The Burnham Review Corneal Dysfunction and Keratoconus
Consider Manual Therapy and Complementary and Alternative Medicine for Optimal Vision
Kimberly Burnham, PhD Editor Corneal Skin & tissue regeneration relying on the Connective Tissue
Corneal tissue is limbal epithelium (the junction zone
made up of the dense between the corneal and conjunctival
5-18: Muscle Energy, Mobility and Function
So something like certain conditions that cause damage
corneal epithelial or alteration of the corneal surface
The Cornea and Manual Therapy peeling could be thought of as flaky (termed limbal deficiency).
There is no recent literature to skin.
Scattered within the corneal epithelial defects is prevented and a
massage directly affects dysfunctions connective tissue, the substantia unique pathological state ensuesof the cornea, but there is evidence to propria are the flattened fibroblasts manifested by poor epithelializationindicate that manual therapy can which produce the collagen and (persistent defects or recurrentaddress the underlying issues that ground substance.
e r o s i o n s ) , c h r o n i c s t r o m a l
The cornea is clear because of the inflammation (keratitis mixed with
first place and that recovery of arrangement of the connective tissue scarring), corneal vascularization,corneal function can be attained with and epithelia tissue.
The nonkeratinized stratified (Aetna Insurance Co. 2007).
squamous corneal epithelium (skin) Dysfunctions of the Cornea
The cornea is made up of skin and consists of several (5 to 6) layers of
connective tissue and where there are cells. These cells are cuboidal there are liver and toxicity issues so
problems of the skin and connective through most of the thickness of the it is not surprising that the cornea is
tissue there are issues with the epithelium but become squamous often damaged by mechanical injury,
i m m u n e s ys t em . T h e r e i s (thin and flat) at the surface.
Complementary and Alternative substance is carefully regulated, toMedicine (CAM) approaches can maintain uniformsupport the immune system.
There is also evidence that collagen fibers.1
The Burnham Review
n u t r i t i o n a l s u p p l e m e n t a t i o n (King, 2007).
Kimberly Burnham, PhD Editor
improve the blood vessels skin, “the corneal
relationship with the corneal and epithelium is
For clients, practitioners and all people interested
Addressing the thyroid dysfunction its rapid self-
can also be a way to improve corneal renewal process,function. 24 e-Newsletters per year $100 24 Issues per Year TheBurnhamReview.com 1 (c) 2007 Kimberly Burnham 5-16 Cornea
dysfunction include: Chemical / 'imposition' of the immature back and in fact, the whole body. thermal injuries of the ocular surface; phenotype on its resident bone Reducing the stress load on the bodyStevens-Johnson syndrome (reaction marrow-derived cells.”4(Hamrah, increases the level of health and thus,to medications); Multiple surgeries 2007).
the ability of the body to help itself. Hands On Care fo the Immune
(hypofunction or total loss of stem expertise in the field of Hands On Solutions for Visual
cells); Aniridia (hereditary); Keratitis complementary medicine, that Dysfunctions
associated with multiple endocrine support the immune system including
deficiency (hereditary); Eurotrophic massage therapy 5(Shor-Posner, c l i e n t s , l i t e r a l l y s e e i n g
keratopathy (neuronal or ischemic); 2006); 6(Field, 2005) and improvements, include both adults
C h r o n i c l i m b i t i s ( c o r n e a l
7 Hernandez-Reif, 2004); Integrative and children with visual labels such
inflammation); Peripheral corneal Manual Therapy 8(Burnham, 2007) as detached retina, lazy eye, visual
ulcerative keratitis; Pterygium and and 9(Giammtteo, 2005); Qigong headaches, migraines with visual
pseudopterygium; Superficial corneal 10(Lee, 2003) and 11(Lee, 2005); auras, cataracts, glaucoma, corneal
dystrophy (including granular, lattice, Reflexology 12(Lee, 2006); ulcers, keratoconus, astigmatisms
and Reis-Bückler's dystrophy); Osteopathic Manual Therapy 13 (Noll, and dyslexia. IMT is also effective
Epithelial membrane dystrophy; 2004), and acupuncture. 14 (Karst, for clients with conditions involving
Irregular corneal surfaces due to 2003).
Imagery 15 (Richardson, 1997) and cord injuries, multiple sclerosis, high
keratoconus nodules; Corneal scars Laughter 16(Berk, 2001) are cheap blood pressure, seizures, tinnitis,
and opacities (including post- and easy ways to help improve our Cerebral palsy &Down’s syndrome.19
traumatic, post-infectious, post- immune system and bring a sense of
Syphilitic interstitial keratitis; Herpes Effects of Treatment
Visual problems are very common disorder where the cornea becomes
simplex disciform keratitis; Measles in today's society and take many weaker than it should be. I also hadkeratoconjunctivitis; Gonococcal forms. A good number of these go nystagmus, where the eyes would getk e r a t i t i s a n d M e c h a n i c a l undiagnosed or untreated, but are twitchy, especially when I was tired. complication due to corneal graft3 amenable to osteopathic treatment, My knowledge of what can be done(Aetna Insurance (2007).
including functional eye problems with visual and eye related problemsand visual strain.17 (Dolgin, 2003). Cornea and The Immune System
In speaking about an osteopathic started wearing glasses when I was
In a recent study, researchers approach to vision prescriptions, about 10 years old. About five years
collected data on the immune Dolgin says, “remember, the proper ago in my 40's I stopped wearing
function of the corneal layer of the prescription will produce the least them one day and pursued IMT
eye. The results “suggest that the effect on the body's normal motion treatment to help with my vision,
cornea is capable of actively and will add no new strain patterns nystagmus, and keratoconus (corneal
participating in the immune response with light coming through the eyes. weakness). All have improved. For a
to foreign antigens and autoantigens, As the body is one continuous unit, while the nystagmus was only
rather than being a passive bystander. this balanced prescription will not slightly visible when I was very tired
Additionally, one important aspect of only reduce the physical strain on the and look to the extreme right side.
immune privilege is likely the ocular head, but also on the neck, shoulders, Now it is completely gone. The
24 Issues per Year TheBurnhamReview.com 2 (c) 2007 Kimberly Burnham 5-16 Cornea
k e r a t o c o n u s h a s s t o p p e d with one hand on the eyes and the flavonoids in the plant kingdomdegenerating and is reversing. I have other on the Low Back/Ureters for a together with the presented resultsvirtually no dysfunctional light total of several hours and then suggests that flavonoids maysensitivity, which is usually a big several hours of NFP from the eyes contribute to the preventive effect ofproblem with keratoconus. My to all process centers. There is a plant-based diet on neovascularastigmatism is improving, as is my detailed information about this easy disease of the eye.”26 (Joussen,vision. I have had one migraine to do, yet time consuming self-care 2000). headache in the last 5 years, previous approach in the book Body
to that I had 3-6 severe migraines a Wisdom.23(Weiselfish-Giammatteo, phytochemicals contributing to theyear. About 6 months after I stopped 2002)
Biophysiography and Nutritional Wellness
it used to look like I couldn’t see.
complex, for specifics speak to a Baglio, 2004). Medical Treatment Keratoconus
By way of comparison, evaluate what would be best for you indicated that regular consumption of
investigators in a medical study as an individual.
“found that the mean improvement in Vitamin A and The Cornea
Night blindness is one of the first disease and tumor progression. The
with keratoconus who received signs of vitamin A deficiency. In development of tumors and of
Intrastromal corneal ring segments ancient Egypt, it was known that atherosclerosis lesions to advanced
(INTACS) was four lines of night blindness could be cured by plaques, which are prone to rupture,
uncorrected visual acuity and two eating liver, which was later found to is accelerated by the formation of
lines of best corrected visual acuity. be a rich source of the vitamin24 new blood vessels. These new blood
The investigators also reported (Gerster 1997).
Night blindness is the flip side of to neighboring cells. Therefore,
light sensitivity, which is typical in recent studies have examined
In a prospective study involving 10 people with corneal problems.
Vitamin A deficiency contributes compounds (RWPCs) and green tea
al. (2000)21 reported a 70 percent to blindness by making the cornea polyphenols (GTPs) have
improvement in uncorrected visual very dry and damaging the retina and antiangiogenic properties.
acuity and a 50 percent improvement cornea25 (Sommer 1982).
INTACS was approved by the U.S. Cornea and Blood Vessels
The cornea itself doesn’t have by proangiogenic factors such as
(FDA) for use in keratoconus under a blood vessels. It would not be clear if VEGF and fibroblast growth factor in
Humanitarian Device Exemption it did. When blood vessels start to mice.” (
(HDE), as the FDA has determined form (neovascularization [new
that INTACS are a medical device vasculature]) it can cause a number decreased vision, photophobia [light
intended to treat a condition that of visual problems related to the sensitivity], severe dry eyes and
affects fewer than 4000 individuals cornea. A reading of the literature on progressive corneal vascularization
per year in the United States22 (FDA, neovascularization could be caused by graft-versus-host disease
interpreted to mean that corneal (GVHD) after a bone marrow
NFP for Vision 24 Issues per Year TheBurnhamReview.com 3 (c) 2007 Kimberly Burnham 5-16 Cornea Withania, Medicinal Plant Glaucoma, Corneal Mechanical Stress and Membrane Integrity
sex, intraocular pressure, optic nerve arrhythmias, but it is associated with
Copper Metabolism Dysfunctions
changes, corneal thickness, refractive numerous side effects.
“Wilson disease, an autosomal error, systemic diseases, family
recessive disorder due to mutations history and trauma.
Central corneal thickness plays an rarely been reported heretofore. In
by copper accumulation and toxicity important role in risk stratification this report, we describe a case of a
in the liver and subsequently in other among patients in whom glaucoma 73-year-old man who developed
organs, mainly the brain and was of concern. Scleral thickness and symptomatic hypothyroidism,
central corneal thickness have a pulmonary toxicity, and vortex
Blood Sugars & Corneal Stiffening
overestimation in diabetic patients.
conjunctiva, eyelids, lips, and tongue.
g l a u c o m a p r o g r e s s i o n . ” 3 2
amount of stress increases inversely.
This leads to more interruption of pheochromocytoma may be life
Corneal Biomechanics and Age
retinal layers and consequent higher saving.”38 (Jacobs, 2001).
“There was a considerable increase levels of neural tissue strain that
in stiffness associated with both age increases the risk of sufferingand load rate. Equations were derived glaucoma.”34 (Mehdizadeh, 2007). For more information and references see Cornea Connected To The Thyroid www.TheBurnhamReview.com and The Heart 24 e-Newsletters per year $100
cornea demonstrates considerable development of the cell membranes
stiffening with age with the behavior of apposed cells in epithelium as well
closely fitting an exponential power as the endothelium of the embryonic
function typical of collagenous chick cornea.”35(Masterson, 1977).
be related to the additional age- cardiac antiarytmic drug. Long-term,
related nonenzymatic cross-linking high dose use of the drug is
affecting the stromal collagen associated with skin discoloration,
24 Issues per Year TheBurnhamReview.com 4 (c) 2007 Kimberly Burnham 5-16 Cornea References 1. King, D. (2007). "Cornea, epithelium and connective tissue Histology." Southern Illinois University School of Medicine(http://www.siumed.edu/~dking2/intro/IN022b.htm). 2 . A e t n a I n s u r a n c e ( 2 0 0 7 ) . " C o r n e a l D y s f u n c t i o n s . " C l i n i c a l P o l i c y B u l l e t i n : f r o m www.aetna.com/cpb/medical/data/200_299/0293.html and www.aetna.com/cpb/medical/data/1_99/0023.html. 3 . A e t n a In s u r a n c e ( 2 0 0 7 ) . " C o r n e a l D y s f u n c t i o n s . " C l i n i c a l P o l i c y B u l l e t i n : f r o m www.aetna.com/cpb/medical/data/200_299/0293.html and www.aetna.com/cpb/medical/data/1_99/0023.html. 4. Hamrah, P. and M. R. Dana (2007). "Corneal antigen-presenting cells." Chem Immunol Allergy 92: 58-70. 5. Shor-Posner, G., M. Hernandez-Reif, et al. (2006). "Impact of a Massage Therapy Clinical Trial on Immune Status in Young Dominican Children Infected with HIV-1." J Altern Complement Med 12(6): 511-6. 6. Field, T., M. Hernandez-Reif, et al. (2005). "Cortisol decreases and serotonin and dopamine increase following massage therapy." Int J Neurosci 115(10): 1397-413. 7. Hernandez-Reif, M., G. Ironson, et al. (2004). "Breast cancer patients have improved immune and neuroendocrine functions following massage therapy." J Psychosom Res 57(1): 45-52. 8. Burnham, K. (2007). What to Expect in an IMT Treatment, HealthandGoodness.com: from www.healthandgoodness.com/Therapies/IMT-session.html. 9. Giammatteo, S. W. (2005). Integrative Manual Therapy for Facial Palsy, Bell's Palsy Research Foundation: from www.bellspalsy.com/giammatteo.htm. 10. Lee, M. S., H. J. Huh, et al. (2003). "Effects of Qigong on immune cells." Am J Chin Med 31(2): 327-35. 11. Lee, M. S., M. K. Kim, et al. (2005). "Qi-training (qigong) enhanced immune functions: what is the underlying mechanism?" Int J Neurosci 115(8): 1099-104. 12. Lee, Y. M. (2006). "[Effect of self-foot reflexology massage on depression, stress responses and immune functions of middle aged women]." Taehan Kanho Hakhoe Chi 36(1): 179-88. 13. Noll, D. R., B. F. Degenhardt, et al. (2004). "The effect of osteopathic manipulative treatment on immune response to the influenza vaccine in nursing homes residents: a pilot study." Altern Ther Health Med 10(4): 74-6. 14. Karst, M., D. Scheinichen, et al. (2003). "Effect of acupuncture on the neutrophil respiratory burst: a placebo controlled single-blinded study." Complement Ther Med 11(1): 4-10. 15. Richardson, M. A., J. Post-White, et al. (1997). "Coping, life attitudes, and immune responses to imagery and group support after breast cancer treatment." Altern Ther Health Med 3(5): 62-70. 16. Berk, L. S., D. L. Felten, et al. (2001). "Modulation of neuroimmune parameters during the eustress of humorassociated mirthful laughter." Altern Ther Health Med 7(2): 62-72, 74-6. 17. Dolgin, (2006 ) from http://www.osteohome.com/MainPages/vision.html 18. Dolgin, (2006 ) from http://www.osteohome.com/MainPages/vision.html 19. Center for Integrative Manual Therapy and Diagnostics (2005) from www.CenterIMT.com 20. Boxer Wachler BS, Christie JP, Chandra NS, et al. Intacs for keratoconus. Ophthalmology. 2003;110(5):1031-1040. 21. Colin J, Cochener B, Savary G, et al. Correcting keratoconus with intracorneal rings. J Cataract Refract Surg. 2000;26(8):1117-1122. 22. U.S. Food and Drug Administration, Center for Devices and Radiologic Health. ViewPoint™™ CK System. Summary of Safety and Effectiveness and Labeling. PMA No. P010018. Rockville, MD: FDA; April 11, 2002. Available at: http://www.fda.gov/cdrh/pdf/p010018.html. Accessed May 13, 2002. 23. Weiselfish-Giammatteo, S. and T. Giammatteo (2002). Body wisdom : light touch for optimal health. Berkeley, Calif., North Atlantic Books. 24. Gerster H. Vitamin A-functions, dietary requirements and safety in humans. Int J Vitam Nutr Res 1997;67:71-90. http://dietary-supplements.info.nih.gov/factsheets/vitamina.asp 25. Sommer A. Nutritional Blindness: Xeropthalmia and Keratomalacia. Oxford University Press, London and New York, 1982. http://dietary-supplements.info.nih.gov/factsheets/vitamina.asp 26. Joussen, A. M., K. Rohrschneider, et al. (2000). "Treatment of corneal neovascularization with dietary isoflavonoids and flavonoids." Exp Eye Res 71(5): 483-7. 27. Bagli, E., M. Stefaniotou, et al. (2004). "Luteolin inhibits vascular endothelial growth factor induced angiogenesis; inhibition of endothelial cell survival and proliferation by targeting phosphatidylinositol 3'-kinase activity." Cancer Res 64(21): 7936-46. 28. Oak, M. H., J. El Bedoui, et al. (2005). "Antiangiogenic properties of natural polyphenols from red wine and green tea." J Nutr Biochem 16(1): 1-8. 24 Issues per Year TheBurnhamReview.com 5 (c) 2007 Kimberly Burnham 5-16 Cornea
29. Mohammadpour, M. (2007). "Progressive corneal vascularization caused by graft-versushost disease." Cornea 26(2):225-6. 30. Mohan, R., H. J. Hammers, et al. (2004). "Withaferin A is a potent inhibitor of angiogenesis." Angiogenesis 7(2): 115-22. 31. Leggio, L., N. Malandrino, et al. (2007). "Analysis of the T1288R Mutation of the Wilson Disease ATP7B Gene in FourGenerations of a Family: Possible Genotype-Phenotype Correlation with Hepatic Onset." Dig Dis Sci. 32. Krueger, R. R. and J. C. Ramos-Esteban (2007). "How might corneal elasticity help us understand diabetes and intraocularpressure?" J Refract Surg 23(1): 85-8. 33. Elsheikh, A., D. Wang, et al. (2007). "Assessment of corneal biomechanical properties and their variation with age." CurrEye Res 32(1): 11-9. 34. Mehdizadeh, A., A. Hoseinzadeh, et al. (2007). "Central corneal thickness as a risk factor for glaucoma." Med Hypotheses. 35. Masterson, E., H. F. Edelhauser, et al. (1977). "The role of thyroid hormone in the development of the chick cornealendothelium and epithelium." Invest Ophthalmol Vis Sci 16(2): 105-15. 36. Bahadir, S., R. Apaydin, et al. (2000). "Amiodarone pigmentation, eye and thyroid alterations." J Eur Acad DermatolVenereol 14(3): 194-5. 37. Chuang, C. L., M. S. Chern, et al. (2000). "Amiodarone toxicity in a patient with simultaneous involvement of cornea,thyroid gland, and lung." Am J Med Sci 320(1): 64-8. 38. Jacobs, J. M. and M. J. Hawes (2001). "From eyelid bumps to thyroid lumps: report of a MEN type IIb family and reviewof the literature." Ophthal Plast Reconstr Surg 17(3): 195-201. General References 1. American Academy of Ophthalmology. Corneal opacification. Preferred Practice Pattern No. 15. San Francisco, CA: AAO; September 16, 1995. 2. Boruchoff SA, Thoft RA. Keratoplasty. In: The Cornea: Scientific Foundations and Clinical Practice. 2nd ed. G Smolin, RA Thoft, eds. Boston, MA: Little, Brown and Co.; 1987; Ch. 15, pp.543-551. 3. Colin J, Cochener B, Savary G, et al. INTACS inserts for treating keratoconus: One-year results. Ophthalmology. 2001;108(8):1409-1414. 4. Colin J, Velou S. Current surgical options for keratoconus. J Cataract Refract Surg. 2003;29(2):379-386. 5. Dart, Paul, M.D., Ophthalmologic Principles And Their Relationship To Osteopathy In The Cranial Field, Second Edition, privately published, Eugene, Oregon, 2002 in Research in Support of the Cranial Concept www.cranialacademy.org/pdf/PRMresearch.pdf 6. Dart, Paul, M.D., Ophthalmologic Principles And Their Relationship To Osteopathy In The Cranial Field, Second Edition, privately published, Eugene, Oregon, 2002 in Research in Support of the Cranial Concept www.cranialacademy.org/pdf/PRMresearch.pdf 7. Feldman ST, Ellis W, Frucht-Pery J, et al. Regression of effect following radial thermokeratoplasty in humans. Refract Corneal Surg. 1989;5(5):288-291. 8. Guo B. Keratoprosthesis for the treatment of severe bilateral cornea disease. Technote TN 26. Edmonton, AB: Alberta H e r i t a g e F o u n d a t i o n f o r M e d i c a l R e s e a r c h ( A H F M R ) ; April2001.Availableat:http://www.ahfmr.ab.ca/publications/?dept=&search=keratoprosthesis&type=5&sort=date&dir=DESC. Accessed January 17, 2006. 9. National Institute for Clinical Excellence (NICE). Laser in situ keratomileusis for the treatment of refractive errors. Interventional Procedure Guidance 102. London, UK: NICE; December 2004. Available at: http://www.nice.org.uk/page.aspx?o=236088. Accessed January 3, 2005. 10. No authors listed. Keratophakia and keratomileusis: Safety and effectiveness. American Academy of Ophthalmology. Ophthalmology. 1992;99(8):1332-1341. 11. Silverio Healthcare Management Services. Corneal relaxing incisions. AccuLibrary. AccuChecker [website]. Miami, FL: Silverio and Associates; 2001. Available at: http://www.accuchecker.com/AccuLibrary 12. Stoiber J, Muss WH, Pohla-Gubo G, et al. Histopathology of human corneas after amniotic membrane and limbal stem cell transplantation for severe chemical burn. Cornea. 2002;21(5):482-489. 13. Tsubota K, Satake Y, Kaido M, et al. Treatment of severe ocular-surface disorders with corneal epithelial stem-cell transplantation. N Engl J Med. 1999;340(22):1697-1703. 14. Waring GO. The challenge of corneal wound healing after excimer laser refractive corneal surgery. J Refract Surg. 1995;11(5). Available at: http://www.slackinc.com/eye/jrs/vol115/9ed2.htm. Accessed June 26, 2002. 24 Issues per Year TheBurnhamReview.com 6 (c) 2007 Kimberly Burnham 5-16 Cornea Synchronizers for Vision
Your IMT therapist can give you synchronizers / reflex points that can help improve your vision. (Below).
J Microbiol Immunol Infect2004;37:382-384 Guidelines for chemotherapy of tuberculosis in Taiwan Infectious Diseases Society of the Republic of China; The Society of Tuberculosis, Taiwan; Medical Foundation in Memory of Dr. Deh-Lin Cheng; Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education; and CY Lee’s Research Foundation for Pediatric Infectious Tuber
Program Director/Principal Investigator (Last, First, Middle): BIOGRAPHICAL SKETCH Provide the following information for the key personnel and other significant contributors in the order listed on Form Page 2. Follow this format for each person. DO NOT EXCEED FOUR PAGES. Assistant Professor of Chemical Engineering eRA COMMONS USER NAME (credential, e.g., agency login) portizbermudez E