weeks after treatment:
Visual acuity - right eye = 20/20-1
Note:
Treatment for Dry Age-related Macular Degeneration (AMD) and Macular hole
Case 15 - Macular hole and Dry AMD
Ms. S.S., age 65, has hypertension.
Treatment history before visiting Dr. Athikhomkuchai:
The patient went to another ophthalmologist a month ago due to blurred vision in her right eye. The doctor found a hole in Macular area and told the patient that no treatment available.
Examination and diagnosis by Dr. Athikhomkulchai:
Through fundus examination - right eye - found Macular Degeneration with hole
- left eye - found Macular Degeneration
Visual acuity - right eye = finger count at 3 feet
- left eye = 20/40+3
Diagnosis: Right eye - Macular hole
Left eye - Dry AMD
Treatment
After eye examination, Dr. Athikhomkulchai recommended:
Two weeks after treatment:
Visual acuity - right eye = 7/200, with the pinhole 7/200
- left eye = 20/30-1, with the pinhole 20/20
Six weeks after treatment:
Visual acuity - right eye = 7/200, with the pinhole 20/200
- left eye = 20/20-2
Three months after treatment:
Visual acuity - right eye = 12/200, with the pinhole 20/200
- left eye = 20/30+1, with the pinhole 20/30+1
Five months after treatment:
Visual acuity - right eye = 20/200-1, with the pinhole 20/200
- left eye = 20/30+1, with the pinhole 20/30+1
Seven months after treatment:
Visual acuity - right eye = 20/200, with the pinhole 20/200
- left eye = 20/20
Note:
The Conventional treatment recommendation for Macular hole is to observe the hole if it is small and not interfere with the vision. If the doctor recommends surgery, that means the doctor removes the vitreous fluid and replace with sterile gas. The gas maintains pressure on the macular hole during the healing process. The patient must maintain face-down position for 1-2 weeks. The surgery helps to close the hole but rarely improve the patient's vision.
Dr. Athikhomkulchai believes that the cause of Macular hole is not from vitreous degeneration that shrinks and pulls macula as other researchers believe. The surgery used by many Ophthalmologists to correct the problem is futile. After surgery, the patient's vision continues declining.
Instead, Dr. Athikhomkulchai believes in the theory that the cause of Macular hole is an insufficient supply of blood (ischemia) to the Macular area of the retina similar to that of dry AMD. PPT can improve blood circulation to the retina, hence improves the eyesight. His suggestion is to avoid surgery unless an early sign of retinal detachment is evidence. All his patients treated with PPT have visual improvement without surgery except one case that has a deep Macular hole; he did Grid laser photocoagulation to prevent the progression to retinal detachment.
Case 16 - Retinitis Pigmentosa (RP)
Mr. A.B., age 27, no systemic condition.
Treatment history before visiting Dr. Athikhomkulchai:
His diagnosis was Retinitis Pigmentosa. Several Ophthalmologists, he visited told him that there is no cure for his condition.
Examination and diagnosis by Dr. Athikhomkulchai:
Treatment
After the eye examination, Dr. Athikhomkulchai recommended:
Two months after treatment:
Visual acuity - right eye = 20/70+2, with the pinhole = 20/70+2
- left eye = 20/30-1, with the pinhole = 20/30-1
Four months after treatment:
Visual acuity - right eye = 20/70, with the pinhole = 20/30
- left eye = 20/30, with pinhole 20/20
- left eye = 20/20-1
Four weeks after treatment:
Visual acuity - right eye = 10/200, with the pinhole 20/200
- left eye = 20/20-1
Three months after treatment:
Visual acuity - right eye = 15/200, with the pinhole 20/200
- left eye = 20/20
Five months after treatment:
Visual acuity - right eye = 20/200, with the pinhole 20/200
- left eye = 20/20
Note: The visual acuity reading in the right eye is stable at 20/200. The patient has regained sufficient visual field in the right eye that the combined left and right eye vision make it possible to live a normal life again.
Case 17 - CRAO with Cilioretinal artery sparing
Ms. JP, age 56, no other medical condition
Treatment history before visiting Dr. Athikhomkulchai:
three days before a visit, the patient had a sudden vision loss in the right eye after prolong using a computer right before bedtime. The patient's vision on her right eye limited to a small window at the center. Patient woke up the next day without any improvement. The general ophthalmologist she visited diagnosed the condition as CRAO and referred her to the retina specialist for further assessment. Her doctor warned her that there was no treatment for her condition.
Examination and diagnosis by Dr. Athikhomkulchai:
- Fundus examination of the right eye reveals pale and edema of the retina due to the lack of blood supply except for the central of the retina that maintain the blood supply through the cilioretinal artery. Cilioretinal artery is one of the anatomical variants that provides blood to maculopapular bundle that contains the photoreceptors. Therefore, when CRAO occurs in patient with cilioretinal artery the central part of the retina is not affected. The presence of a cilioretinal artery helps maintain Ms. JP's vision. She was not in a complete loss of eyesight as a result of CRAO.
- Visual acuity - right eye = 20/100, left eye = 20/20
- Diagnosis; CRAO with Cilioretinal artery sparing
After the eye examination, Dr. Athikhomkulchai recommended:
- Vitamin A
- Baby Aspirin
- Steroid
- PPT
One week after treatment:
Visual acuity - right eye = 20/30-2
Two weeks after treatment:
Visual acuity - right eye = 20/20-1
 |
| Fundoscopy before the treatment |
 |
| Fundoscopy after PPT |
Note:
- The instantaneous anticipation and action taken helped save Ms. JP's eyesight. She refused to accept that there is no cure for her condition and did her research that led her to Dr. Athikhomkulchai.
- In CRAO without Cilioretinal artery variant, if the patient applies PPT within 24 hours before permanent damage to retinal nerve occurs, there is a very high probability of regaining normal eyesight.
- There are 14 % of the total populations that have Cilioretinal artery variant. This group of patients can restore vision even when the treatment begins after 24 hours. Ms. JP is one good example of such a patient.
Treatment for Dry Age-related Macular Degeneration (AMD) and Macular hole
Case 15 - Macular hole and Dry AMD
Ms. S.S., age 65, has hypertension.
Treatment history before visiting Dr. Athikhomkuchai:
The patient went to another ophthalmologist a month ago due to blurred vision in her right eye. The doctor found a hole in Macular area and told the patient that no treatment available.
Examination and diagnosis by Dr. Athikhomkulchai:
Through fundus examination - right eye - found Macular Degeneration with hole
- left eye - found Macular Degeneration
Visual acuity - right eye = finger count at 3 feet
- left eye = 20/40+3
Diagnosis: Right eye - Macular hole
Left eye - Dry AMD
Treatment
After eye examination, Dr. Athikhomkulchai recommended:
- Vitamin A
- Lutein
- PPT
Two weeks after treatment:
Visual acuity - right eye = 7/200, with the pinhole 7/200
- left eye = 20/30-1, with the pinhole 20/20
Six weeks after treatment:
Visual acuity - right eye = 7/200, with the pinhole 20/200
- left eye = 20/20-2
Three months after treatment:
Visual acuity - right eye = 12/200, with the pinhole 20/200
- left eye = 20/30+1, with the pinhole 20/30+1
Five months after treatment:
Visual acuity - right eye = 20/200-1, with the pinhole 20/200
- left eye = 20/30+1, with the pinhole 20/30+1
Seven months after treatment:
Visual acuity - right eye = 20/200, with the pinhole 20/200
- left eye = 20/20
Note:
The Conventional treatment recommendation for Macular hole is to observe the hole if it is small and not interfere with the vision. If the doctor recommends surgery, that means the doctor removes the vitreous fluid and replace with sterile gas. The gas maintains pressure on the macular hole during the healing process. The patient must maintain face-down position for 1-2 weeks. The surgery helps to close the hole but rarely improve the patient's vision.
Dr. Athikhomkulchai believes that the cause of Macular hole is not from vitreous degeneration that shrinks and pulls macula as other researchers believe. The surgery used by many Ophthalmologists to correct the problem is futile. After surgery, the patient's vision continues declining.
Instead, Dr. Athikhomkulchai believes in the theory that the cause of Macular hole is an insufficient supply of blood (ischemia) to the Macular area of the retina similar to that of dry AMD. PPT can improve blood circulation to the retina, hence improves the eyesight. His suggestion is to avoid surgery unless an early sign of retinal detachment is evidence. All his patients treated with PPT have visual improvement without surgery except one case that has a deep Macular hole; he did Grid laser photocoagulation to prevent the progression to retinal detachment.
Case 16 - Retinitis Pigmentosa (RP)
Mr. A.B., age 27, no systemic condition.
Treatment history before visiting Dr. Athikhomkulchai:
His diagnosis was Retinitis Pigmentosa. Several Ophthalmologists, he visited told him that there is no cure for his condition.
Examination and diagnosis by Dr. Athikhomkulchai:
- Visual acuity - right eye - 20/70, with the pinhole - 20/70
- left eye - 20/40, with the pinhole - 20/40 - Fundus Examination found
- Retinal degeneration with bone spicule pigments in both eyes, a pathognomonic sign of Retinitis Pigmentosa
- Macular degeneration
Treatment
After the eye examination, Dr. Athikhomkulchai recommended:
- Vitamin A
- Baby Aspirin
- PPT
Two months after treatment:
Visual acuity - right eye = 20/70+2, with the pinhole = 20/70+2
- left eye = 20/30-1, with the pinhole = 20/30-1
Four months after treatment:
Visual acuity - right eye = 20/70, with the pinhole = 20/30
- left eye = 20/30, with pinhole 20/20