American Academy of Acupuncture and Oriental PowerPoint Presentation

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1 Acupuncture Therapy for Age-Related Macular Degeneration “The Santa Fe Eye Protocol” American Academy of Acupuncture And Oriental Medicine 18 July 2012 Alston C. Lundgren, MD, FAAFP, FAAMA Santa Fe NM USA Full Text: www.ReverseAMD.com e.mail: Alston@LundgrenMD.com

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My acupuncture training is mostly European and Canadian. I am here to share with you acupuncture principles which may not be familiar to you . In particular, I am giving you a tool to treat many patients who previously have been unable to be treated – thus helping alleviate human suffering 2

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This AMD treatment is the first situation I know of where acupuncture treatment can do something with quantifiable endpoints that other medical modalities cannot. That means credibility in conventional Western Medical eyes 3

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4 Significance Millions of persons afflicted with AMD can now have help. This can help legitimize acupuncture because the condition is quantifiable – and conventional medicine cannot help.

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Presentation outline 5 AMD background Current conventional treatment Description of the Santa Fe Eye Protocol Results of the Santa Fe Eye Protocol Statistical significance Historic and Suggested Treatment Technical Details

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6 Prevalence : up to 9 million cases in US Cause: Unknown Risk factors: Northern and Western European ancestry Ultraviolet exposure Smoking Family history Most significantly, growing older

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Two varieties 7 Dry AMD represents 90 % of cases – usual course is a slow decline in vision. Treatment is limited to hypertension control, avoiding UV exposure, quitting smoking, and AREDS vitamins and lutein. Wet or Neovascular is 10% of cases - but the more likely to lead to sudden and severe vision loss.

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8 Ophthalmologists are now able to stop bleeding by various techniques. Thermal laser started 20 years ago – with 3 line vision loss an immediate consequence. Photodynamic Therapy – IV Verteporfin with cold laser – could treat 40 % of wet AMD cases without the laser 3 line loss.

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9 Anti Vascular Epithelial Growth Factor: intraocular injections of: Macugen, Lucentis, and off label Avastin. Literature and advertising reports 20+% of these patients regain lost vision – BUT most likely the vision gain is the body reabsorbing blood after leak stops –NOT the action of the drug itself.

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Since 2001 more than 1500 persons have been treated with variations of the same protocol involving several different acupuncture modalities. Overall, 85% of patients had an overall improvement in visual acuity. 10 Today’s Report on My Work

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11 Basic Definitions AMD = Age-Related Macular Degeneration OS = left eye OD = right eye ETDRS charts (Early Treatment of Diabetic Retinopathy Study) 5 letters each line Logarithmic -3 lines = doubling vision Validated by National Eye Institute

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The Santa Fe Eye Protocol works on related retinal conditions - but only half as well. In Asians, Myopic Degeneration is the most common type of retinopathy. In Caucasians it is Retinitis Pigmentosa, Stargardts, and Best’s Disease plus many other rare congenital conditions. 12

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13 Reporting Convention Most of my patients were not local and came for a week for daily treatments and were tested on Monday, Wednesday and Friday before treatment. Thus reports were standardized to reflect 4 treatments

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Overall Population Characteristics 14 Previously Reported 2010 ICER, Beijing

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Overall Results 15 Letters

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Methods At intake: Measure visual acuity using ETDRS eye charts for both near and distant vision. VF-14 subjective measures Color screen using HRR isochromic color chart Pelli-Robson Contrast Sensitivity measurement 16

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Inclusion Criteria 17 Must have ophthalmologist diagnosed AMD Must have ophthalmologist exam saying no bleed: Within 3 months if Wet AMD Within 12 months if Dry AMD If any significant vision loss Must not be demented No seizure history

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18 ETDRS Visual Acuity Chart

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ETDRS Near Chart 19

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Pelli-Robson Contrast Sensitivity Pelli-Robson Contrast Sensitivity 20

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Santa Fe Eye Protocol Components German Ear Acupuncture Canadian Neuroanatomic Acupuncture Classic Chinese Scalp Acupuncture Yamamoto Scalp Acupuncture 21

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Indirect stimulation of specific parts of brain through ear acupuncture 22

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XMHN # 1, Yamamoto CN needles. Visual cortex over lambdoid suture is being re-investigated X15 mm needles, 2 cm lateral to midline, insert down, at lambdoid suture Yamamoto CN:30mm Needles, insert 2 cm behind hairline, 1 cm either side of midline.

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Direct Electrical Stimulation of Periorbital area 24

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Dry AMD Gains after 4 Tx 25 Letters n=367 n=398 n=370

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Wet AMD Gains after 4 TX 26 Letters

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Overall Gain vs Intake Acuity 27

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Vision Gains By Tx Date 28 Sum of letters OS and OD, both Near and Far

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Hard to Quantify Gains Distortions lessen. Scotomas diminish or disappear. Less light needed to see. Sensation of a film over eyes decreases. Colors become more vibrant. 29

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30 Function vs Physical Changes Most patients and I focus on function. For many retinologists, the more important issue is changes in retinal photographs , angiograms or OCT measurements . A few patients have reported significant gains in those tests, but I have not performed them. Those studies should be performed by an independent, academic center in a systematic way.

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Durability An IRB study is underway to determine durability and also late gains. Release of records forms have been signed – but it is a massive effort yet to be done. Anecdotally, patients have retained vision gains upwards of 5 years. When there are losses, a big portion of the time they are associated with a CVA. Rarely is it a hemorrhage – but that is the big concern. 31

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Late Gains 32 A significant portion of patients report late gains – scotomas clearing, more colors, clearer vision, etc. Since most patients are not local, the next stage of research is obtaining vision records from treating eye doctors.

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Risks 33 To date only black eyes – which always spontaneously resolve. There is a concern that there might be an increase in the number of bleeds in persons with wet AMD. Only 2 cases have occurred near the time of treatment. Periorbital infections are rare – but must be treated aggressively with antibiotics.

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Statistical Significance Central Limit Theorem: Standard deviation of a group of N independent distributions equals the standard deviation of an individual divided by the square root of N. 34

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For a 100 member group of those individuals, the standard deviation is 0.1 x 0.75 or 0.075.For groups the size in this presentation, the p value < 0.001 that the improvement is from random variation. The results are real!! Typical test-to-test variation for visual acuity is 1 ½ lines with 95% confidence. That is, one standard deviation = 0.75 lines. 35

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Conclusion 36 The acupuncture protocol reported here increased visual acuity for both dry and wet varieties of AMD much more than can be explained by random chance or test variation.

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37 Research Questions What electric frequency to use? Duration of each treatment? Interval between treatments? Are there observable changes in retinal photographs/angiograms? Optimal needle placement?

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38 Santa Fe Eye Protocol 2012 Suggested Needle Placement and Technical Details

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Methods At intake: Measure visual acuity using ETDRS eye charts for both near and distant vision Pelli-Robson Contrast Sensitiviy measurement Color screen using HRR isochromic color chart VF-14 subjective measures

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40 German Ear: Bilaterally gold ASP at Eye, CN 2, Pineal, Diazepam Analog and Interferon and steel mastoid Scalp: XMHN#1, 15 mm x 0.20 mm needle (-) at lambdoid to ipsilateral Yamamoto CN line (+) Canadian Neuroanatomic 0.20 mm x 15 mm Nasal infraorbital ridge (-) to 0.20 x 30 mm temporal supraorbital ridge (+) Temporal infraorbital ridge (-) to nasal supraorbital ridge (+)

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German pineal, CN 2, pineal, diazepam analog, interferon and steel ASP needle behind earlobe

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42 German Ear  Simplified protocol: Both ears the same:  non dominant ear gold at named Pineal, Diazepam Analog, Interferon, CN 2 and Eye point with steel on mastoid earlobe  opposite CN 2.   This represents “cookbook recipe” as opposed to practitioners needing to know German Auricular.

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43 Be sure to add gold ASP studs Bilaterally at eye and CN 2 points And a steel ASP on mastoid Earlobe to form a Bahr Forceps

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ppt slide no 44 content not found

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45 Modified XMHN#1 using 0.20 x 15 mm needles oriented not to fall out As of 2012 my preferred approach is (-) at lambdoid suture over visual cortex, 2 cm from midline to (+) at ipsilateral Yamamoto CN site 1 cm lateral to midline. This starts 2 cm cephalad of hairline toward forehead Scalp

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XMHN # 1, Yamamoto CN needles, visual cortex over lambdoid suture X15 mm needles, 2 cm lateral to midline, insert down, at lambdoid suture Yamamoto CN:30mm Needles, insert 2 cm behind hairline, 1 cm either side of midline.

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Direct Electrical Stimulation of Periorbital area

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48 Nasal infraorbital ridge  (-)  to temporal supraorbital ridge (+) and temporal  infraorbital ridge (-) to nasal supraorbital ridge    Needles arranged such that electric current will flow through the whole retina – including the macula Suggested Eye Needle Placement

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Old array – no time for new slide. Crisscross pattern (-) nasal infraorbit to (+) temporal supraorbit, (-) tempral infraorbit to (+) nasal supraorbit

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50 ENERGY This is my historic protocol. Going forward I will simplify my protocol by eliminating this part except in those persons suffering excess fatigue. I started it because older persons coming from sea level to Santa Fe’s 7000 foot elevation suffered.

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51 SP 4  connected to KI 3 (-) to ST 30 connected to CV 2/4(+),   CV 12, 17, tack at PC 6 with return LI 11 (-) to ST 36 (+) This is Chong Mo expanded – to add energy to the system, with a French Energetics return that stimulates the immune system.  These circuits alone are a very powerful combination to add energy and stimulate immune system in  a very large number of clinical situations. Abandoned Energy Component

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{KI 3 to SP 4} (-) to {CV 2/4 to ST 30} (+), tack or needle at PC6 LR 3 (-) to LR 9 (+) Return: LI 11 (-) to ST 36 (+)

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53 Precautions Periorbital infections MUST BE aggressively treated with antibiotics Seizures are a contraindication Demented persons do not respond well and cannot validly report

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54 Anti-coagulation is not a contraindication Black eyes are very common – but always resolve spontaneously. I always apply an ice pack for 5 – 10 minutes after each treatment Helpful Pointers

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Technical Details I have no business interest with any supplier ETDRS and Pelli-Robson charts from several sources. Precision Vision, La Salle, IL is one. Needles: Many sources. I use Accuglide from Helio and gold ASP semipermanent needles from Lhasa 55

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Stimulators: Most stimulators do NOT deliver the frequencies indicated. Ito and several Chinese devices are commonly off by 50%. Pantheon Electric (Santa Monica, CA) devices cost twice as much but are exactly correct as tested by oscilloscope. They also will set units at Nogier frequencies. Electrodes formerly from Helio, now from Lhasa. Better ones are small wires, 3 prongs on one clip and 2 on the other. 56

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Thank you for your attention. 57 Full Text Posted: www.reverseAMD.com Alston@LundgrenMD.com