PER OTTE: Thank you for letting us join your MD list and become part of your group. If there are any questions or concerns about microacupuncture and vision, please don't hesitate to ask. We are joining the MD list to give more knowledge and understanding of microacupuncture.

The main difference between micro-acupuncture and acupuncture is in microacupuncture we do not put needles close to the eyes. Microacupuncture is fast acting and we can see improvement in as little as two days! Microacupuncture is not a cure for eye diseases. It is able to change your visual acuity traumatically. We often see 20/300 go to less than 20/100, in a week of treatments. Please go and check our web-sites for some ideas for questions. Remember microacupuncture is no cure, but it's a way to improve your life's quality. We are looking forward to answering any questions you might have.

DAN: Thank you for spending this time to help us learn more about your treatment. I understand that it is often difficult for alternative therapists to get an unbiased forum in which to explain their positions, and I hope that we will all benefit from this discussion. Hot Springs, Arkansas is a beautiful little town just a few hours south of my home. How did you happen to settle there all the way from Denmark?

PER OTTE: Let me tell you a secret about Denmark. It is very beautiful, you have government paid medical expenses, and a lot of other things, for which you have up to 70% income tax and 25% sales tax. Does this give you an idea why I left? I like the area of Hot Springs because of the four seasons, and the winter isn't too bad. We have no hurricanes, no earthquakes, but beautiful nature around. This is a good place to relax and be as stress-free as possible. This is good for the patients to have a relaxing environment while they are getting treatments.

DAN: Acupuncture has been performed successfully by the Chinese for thousands of years. Can you explain the resistance to it by the American medical establishment?

PER OTTE: No! But, let me guess. The American medical establishment will except things only that can be done by a "double blind study," which means neither patient nor physician knows if they are getting the real treatment or placebo. Which means the physician doesn't know which treatment he is administrating and, therefore, will not show any different emotions for the patient who is being treated or receiving the placebo. If you are given acupuncture treatments, you would definitely know if you give the right treatment or not, which means that the physician is not "blind," and there can be no double blind study with acupuncture.

BRYNJULV: As I am a subscriber from Norway, I wonder if microacupuncture is readily available in my country? Also we have recently have been offered a new form of alternative treatment here called Low Level Laser Treatment (LLLT). The person doing the treatments is from Sweden and refers to this as Laser Acupuncture or as biostimulating laser treatment. Does microacupuncture have anything in common with this other form of treatment? Can a laser be used as part of acupunctural treatment?

Last, I found some information about a Danish practitioner who offers acupuncture for MD and RP in Scandinavia, but calls his method "akupunktur2000". His name is John Boel and he claims to have many patients from throughout Scandinavia. Is his technique the same as yours?

PER OTTE: I know Dr. John Boel very well and I recommend that you see him for your vision disorder. He has been using microacupuncture since the beginning, so he does have a lot of experience. He would know if any one was doing microacupuncture in Norway. Can you explain the laser questions to me? Do you mean laser instead of needles or laser treatment in the eyes? If you mean laser instead of needles in microacupuncture laser has a lower effect on adults than needles, and is there for not recommended in microacupuncture for adults. However, in children and teens it is effective as needles.

SHARON: Recently a Chinese doctor provided me with an acupressure treatment for good vision used by Chinese school children during school hours. We were in a social situation, so I didn't ask her to re-do the acupressure points. To the best of my recall, you start by rotating clock-wise and counter-clockwise between the brows for a count of 10. Next, you rub the eye brow, proximal to distal x5. Thirdly, you find the point on the lower orbit that is sore to the touch and rotate x5 or 10. Next, rotate at the posterior of the ear, at the mandibular joint. Last, you lightly pinch and rotate the ear lobe. Are you aware of the technique?

PER OTTE: Yes, I have heard about that technique used for relaxing tension in the eyes. In this case, massaging the acupuncture points surrounding the eyes will help relieve the tension and restore the blood flow. People who are interested in those points can find them in most books about acupressure.

FRANCES: My eyesight is not too bad, but distortion is my problem. Can this help?

PER OTTE: Microacupuncture would be able to increase your reading without the distortion.

JUDY: From what I understand...acupuncture is sometimes used as an anaesthetic for simple surgical interventions in the Orient.

PER OTTE: If you look into traditional acupuncture and not only the western version, you will see that pain and anaesthetic is only a small part of acupuncture.

JUDY: Am I correct in saying that acupuncture focuses on a holistic approach to the patient, rather than a diagnosed disease orientated treatment plan?

PER OTTE: No...in ancient time they had to use the holistic approach, simply because there were no diagnostic systems. Today, the modern system is more and more incorporated into the treatment approach.

JUDY: According to some eastern philosophies, pain and disease occur because of an imbalance between two main forces of nature called yin and yang, and acupuncture is thought to restore the balance between these two forces. In other words, you could almost call acupuncture a type of belief system, meaning if you really believe this will help, then it might.

PER OTTE: According to your way of interpretation and conclusion about eastern philosophies, I must be very good at convincing people that acupuncture works, because it is a known fact that belief causes a placebo effect of 33%. We do the treatments here, with better than 9 out of 10 noticing improvement in visual acuity in as little as two days. Even to the point where a patient can get a treatment in the morning, go to lunch, and come back crying, because, for the first time in years, they could read the menu. It does not matter how positive they might have been, that was not what they expected! So, it is a little bit more than just belief.

JUDY: Am I right in saying that the more severe your vision loss, the more acupuncture you will need to notice an improvement?

PER OTTE: Yes, the more vision loss a patient has, the more microacupuncture treatment they will need. If you stop seeing things around 20/300 or 20/400, and your vision is worse than 20/2000, it takes a while before you will be able to see 20/400 and notice a difference in your vision. Even if you are able to see smaller letters on a near reading chart at Snelling distance of 2-3 inches (worse is normally at 16 inches), or from seeing one or two lights when doing vision field scanning to seeing 15 to 16 lights. A typical reaction in these cases is when the patient says, "I can't see things, but I feel that it's brighter!"

JUDY: How can we believe that acupuncture will work for scientifically proven, genetically hereditary forms of macular dystrophies, commonly called juvenile macular degeneration?

PER OTTE: What is the difference in scientifically proven or not? You can still lose your vision if it's scientifically proven or not. What matters to me is two weeks ago, I treated a thirteen year old boy with macular dystrophy, and he was unable to see any light whatsoever on the vision field scan, no letters on the visual acuity test at a 2 inch distance, and no finger counting, but he was able to see a pen light from all angles. The second day of treatments, his mother panicked, because he walked off by himself, which he has not done in a couple of years. Before, he didn't even know what was in front of him, now he is able to see doorways and openings. His little sister is suffering from the same disease, but her vision was 20/600, and in two days it changed to 20/300. Her mother stated that her vision was 20/300 six months ago, and in two days she gained back what she had lost in six months. I think that speaks for itself.

JUDY: An inherited eye disease, such as your example of macular dystrophy, is the result of a defective gene. Microacupuncture could possibly temporarily improve an individualÕs visual acuity, but you certainly cannot eventually repair the cause and effect of this gene through your treatments. That is impossible without a gene delivery system, for example, as one scientific possibility. Do you not agree?

PER OTTE: I have certainly never stated that microacupuncture is a permanent "fix" nor a "cure" for any eye diseases. But, if you can keep a temporary improvement (improving) with continuous treatments, that must be a whole lot better than the alternative, "downhill."

JUDY: I do believe, however, that your boy with macular dystrophy had a placebo effect.

PER OTTE: In that case I must be very good at convincing people about the effect of microacupuncture, because his sister improved, too. And this morning we have just rechecked three patients with macular degeneration, one with RP, and all eight eyes had improvement in the vision field scanning. They also had at least one line of improvement on the visual acuity test. The winner had three lines! Those four had the first treatments on Monday. That means that my placebo effect is 100%, not bad, uh??

JUDY: There is no pain at all with retinal degenerations, so what purpose does acupuncture really serve? These inserted needles act as a stoppage for nerve receptors, hence the brain does not receive pain signals. Now, that makes sense. Acupuncture does not make sense when we are talking about an acquired disease. It it did work for relief of non pain related diseases, why are there not headlines in every major world newspaper? This would be astounding news for all of we macular degenerates.

PER OTTE: Let's upgrade your thinking about acupuncture! Acupuncture does not work through nerves. It works through pathways called meridians. I think that meridians are left-overs of the nerve system that monitored our development as the fetus, which was controlled by the mother through the umbilical cord. That system was shut down at birth, and the pathways are now changed to what we now call meridians, which distribute energy from the production to the area of use. The more active the tissue is, the more energy is produced (arms, legs, hands, feet, where there is the most mobility). The thought is that acupuncture might be able to reactivate the original function of that nerve system to build new cells, which would explain the effect of microacupuncture on rebuilding the cells of the retina.??

JUDY: Your description of what you think meridians really represent is stretching the point a bit, do you not think so?

PER OTTE: If you would read more advanced acupuncture books, which describe advanced theories and techniques, you would probably agree with me. Acupuncture is a whole lot more than pain.

As to your question about newspaper news, the editor asks, "Has it been in a medical journal? If not, we will not write about it." I contacted the National Eye Institute, which let me know that they definitely did not have an interest in it. When you get enough response like that, you tell yourself, "If they don't want it, who cares?"

JUDY: The recognized eye institutes in North America want to have concrete scientific proof that a treatment works. This can only come about through clinical trials which have rigid standards.

PER OTTE: When I contacted the National Eye Institute, there was nothing about clinical trials. It was very straight forward, this was an alternative method, and they did not deal with anything alternative. [They directed me to] the National Institute of Health, which had a department called Alternative Health. I contacted them, and they told me they definitely did not have funding allowing them to even look into a project like this. At the moment, they were dealing with a project called "Prayers Effect on Pain." That project took all of the funding they had a the time. It might have changed, because this was in 1994/1995, but their whole attitude was "do not bug us with alternative medicine."

JUDY: Why can you not apply for clinical trial testing if you feel that patients are improving their vision with your treatments?

PER OTTE: According to clinical trial testing, you cannot fulfill the criterias of double blind testing with acupuncture. So, if you have any ideas as to how, let me know.

JUDY: You say on your website that neovascularization "cannot be repaired by modern medicine." Photocoagulation, and now photodynamic laser, attempt to repair this leakage, so I do not understand your statement. I fully realize that both of these treatments are really only bandaid solutions, as neovascularizations can reoccur; but at least an attempt is made to halt the leaking blood vessel.

PER OTTE: The web site states, as you say, "cannot be repaired by modern medicine," and your question agrees with me. As you say, the photodynamic laser attempts to repair the leakage, but not restore the damage. As far as I know, please correct me if I'm wrong, the photocoagulation plugs up the blood vessels to minimize or stop the leakage. To me it sounds like creating an area of dry retinal degeneration.??

JUDY: I [do] not agree with you. The word "repair" might be misunderstood by both of us. To me, photocoagulation and PDT lasers attempt to "repair" the leakage that occurs from wet MD. They do not, and say they do not, cure or restore the vessel back to what it was. All they do is leave a scar that can be seen on a flourescein angiogram. Photocoagulation, for example, cauterizes the leakage so the bleeding will stop. I am legally blind in one eye by this treatment, with a visual acuity of 20/800. There is nothing that can be done to reverse that, and I do not believe that any treatment ever could.

PER OTTE: I guess we both now know what "repair," means and can agree about that. I'm very sorry to read about your experience with photocoagulation, but it makes me more sorry to read that you "gave up." When we see patients here who have had laser treatments, photocoagulation therapy, or visudyne treatments, it seems there is a big partially-affected area around the procedure. The affected area that shows up as a black spot on the vision field scan is often diminished from one inch in diameter, or the size of central ten degree vision field, to a quarter of an inch in diameter, which probably is the true treated area. This causes a dramatic change in the patient's vision. (They feel that someone has turned a bright light on.) You don't tell me how much vision you have lost in your other eye, but if you were a person calling me about your eye condition, I would (knowing what it is leading to) tell you to be here yesterday! One good thing we can say about acupuncture is, if it doesn't work, it doesn't do any harm!

DR. WENDY: The black spot that shows up on the visual field shows the area of the retina affected and the nerve fibers affected by the changes caused by the macular degeneration or other retinal degenerations. It is a central blind spot that correlates to the macula and area around it. The black or gray spot that patients see obliterates their central vision, making reading and other detailed near vision, seeing faces, etc. very difficult. Laser photocoagulation does cause more scar tissue and loss of vision centrally, the extent of which depends on the locality an can increase the size of the central blind spot. PDT preserves the underlying retina, no damage occurs in the retina, and there is no increase in the size of the blind spot. Also, with lasers used to treat wet macular degeneration they don't "burn away the optic nerve" as the macula is the area being treated.

JUDY: Is this visual acuity improvement obtained from eyes that have not been treated by laser? Is it a question of age of the patient or whether the degeneration is caused by only the dry form of MD, for example?

PER OTTE: It doesn't matter what diseases or what age the patient is. Even though the eye has been lasered, as long as they didn't burn the macula or the optic nerve away, they can be treated.

JUDY: Why are you not using flourescein angiograms also, as a retina photographic clinical tool, and only visual field testing?

PER OTTE: The reason is, neither I nor the patient really have any interest in what name you give the disease. Our interest is in what the eye can do.

JUDY: You say on your web site that five treatments are needed before an assessment can be made as to hopeful improvement to warrant continued treatments. Am I right in saying that it would cost approximately $580.00, not including planes or gas, to see if the five treatments worked well enough to continue? Then the remaining treatments and additional expenses would probably total altogether about $3,000.00, not including planes or gas?

PER OTTE: I'm not sure what you want me to say about the expenses. I would like to see you do some comparing of the cost of going to see an ophthalmologist (no insurance, because not everyone has health insurance). The cost of flourescein angiograms, fundus photos, and some procedures.

KAREN: In June of 1999 I went to Arizona to see Dr Tukan for microacupuncture, and had good results. The second trip, I again had improvements. When I went for my third set of treatments, I had lost everything I had gotten back the previous two visits...and I haven't been back since. SInce Jan 2000, my vision has stayed the same. I am thinking about going back to Arizona for more treatments soon. I was glad to know there was a Doctor in Arizona (within driving distance) that you had trained in this procedure.

PER OTTE: Don't give up hope! When you reacted to the treatments, and for some reason (which I don't know), lost gained vision, it is normally quick to restore it. Sometimes, [doctors] have to be really creative in composing the right needle combination. It takes a long time...to master the system totally.

KARINE: Have you heard about such a treament in France?

PER OTTE: As far as I know, there are none in France. But there is one in Spain, whose name is Freddy Dahlgren. For his e-mail address please contact me.

KEITH: I was wondering if you were going to update your website testimonials. I have been checking to see if any new ones were given.

PER OTTE: We updated our testimonials over the Christmas holidays, and if there is one in particular you are looking for, please contact me. We get a lot of small letters from patients that don't want there neighbors or doctors to know they have been here! We try to put the most common eye diseases in our testimonials that can help benefit more people, but we do have a lot of others.

PEPUKAYE: I live in Sweden...and am very familiar with the use of acupuncture for all sorts of diseases here. I was wondering if you know of any microaccupuncture therapist in Sweden or Denmark who may be able to help with Best's Disease (or juvenile MD)?

PER OTTE: Dr. John Boel is located in Denmark, in a town called Struer.

DR. WENDY: How do you know if the retina bleeds during the course of treatment? If the retina does bleed, what would you do about it?

PER OTTE: We don't know if the retina bleeds under the course of treatment. But if the patient mentions a certain distortion in their vision, we send them to an ophthalmologist.

DR. WENDY: Since you are not an optometrist, an ophthalmologist, or a visual scientist, how do you interpret visual fields?

PER OTTE: When I started doing eye treatments in Denmark, I had an ophthalmologist following the progress in patients. He gave me some intensive instructions about vision field tests.

DR. WENDY: How is the retinal sensitivity changed by your treatments?

PER OTTE: The retinal sensitivity is changed by increased nutritional supply. DR. WENDY: How do you determine what diagnosis each patient has?

PER OTTE: The patients have already seen their ophthalmologists and he/she has given them their diagnosis. Some of the patients' ophthalmologists recommended them to me and send their medical files with them so I can observe. As you might guess from my answers, for the sake of microacupuncture it is of minor importance which diagnosis the patients' have. We put them in five categories: 1) clogged blood vessels, 2) hemorrhaging blood vessels, 3) immune disorder, 4) inflammation, and 5) unknown reason.

DR. WENDY: How do you measure the "great deal of success" you have had in treating the patients?

PER OTTE: If you have 1000 new patients in a year, and only four or five show no change, I think that is a great deal of success. Over the last two years, we have given forty or fifty people a driver's license back.

DR. WENDY: If you do not examine the eye health, how do you know the treatment is effective?

PER OTTE: The treatments are effective because of people's acuity increase. Not only by the acuity test or vision field scanning, but the people see it for themselves, literally!

DR. WENDY: How many lines of improvement on the eye chart is considered significant improvement?

PER OTTE: If I improve the vision one line on a patient who has a slow but steady loss of vision over the last several years, or actually just be able to keep the vision stable on a patient like that would be a significant improvement. However, here patients who just keep the vision and have no improvement in the vision are discharged, so we have no idea of which percentage it makes the eyes stable. Significant improvement here is measured by being able to see letters one-third of the sights from the first day they arrived here. Example: 20/300 to 20/100, which would be a five line improvement. Of course, if a patient comes here with 20/40 there is not room for a five line improvement.

DR. WENDY: What type of eye chart are you using to measure vision?

PER OTTE: Mostly lighthouse near visual acuity tests or medi-source tests (20 ft. tests).

DR. WENDY: Are retinal photographs taken to document the eye health before and after treatment?

PER OTTE: [This] depends on the patient's ophthalmologist.

DR. JEN: Thank you for spending your time answering so many questions on this forum! You mentioned the boy with macular dystrophy who wandered off by himself, able to see doors, etc. People with any macular problem can see a door or navigate alone, as their peripheral vision is intact. Perhaps the less stressful setting that they are in helps to encourage their use of this peripheral vision?