helmholtzeyeinstituteРоссийский офтальмологический журналRussian Ophthalmological Journal2072-00762587-5760Real time Publishers10.21516/2072-0076-2025-18-4-74-82helmholtzeyeinstitute-1958Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESФрактальная фототерапия в зрительной реабилитации пациентов с болезнью ШтаргардтаFractal phototherapy in visual rehabilitation of patients with Stargardt diseasehttps://orcid.org/0000-0003-4675-9648КотелинВ. И.KotelinV. I.

Владислав Игоревич Котелин — канд. мед. наук, старший научный сотрудник отдела клинической физиологии зрения им. С.В. Кравкова

ул. Садовая-Черногрязская, д. 14/19, 105062

Vladislav I. Kotelin — Cand. of Med. Sci., senior researcher, department of clinical physiology of vision named after S.V. Kravkov

14/19, Sadovaya-Chernogryazskaya St., Moscow,105062

https://orcid.org/0000-0002-0161-5010ЗуеваМ. В.ZuevaM. V.

Марина Владимировна Зуева — д-р биол. наук, профессор, начальник отдела клинической физиологии зрения им. С.В. Кравкова, ФГБУ «НМИЦ глазных болезней им. Гельмгольца» Минздрава России, ведущий научный сотрудник, ФГБУН «Государственный научный центр РФ «Институт медико-биологических проблем Российской академии наук»»

ул. Садовая-Черногрязская, д. 14/19, 105062,

Хорошевское шоссе, д. 76а, Москва, 123007

Marina V. Zueva — Dr. of Biol. Sci., professor, head of the department of clinical physiology of vision named after S.V. Kravkov, Helmholtz National Medical Research Center of Eye Disease, leading reseacher, Institute for Biomedical Problems оf the Russian Academy of Sciences

14/19, Sadovaya-Chernogryazskaya St., Moscow,105062,

76a, Khoroshevskoe highway, Moscow, 123007

visionlab@yandex.ruhttps://orcid.org/0000-0003-1038-2746НероеваН. В.NeroevaN. V.

Наталия Владимировна Нероева — д-р мед. наук, начальник отдела патологии сетчатки и зрительного нерва

ул. Садовая-Черногрязская, д. 14/19, 105062

Natalia V. Neroeva  — Dr. of Med. Sci., head of the department of pathology of the retina and optic nerve

14/19, Sadovaya-Chernogryazskaya St., Moscow,105062

https://orcid.org/0000-0001-7264-396XЗольниковаИ. В.ZolnikovaI. V.

Инна Владимировна Зольникова — д-р мед. наук, старший научный сотрудник отдела клинической физиологии зрения им. С.В. Кравкова, ФГБУ «НМИЦ глазных болезней им. Гельмгольца» Минздрава России, профессор кафедры офтальмогенетики, ФГБНУ «Медико-генетический научный центр им. акад. Н.П. Бочкова»

ул. Садовая-Черногрязская, д. 14/19, 105062,

ул. Москворечье, д. 1, Москва, 115522

 

Inna V. Zolnikova — Dr. of Med. Sci., senior researcher, department of clinical physiology of vision named after S.V. Kravkov, Helmholtz National Medical Research Center of Eye Disease, professor, chair of ophthalmogenetics, Research Centre for Medical Genetics

14/19, Sadovaya-Chernogryazskaya St., Moscow,105062,

1, Moskvorechie St., Moscow, 115522

ПрокопьевМ. В.ProkopevM. V.

Максим Владимирович Прокопьев — канд. мед. наук, заместитель руководителя Центра обеспечения безопасности обращения медицинских изделий в медицинских организациях

Каширское шоссе, д. 24, стр. 16, Москва, 115478

Maxim V. Prokopev — Cand. of Med. Sci., deputy head of the center for ensuring the safety of circulation of medical products in medical organizations

24, p. 16, Kashirskoe shosse, Moscow, 115478

 

 

https://orcid.org/0009-0004-6130-9770КолесниковД. Ю.KolesnikovD. Yu.

Дмитрий Юрьевич Колесников — ведущий специалист научной лаборатории «Психологические и психофизиологические исследования профессиональной деятельности»

Хорошевское шоссе, д. 76а, Москва, 123007

Dmitry Yu. Kolesnikov — leading specialist of the scientific laboratory “Psychological and psychophysiological studies of professional activity”

76a, Khoroshevskoe highway, Moscow, 123007

ФГБУ «НМИЦ глазных болезней им. Гельмгольца» Минздрава РоссииРоссияHelmholtz National Medical Research Center of Eye DiseasesRussian FederationФГБУ «НМИЦ глазных болезней им. Гельмгольца» Минздрава России; ФГБУН «Государственный научный центр РФ «Институт медико-биологических проблем Российской академии наук»»РоссияHelmholtz National Medical Research Center of Eye Diseases; Institute for Biomedical Problems оf the Russian Academy of SciencesRussian FederationФГБУ «НМИЦ глазных болезней им. Гельмгольца» Минздрава России; ФГБНУ «Медико-генетический научный центр им. акад. Н.П. Бочкова»РоссияHelmholtz National Medical Research Center of Eye Diseases; Research Centre for Medical GeneticsRussian FederationФГБУ «ВНИИИМТ» РосздравнадзораРоссияFederal State Budgetary Institution “VNIIIMT” of RoszdravnadzorRussian FederationФГБУН «Государственный научный центр РФ «Институт медико-биологических проблем Российской академии наук»»РоссияInstitute for Biomedical Problems оf the Russian Academy of SciencesRussian Federation2025090120261847482Copyright © Котелин В.И., Зуева М.В., Нероева Н.В., Зольникова И.В., Прокопьев М.В., Колесников Д.Ю., 20262026Котелин В.И., Зуева М.В., Нероева Н.В., Зольникова И.В., Прокопьев М.В., Колесников Д.Ю.Kotelin V.I., Zueva M.V., Neroeva N.V., Zolnikova I.V., Prokopev M.V., Kolesnikov D.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://roj.igb.ru/jour/article/view/1958

В настоящее время не существует эффективных медикаментозных методов терапии болезни Штаргардта (БШ). Для повышения качества жизни (КЖ) слабовидящих пациентов большое значение имеет даже незначительное улучшение отдельных зрительных характеристик. Поэтому решающую роль в повышении КЖ могут играть немедикаментозные стратегии зрительной реабилитации, среди которых особое внимание уделяется технологиям, влияющим на пластичность зрительной системы.

Целью работы являлась оценка эффективности зрительной реабилитации с помощью основанного на активации нейропластичности метода фрактальной фототерапии (ФФ) в виртуальной реальности у пациентов с БШ по данным электроретинографии.

Материал и методы

Материал и методы. Обследованы три пациента с БШ с фенотипом STGD1 с патогенными вариантами в гене ABCA4.

Результаты

Результаты. У всех пациентов до терапии документировано снижение по сравнению с возрастной нормой активности центральной сетчатки по данным мультифокальной электроретинограммы (мфЭРГ), а также генерализованное снижение функциональной ретинальной активности, по данным ЭРГ полного поля — колбочковой и ритмической ЭРГ (РЭРГ). После проведения 2-нед курса фрактальной фотостимуляции в виртуальной реальности наблюдалась тенденция возрастания амплитуды a-волны фотопической ганцфельд-ЭРГ (p = 0,0728) и сокращение ее пиковой латентности (p = 0,0625), а также повышение амплитуды фотопических низкочастотных РЭРГ на 10 и 12 Гц, в генерацию которых дают доминирующий вклад колбочковые фоторецепторы. Это говорит об активирующем влиянии ФФ на функцию фоторецепторов, что существенно для патогенных вариантов ABCA4, приводящих к нарушению зрительного цикла и функционирования зрительных клеток. Наиболее значительные и статистически высокозначимые изменения документированы для амплитуды мфЭРГ в зоне фовеа (p = 0,0017), что особенно важно для субъективных зрительных ощущений пациентов и их повседневной деятельности.

Заключение

Заключение. В будущих исследованиях целесообразно подтвердить полученные закономерности воздействия ФФ на ЭРГ в большей группе пациентов с БШ и уточнить показания к зрительным тренировкам с помощью ФФ при различных фенотипах заболевания.

Currently, there are no effective drug therapies for Stargardt disease (SD), although innovative strategies are being sought in several directions. Even minor improvements in individual visual characteristics are of great importance for improving the quality of life (QL) of visually impaired patients. Therefore, non-drug strategies for visual rehabilitation, with special attention paid to technologies that affect the plasticity of the visual system, can play a decisive role in improving QL.

Purpose of the study was to evaluate the effectiveness of visual rehabilitation using fractal phototherapy (FP), a neuroplasticity-activating method, in virtual reality in patients with SD based on electroretinography data.

Material and methods

Material and methods. Three patients with SD of STGD1 phenotype were observed.

Results

Results. In all patients, a decrease in the central retinal activity compared to the age norm was documented before therapy, according to mfERG data, as well as a generalized decrease in functional retinal activity, according to full-field ERG (cone and flicker ERG). After a 2-week course of fractal photostimulation in virtual reality, a tendency towards an increase in the amplitude of the a-wave of the photopic ganzfeld ERG (p = 0.0728) and a decrease in its peak latency (p = 0.0625), as well as an increase in the amplitude of photopic low-frequency RERG at 10 and 12 Hz, in the generation of which cone photoreceptors make a dominant contribution, was observed. This indicates an activating effect of FP on the function of photoreceptors, which is significant for ABCA4 variants leading to disruption of the visual cycle and functioning of visual cells. The most significant and statistically highly significant changes were documented for the mfERG amplitude in the fovea zone (p = 0.0017), which is especially important for the subjective visual sensations of patients and their daily activities.

Conclusion

Conclusion. In future studies, it is advisable to confirm the obtained patterns of the effect of FP on ERG in a larger group of patients with SD and clarify the indications for visual training using FP in various phenotypes of the disease.

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The authors declare that there are no conflicts of interest present.