What is it?

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      Marketing-Agency-Brochure

      Vision deterioration that is caused by optic nerve damage usually shows a limited capacity for automatic and recovery resulting from treatment.

      Developed traumatic optic neuropathy is a potentially blinding condition, which is the result of head or orbital trauma. It was shown that the degree of vision loss does not always correlate with the severity of trauma.

      The optimal treatment of optic nerve injury in the acute stage remains controversial, and management of the patient suffering blindness or severe visual impairment secondary to traumatic optic neuropathy is complex and inconsistent. Corticosteroids treatment and decompression of the optic nerve are advisable in patients who suffer from traumatic brain injury or eye trauma, to cause possible vision recovery.

      Optic nerve trauma is considered a focal central nervous system injury. Its therapy may be supported by evidence for appropriate treatment modalities for other traumatic central nervous system events. Post-traumatic vision loss results have not been studied prospectively, but it is known that automatic recovery may occur in at least a third of patients.

      Patients who did not benefit from these standard approaches have virtually no chance to improve their eyesight, and deteriorated vision is likely irreversible.

      Marketing-Agency-Brochure

      Symptoms

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      Results

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      retinitis-pigmentosa-treatment--our-treatment--therapeutic-electrical-stimulations-thumb

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      retinitis-pigmentosa-treatment--our-treatment--therapeutic-electrical-stimulations-thumb

      What is Electrical Stimulation Therapy

      electrical-stimulation-therapy--therapeutic-electrical-stimulation-thumb

      Therapeutic electrical stimulation is a non-invasive and non-surgical way of natural partial restoration of visual functions done by applying weak currents on retina.

      Electrical Stimulation Therapy helps vision impaired patients with visual disorders that affect their ability to see the world around them. Our support and treatment of impaired vision patients have shown that many patients that suffered from an optic nerve lesion (optic neuropathy) had mostly resigned themselves to living with this serious problem.

      Since 1995 we have been not only developing methods for vision recovery, but also treating patients with optic nerve atrophy and those patients with abnormal retina and vision impairment attributed to brain disorders.

      Benefits of Treatment

      Vision Stabilization

      Further loss of vision resulting from a steady progression of the disease can be avoided or significantly slowed.

      Increased Field of Vision

      Further loss of vision resulting from a steady progression of the disease can be avoided or significantly slowed.

      Improved Night Vision

      More than half those treated showed improved vision in the dark and a reduction in vision haziness.

      Decreased Light Sensitivity or improved Adaptation to Light

      These additional improvements are often experienced after our vision restore treatments.

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      Success cases with our therapy

      Description of Clinical Case and Result


      CLINICAL CASE

      Here is the case of a 27-year-old, male patient who suffered from severe, unilateral traumatic optic nerve atrophy with nearly complete vision loss for more than 10 years. There were no signs of progression or recovery of the visual field in the year before his treatment, as shown by standard perimetry results provided by the patient’s ophthalmologist. Perimetric visual field exams of the left eye showed a complete loss of vision in static near-threshold perimetry (Twinfield, Oculus, Lynnwood, WA). Subjectively, the patient could detect some extra bright dots in the lower temporal quadrant of the left eye, at the baseline.

      After a comprehensive exam, (tests of visual acuity, static perimetry, and kinetic perimetry) the patient received 10 sessions of therapeutic electrical stimulation over two weeks. VF examinations conducted immediately after therapy revealed vision improvement – mean perimetric threshold (ability to see the test stimuli) was increased from 0 dB to 2.21 dB, and kinetic perimetry showed an increase of eccentricity of the visual field border by about 4 Grad as well. After two months, repeated VF exams showed further improvement and stabilizing of the earlier improvements.

      PARTIALLY RESTORED VISION, REVEALED BY STATIC VISUAL FIELD EXAMINATIONS, CONDUCTED AFTER THE TREATMENT

      Subjectively, after the treatment, the patient reported his regained ability to use both eyes in daily life. Due to existing strabismus on his lesioned eye, he noticed an increase of diplopia after the course of the treatment, which was a result of increased visual acuity. Follow-up exams confirmed the stable effect of therapeutic electrical stimulation as a visual field enlargement.

      Considering the patient’s young age and the existing function of one eye, it was important to exclude any side effects in his other eye. The right eye did not show any side effects after 10 sessions, after two months, and with a follow up after 18 months. This eye revealed complete normalization for all VF areas, whereas, before the therapy, some areas with small defects were observed.

      Let us make the following summaries:

      • Severe impaired vision (blindness of the eye) caused traumatic optic neuropathy, which can be improved after two weeks of treatment with repeated therapeutic electrical stimulation.
      • Significant increases in the detection ability of the lesioned eye could be observed
      • Revealed positive dynamic in visual field correlated with the improvement of subjective vision, when the patient started to recognize contrast objects, which previously was not possible
      • The improvement of vision was stable after 18 months, supporting the use of therapeutic electrical stimulations as a treatment that produces long-lasting plasticity changes
      • No side effects were observed for the other eye or the impaired eye as shown in the complete normalization of the detection ability of all VF areas.

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      retinitis-pigmentosa-treatment--success-cases-with-our-therapy

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      FAQ

      What is it?

      What is retinitis pigmentosa?

      Retinitis pigmentosa is a group of hereditary progressive retinal degenerations or dystrophies. There a lot of variations between the different forms of retinitis pigmentosa, but what they all have in common is progressive degeneration of light receptors, also known as the rods and cones as a part of retina. By nature RP is progressive degeneration of the retina (photoreceptor cells detecting light) which leads to the constriction of peripheral vision. RP is considered a rare disease: it affects roughly 1 in 4,000 men and women of all ages, races, cultures, and ethnic backgrounds worldwide.


      What causes retinitis pigmentosa?

      RP can not be caused by injury, infection or any other external or environmental factors. It is an inherited disorder resulted in by pathological changes in one of more than 50 genes. Different kinds of gene mutations lead to damage of the photoreceptors. The first signs of retinitis pigmentosa can be observed by the doctor in affected children as early as age 10 or even at birth. If RP is diagnosed later in life, it is milder and may progress more slowly.


      What do we know about heredity and retinitis pigmentosa?

      Most cases are inherited and fall into three main categories: autosomal recessive, autosomal dominant, and X-linked recessive. The main difference is how high the risk of passing the gene to the child. Some RP cases have no previous family history. The cause of such cases cannot be explained.

      Types of conditions

      Retinitis pigmentosa in glance

      Cataract

      Posterior central subcapsular cataract with a clear nucleus, which is usually present at mid stage of the disease. Its central location blurs the remaining visual field, provoking a sight restriction and leading to photophobia. Phacoemulsification with implantation of intraocular lens is thus required.


      Macular edema

      Macular edema is a frequent complication for PR patients It is usually chronic and cause loss of the visual acuity. Macular complications such as the development of an epiretinal membrane (ERM), cystoid macular edema (CME) and a macular hole (MH) lead to unexpected central vision impairment. Acute episodes of macular edema may be successfully treated with medicaments.


      Toxicity from vitamin A

      Thought it occurs rare, patients should have a pretreatment assessment of fasting serum vitamin A levels and liver function and annually thereafter. High doses of Vitamin A (15,000 IU/day) are not recommended to pregnant women or women planning pregnancy. Older adults should consult with their physicians about their bone health due to the fact that a long term Vitamin A supplementation effects done density. Vitamin A is contraindicated for patients with renal failure or renal transplant because of excessive renal re-absorption and to patients taking doxycycline since the combination can cause increased intracranial pressure.

      Diagnosis

      How is RP diagnosed?

      Tests to confirm RP include:
      RP can be diagnosed during routine eye examination if there are abnormal, dark pigment deposits in the retina. Also the following  examinations are important: Visual acuity, Pupillary reflex response, Refraction, Intraocular pressure, Retinal photography.

      • Electroretinogram (ERG) measures the electrical activity of photoreceptor cells, which is decreased if a person suffers RP.
      • Visual field testing finds defects in the peripheral (side vision) with the degree of loss related to defects in relation to the damage occurring in this disease.
      • With help of genetic testing a patient can learn about the progression of his particular form of the disorder.
      • Color testing: although most of the RP patients do not have difficulties while color testing, commonly mild blue-yellow axis color defects.
      • Dark adaptation study: Disproportionately reduced contrast sensitivity relative to visual acuity in RP; bright-light sensitivity listitem
      • Genetic subtyping: Definitive test for diagnosis to identify the particular defect Ultrasound of the eye
      • Fluorescein angiography
      • Optical computer tomography (OCT)

      Is RP associated with other diseases?

      There are many other mostly genetic retinal degenerations with their own distinct characteristics similar to RP. More known syndromes are:

      • Bardet-Biedl Syndrome. The most common are RP, extra fingers and/or toes, obesity, mental retardation and kidney disease.
      • Usher Syndrome. The combination of RP with congenital hearing deficit and problems with balance (Type II)
      • Bassen-Kornzweig Syndrome. RP combines with severe and progressive neurologic problems.
      • Choroideremia has symptoms similar to RP, including night blindness followed by loss of peripheral vision. It is characterized by degeneration of the retina and of the choroid.
      • Gyrate Atrophy. This retinal degenerative disease is associated with myopia, night blindness, reduction in peripheral vision and cataracts Retinoschisis. Juvenile retinoschisis is characterized by vision loss that is usually diagnosed in childhood.
      • Refsum’s Syndrome. RP with peripheral neuropathy, cerebellar ataxi
      • Alstrom Syndrome. RP with Obesity, Deafness, Diabetes and cardiac complaint
      • NARP Syndrome. RP with Neuropathy and Ataxi
      • Kearns Sayre Syndrome. RP with external ophthalmoplegia and complete heart block

      How does RP affect vision?

      The symptoms usually become apparent between the ages of 10 and 30, although some changes may become apparent in childhood.

      Children often have difficulty adjusting to changes in lighting or getting around in the dark (nyctalopia). People with RP often suffer from photophobia, finding bright lights uncomfortable.

      Progressive loss of peripheral vision is common, although there may be loss of central vision which tends to occur later. This results in impaired sight at a variable rate.


      Constriction of visual field

      Slow constriction of visual fields leads to tunnel vision, which significantly lowers patients’ quality of life, and eventually to total blindness.

      The age of appearance of legal blindness ranges from childhood to the 40s. But symptoms may progress at different rates even in members of the same family.


      RP can affect central vision

      Other forms of RP first affect central vision, that cannot be corrected with glasses or contact lenses.

      Patients can experience disturbances in color perception. As the disease progresses, rod cells degeneration leads to night blindness and peripheral vision loss.

      Live with Retinitis Pigmentosa

      practical tips and recommendations

      There are many practical issues visually impaired patients with RP are looking for. Even though RP is a progressive disease people wonder what else can negativity affect their vision. Below you will find answers to most frequently asked questions regarding RP:

      • Does exposure to light lead to loss of vision for people with RP?
      • Can people with RP drive?
      • Does pregnancy have an effect on RP?
      • What is the likelihood that I will pass the RP gene on to my children?
      • What should I do if my child is diagnosed with RP?

      Does exposure to light lead to loss of vision for people with RP?

      Though many people with RP find it comfortable to avoid bright lights and bright sunlight, there is no scientific evidence that normal levels of light increase vision loss. People with RP can use their eyes in ordinary light conditions without any restriction. But it is recommended taking precautions to protect eyes from long term exposure to bright sunlight and wear good quality sunglasses until more is known about this subject.


      Does pregnancy have an effect on RP?

      It has been reported that some women have experienced more rapid progression of RP during pregnancy, but it is problematic to study the issue thoroughly because RP is rare. If a woman is pregnant or is planning to get pregnant, she should make sure that her ophthalmologist knows about her pregnancy and her gynecologist is aware of her vision problems.


      Can people with RP drive?

      A lot of people with RP drive legally with no problems, but legal vision requirements vary from country to country. That is why an RP patient should discuss the issue with his eye care professional. There are several main criteria that affect driving such as visual acuity, extent of visual field loss, binocular field of vision and diplopia (double vision).


      Drivers need to be considered for re-licensing if:

      • Visual acuity is not sufficient: you should be able to read a 8 cm plate number at 20.5 metres
      • Visual field for one eye is not full. Monocular vision is allowed only if the visual field is complete
      • Field of vision for both eyes is below 120°.
      • Double vision Diplopia is not allowable unless mild and correctable, by an eye patch.

      What is the likelihood that I will pass the RP gene on to my children?

      The issue about inheritance pattern of PR in the family should be discussed with a genetic specialist. An eye care professional specializing in hereditary retinal degenerations can help to learn how RP gene is inherited in a particular family and what is the chance of its further inheritance.

      Possible Treatments

      RP Management

      RP management aims at slowing down the degenerative process, providing low vision aids and psychological support. A number of drugs have been proposed for the management but the evidence supporting their effectiveness is variable and generally limited. Referral to a low vision specialist is very helpful.

      • Patients should regularly visit an eye care specialist for examinations and treatment any ocular complications such as cataracts, glaucoma and cystoid macular edema.
      • Patient should use sunglasses to protect the retina from ultraviolet light. Bright light can damage the epithelium.
      • It is important to receive genetic consulting and have all the family members (siblings and offspring) examined for evidence of RP.
      • General consulting by experienced staff is essential. It is worth mentioning that most children have enough sight to complete their education in normal schools.
      • It is legally required that the RP patient must inform services responsible for providing driver License about his medical condition and do a specialised visual field test which is carried out by specially approved optometrists.
      • The patient should make registration for severe sight impairment or for sight impairment.

      What should I do if my child is diagnosed with RP?

      If you child is diagnosed with RP, his or her case should be evaluated by a low vision specialist as soon as possible. School administration and teachers should also be warned of his or her medical condition. Nowadays there are a lot of low vision aids which help to maximize existing vision. For example, there are special lenses that magnify central vision to expand visual field and eliminate glare, computer programs, reading the text, portable lightning devices, adjusting a dark environment. It is also important to have regular eye examinations.


      What is the extent of independence for people with advanced RP?

      What can increase the quality of such people’s lives?

      Nowadays there are quite a number of services helping people with RP to conduct their daily business of living: from transportation to housekeeping. Such services teach how to orientate and travel with a white cane or a dog guide, and inform about control of illumination and contrast, special lenses. With advancing technology many assistive devices appear, becoming more and more sophisticated and helpful for people with RP. They include closedcircuit televisions (CCTV), reading machines, different computer programs which allow to enlarge type on screen or provide braille version of what the screen shows.

      Also there are optical devices which maximize the usable vision: eyeglasses, prisms, telescopes, and night vision aids, which can be useful way to scan surroundings and find the bearings.


      Treatments for RP

      Known facts about possible therapies for RP with drugs

      With the exception of vitamin A palmitate, there are currently no drugs available to actually treat people with RP. But work by scientists around the country is beginning to lay the foundation for the development of pharmaceutical agents that one day might alleviate or prevent the symptoms of RP.

      Several drugs treatments have been proposed to slow down progression of Retinitis pigmentosa. There are following treatment are know as hyperbaric oxygen delivery, topical brimonidine tartrate, vitamins, docosahexaenoic acid, gangliosides, lutein, oral nilvadipine, ciliary neurotrophic factor, and valproic acid. All treatments seems to be safe but did not show significant benefit on visual function. Although all medical treatments for RP appear safe, evidence of effectiveness is limited.

      Important! Please note that:

      • Never try on your own drug therapies as a self prescription.
      • The decision to use any drugs should be discussed with your local eye specialist
      • It is difficult to predict how anyone will respond to particular drugs and in certain conditions there is a risk of getting side effects.

      About vitamin A

      Some practitioners also consider vitamin A as a possible treatment option to slow down the progression of RP. Research suggests taking high doses of vitamin A (15,000 IU/day) may slow progression a little in some people, but the results are not strong enough. Taking too much vitamin A can be toxic and the effects of vitamin A on the disease is relatively weak. Talk to an eye care professional to determine if taking vitamin A is right for you or your child.

      Gene therapy research

      Since RP is usually the result of a defective gene, gene therapy has become a widely explored area for future research. The goal of such research would be to discover ways healthy genes can be inserted into the retina.

      Gene therapy is based on simple logic: If a gene is defective, replace it with one that is not defective. While this may sound simple, the actual procedure of gene therapy is very complex. There are a number of reasons why RP is a disease particularly suited to the use of gene therapy. First and foremost, some of the defective genes have been identified. Also, there are a number of applicable animal models in which gene therapy can be tested for effectiveness and safety. While all of the above factors make gene therapy a promising future approach for treating RP, there are still many obstacles remaining. One key question is how to actually introduce the healthy gene into diseased cells. In laboratory experiments, researchers have found that a neutralized virus can transport a healthy gene to degenerating photoreceptor cells. This viral delivery method must be made safe and effective before gene therapy can be tested in humans.

      Retinal cell transplantation

      Retinal cell transplantation is a procedure that may have promise for people with RP in the future, although it is still in its early experimental stages. Scientists hope to restore sight or prevent further vision loss by transplanting healthy retinal cells. Retinal transplantation has shown some promise in animal models. As a result, researchers have begun testing the safety of this experimental therapy in humans. While promising, retinal cell transplants must first be proven safe and effective in clinical trials before they can be made available as a therapy for patients. Currently, the progress of transplant research is rapidly evolving. Attempts at transplanting healthy retinal cells into sick retinas are being made experimentally and have not yet been considered as clinically safe and successful.

      Retinal prosthesis

      Retinal prosthesis is also an important area of exploration because the prosthesis, a man-made device intended to replace a damaged body part, can be designed to take over the function of the lost photoreceptors.

      An artificial vision device called the Argus II has also shown promise for restoring some vision to people with late-stage RP. The Argus II is a prosthetic device that functions in place of lost photoreceptor cells. It consists of a light-sensitive electrode that is surgically implanted on the retina. A pair of glasses with a camera wirelessly transmits signals to the electrode that are then relayed to the brain. Although it does not restore normal vision, in clinical studies, the Argus II enabled people with RP to read large letters and navigate environments without the use of a cane or guide dog. Argus II device has not proven effective, but the FDA has determined that its probable benefits outweigh its risks to health.

      Novel researches dedicated to growth factors

      Growth factors are a group of molecules. If they are introduced to a diseased retina, they might prevent or delay the degeneration of photoreceptor cells. Growth factors are small proteins that sustain cells or cause cells to multiply. When healthy cells are injured, growth factors go to work to repair cellular injury and prevent cell death. Scientists have demonstrated that several different growth factors can keep injured and dying photoreceptor cells alive in rats. They have even found that injecting the factor into the eye of a rat with an inherited retinal degeneration can delay the onset of the disease. There is a long way to go to determine important information about growth factors and other drugs regarding potential toxicity and appropriate dosages. But the interest in growth factors continues, and increasing support for this work from The Foundation Fighting Blindness as well as drug companies and the federal government, is helping to accelerate the pace of research into what could be a future treatment for retinal degenerations.

      Non invasive therapeutic electrical stimulation of the retina

      Therapeutic electrical stimulation is a relatively new technology developed in 90th and has been used clinically since 1991. It is a non invasive and non surgical way of natural restoration of visual functions done by applying weak currents around the eye. Stimulations are not aimed at the replacement of damaged cells, but are focused on an increase in the functionality of preserved neurons on the retina and on the enhancement activity of the visual system at all levels. Approximately 55% of all the RP patients experience increasing of seeing area (central area in 30 degree) in about two times. The other 45% of the patients demonstrate enlargement of VF size for 25-75% from initial level.

      Besides VF loss, many RP patients have a lot of no less severe complaints such as night blindness, disturbed central vision, high light sensitivity combined with light glare and difficulties in adapting to environments with different illumination.

      Our treatment

      Therapeutic non invasive electrical stimulations

      Therapeutic electrical stimulation is a relatively new technology developed in 90th and has been used clinically since 1991. It is a non invasive and non surgical way of natural restoration of visual functions done by applying weak currents around the eye. Stimulations are not aimed at the replacement of damaged cells, but are focused on an increase in the functionality of preserved neurons on the retina and on the enhancement activity of the visual system at all levels.

      Applied therapeutic electrical stimulations are also aimed at preventing further deterioration of retina. These protections are the result of activated downstream influences (nature signal of stimulation) from the visual cortex to the retina which supports functionality of retina neurons. There is a collected level of evidence that shows that applied electrical therapy induces neuroprotection in retinal degenerations by fascinating releasing of endogenous growth factors (e.g. brain-derived neurotrophic factor, ciliary neurotrophic factor).

      Are stimulations beneficial for RP

      More than 400 retinitis pigmentosa patients we have been treated with therapeutic electrical stimulations. In case of initial or moderate vision deterioration there is a high possibility to achieve a positive fluctuations or notable enlargement of the visual field size. But the extent of VF enlargement and duration of the improvement can vary significantly. For patients with advanced stage of RP the possible benefits of therapeutic electrical stimulation are determined based on analysis of structural changes of the retina and preserved function (visual field defects). Approximately 55% of all the RP patients experience increasing of seeing area (central area in 30 degree) in about two times. The other 45% of the patients demonstrate enlargement of VF size for 25-75% from initial

      What else can be improved?

      Besides VF loss, many RP patients have a lot of no less severe complaints such as night blindness, disturbed central vision, high light sensitivity combined with light glare and difficulties in adapting to environments with different illumination.

      It is important to emphasize that therapeutic electrical stimulations can reduce mentioned above complaints and notably improve vision under dark circumstances, decrease night blindness and allow to be much more independent in the evening or at night.

      If RP combines with cone dystrophy significant amount of patients (more than 75%) report that visual acuity increases which makes it possible to use disturbed central vision for more comfortable and efficient reading and writing.

      Vision related quality of life is the main goal of out therapy.

      The improvement of quality of life is the main goal of out therapy. We reach this through a combination of different medical approaches, such as therapeutic electrical stimulation, visual training and medications. Once the vision restoration treatment starts, many of our patients have a positive response. Keep in mind that increased quality of life can be achieved only if the patient follows our prescribed recommendations. If you entrust your treatment to us, a Personalized Care Plan will be provided and following our tested guidelines can increase your chances of significant vision restoration.

      Initial positive changes can be observed during the first 10 sessions of treatment. With repeated visual field tests the degree of change can be estimated after 2 weeks. In most cases you should see a stable improvement within 4-8 weeks after the treatment. The improvement is typically stable. Follow-up results one year after the treatment have shown 80-85% of stable improvement.

      How to regain maximal possible eyesight

      Its necessary to stress that just single course of therapeutic electrical stimulation would not be enough strong to regain maximal possible eyesight. Due to the fact that retinal abnormalities caused by retinitis pigmentosa are progressive, the patients need to repeat the course of our therapy several times within next few years. A specific plan of the repeated therapeutic electrical stimulation course is based on the results of the first course, conditions of your retina (will be estimated with OCT examination) and severity of functional deficits.

      We also advice our patients to continue doing at home a visual training program specially developed in our center, which is aimed not only to keep effects of therapeutic electrical stimulations but to regain even more sight.


      Vitamin A palmitate is not a cure for Retinitis Pigmentosa

      One should understand that Vitamin A palmitate is not a cure for RP, that can anyhow improve your vision. But there has been some evidence that the higher doses of it can possibly make this degenerative process slower.

      People with very advanced RP are not recommend to take Vitamin A but in case of non-advanced stages of RP slowing could mean additional years of useful vision.

      What is retinitis pigmentosa

      However, there are some warnings that accompany this recommendation. Thought it occurs rare, patients should have a pretreatment assessment of fasting serum vitamin A levels and liver function and annually thereafter. High doses of Vitamin A (15,000 IU/day) are not recommended to pregnant women or women planning pregnancy. Older adults should consult with their physicians about their bone health due to the fact that a long term Vitamin A supplementation effects done density. Vitamin A is contraindicated for patients with renal failure or renal transplant because of excessive renal re-absorption and to patients taking doxycycline since the combination can cause increased intracranial pressure.

      Important! RP patients under the age of 18 were not evaluated and 15,000 IU of supplementary vitamin A palmitate is not recommended for them and must be discussed with an eye care specialist

      About Vitamin E

      Vitamin E has an opposite effect compared to Vitamin A: clinical studies have shown that people taking 400 IU daily of vitamin E have a faster rate of retinal degeneration than those who do not take any. Thus if recommended that people with RP should avoid high doses of vitamin E supplements. However, there is no evidence that small supplemental amounts of vitamin E lead to any progression of RP.

      Recommended food which contains Vitamin A

      Besides Vitamin A, there is also omega-3 rich diet, suggested to slow down the process of vision loss. Omega-3 can be found in oily fish such as tuna, salmon, herring.

      Further sources of Vitamin A: carrots, butter, cheese, milk, cod liver oil, apricots, egg yolk

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