Quick answers
- Role: coMra is an adjunct you can layer into existing care plans to support perfusion, neurotrophic/anti-inflammatory signaling, and patient adherence.
- Safety: Safe for use over the eye (closed lids) using contact or hover technique. Gentle, low-intensity, non-thermal
- Workflow: Slot into pre- or post-exam blocks or alongside VT/rehab stations; typical session time is brief and protocolized.
- Evidence: See the Clinical Brief, Case Gallery, and Research Digests for condition-specific rationale and documentation.
- Training: No special “new skill” barrier—follow the standardized protocols; clinical judgment stays central.
Terminology: “Managing clinician” = the OD or MD primarily responsible for the patient’s plan.
Where relevant, we’ll say OD/MD team.
FAQs & Common Concerns
1) Is coMra therapy safe to use over the eye (closed lids)?
Yes — when used as directed. coMra is gentle, low-intensity, and non-thermal (doesn’t cut or heat). It is safe for use over the eye (closed lids) using contact or hover technique.
Good practice: follow the eye protocol; avoid pressure on the globe; keep terminals clean/covered; don’t treat through dressings; use hover for fresh post-op tissue; escalate or defer if red flags are present.
2) Where does this fit in a glaucoma or optic neuropathy plan?
Default posture: adjunct. Maintain standard of care (IOP management, meds, surgery when indicated, VT/rehab) and layer coMra to support microcirculation, neurotrophic signaling, and inflammation modulation as part of the structured care plan and scheduled sessions.
When meds or procedures fall short: Some patients present after med intolerance/side effects, insufficient pressure control, or when SLT/MIGS/other procedures don’t work or wane over time. With the managing clinician (OD/MD), plans may shift to reduce/stop certain meds or consider alternatives. In these cases coMra can be part of an alternative pathway—only with clear baselines and close monitoring (IOP, VF/function, symptoms) and appropriate escalation if the disease course worsens.
3) Will this raise or lower IOP?
Positioning: coMra isn’t an IOP-lowering device per se. Its role is supportive—aimed at tissue health (perfusion, neurotrophic/anti-inflammatory signaling) while you continue standard of care.
Medication adjustments (case-by-case): In real-world use, some patients—under their managing MD—reduce or discontinue certain meds when pressures normalize and remain stable on follow-up. This is not a guarantee and should only occur with clear baselines and close monitoring (IOP, VF/function, symptoms).
Short-term variability: As the system re-balances, a transient IOP change can occur after sessions (occasionally a brief rise followed by settling). This isn’t the norm, but it’s possible—similar to how blood pressure in some patients dips immediately post-treatment while others see a short uptick before regulating. Treat early visits as data-gathering and watch the trend, not single points.
Practical monitoring tips:
- Establish pre-treatment baselines and keep measurement timing consistent (e.g., same time of day).
- Consider an early post-session check during the first 2–3 visits (e.g., 30–120 minutes) if clinically warranted.
- If you see sustained elevation or progression, escalate per standard protocols; coMra remains adjunct to responsible IOP management.
3a) What if a patient cannot tolerate glaucoma meds?
Coordinate with the managing MD. Establish baselines (IOP, VF/contrast, symptoms), agree on a monitoring cadence, and consider coMra as a supportive modality while adjusting therapy. If any sign of decompensation appears (rising IOP, VF progression, new symptoms), escalate per standard protocols.
4) What clinical outcomes should I realistically watch for?
Primary signals: VF trend (MD/PSD/Bjerrum changes), contrast sensitivity, subjective comfort/eye strain, headaches, reading endurance, diplopia/ocular alignment symptoms, and case-by-case changes in field defects.
Short-term adaptation: As oculomotor/visual processing re-coordinates, a temporary uptick in headaches or discomfort can occur. This is not the norm and should be short-lived; start conservatively, treat early visits as data-gathering, and watch the trend, not single points.
If symptoms flare locally, shift support systemically: Rather than stopping, consider pivoting from local ocular-only work to short blocks of systemic/regulatory support so the change integrates more easily—for example, brief passes over the cerebral hemispheres for headache relief and the carotid arteries for generalized support—then return to local work once comfortable.
When to adjust or pause: If discomfort is more than mild, lasts >24–48 hours, or function regresses (e.g., sustained VF worsening), reduce intensity/frequency, re-check placement, and co-manage as needed.
Practical tracking: Capture baselines and scheduled re-tests; keep measurement timing consistent; add a 1–10 comfort/strain scale each visit.
5) How many sessions do patients typically need?
Session frequency: adapt to your clinical model (weekly, biweekly, or integrated with existing therapy blocks).
Typical course length: Plan a defined block (often ~10 sessions or match your VT course), then reassess. A minority are “one-visit responders,” but most benefit from a full course.
Follow-up cadence (especially in chronic disease): Complete a course → schedule a follow-up to see if improvements hold. The more severe/chronic the condition, the sooner the first follow-up should be. Set expectations that some patients may need several courses over time—effects often continue to consolidate after a course ends, but deeper chronicity means the body needs more support to reach a stable, coherent state.
Patient analogy (optional): Think training wheels—do a course, pause, and observe. If balance holds, take the full pause; if things slip during the pause, resume sooner. That feedback tells you how much support the system still needs.
Comorbidities matter: Systemic factors (vascular/metabolic disease, sleep apnea, chronic inflammation, meds) influence response. Co-manage and tailor cadence accordingly.
Home program (when appropriate): A simple home plan between visits can preserve gains and improve adherence.
6) Does this require special skills or certification?
No special skills beyond normal clinical competence. Protocols are standardized. A brief orientation covers placement, dwell time, and cautions. Your existing differential diagnosis and follow-up routine remain the backbone.
7) How does coMra differ from “just red light” or PBM alone?
Not one tool—coherence. With coMra you’re not treating with laser alone, or magnet alone. The radiances are combined and timed so the tissue receives a coherent signal—cells can act in a more energy-efficient, harmonized way.
Lower power, broader safety/ease. Because the radiances are coordinated, their individual power levels are turned way down—yet the combined effect improves. That widens the effective & safe operating window and reduces the need for “precision dosing” expertise compared to mono-PBM.
How the pieces complement each other (conceptual):
- Laser + magnetic field: support mitochondrial dynamics → ATP availability and energy efficiency.
- Magnetic field + ultrasound: nudge enzymatic efficiency and transport processes.
- Laser + color LEDs: reinforce the body’s oscillatory/rhythmic phases (inflammatory → anti-inflammatory → regulatory) so patients “stuck” in one phase can re-enter a healthy rhythm.
Clinical take-home: coMra applies coherence—not power—to help the body re-modulate itself safely and consistently alongside standard care.
8) Can I use coMra after ocular surgery?
Short answer: Often yes, with the surgeon’s coordination and a conservative start. coMra can be particularly helpful in the early recovery window, but technique matters.
Don’t treat through a bandage/dressing. Laser/LEDs scatter and effectiveness drops. If your clinic is authorized to remove and re-apply the dressing per the surgeon’s protocol, you may treat while it’s off—using non-contact “hover” (about ½ inch / 1–2 cm above skin), then re-dress.
When tissue is fresh/unstable (new incision, burns, grafts):
- Use non-contact hover over closed lid/periocular skin; avoid pressure on the globe.
- Maintain sterility: disinfect the terminal and consider a single-use barrier (plastic film) over the terminal.
- Start conservatively and titrate based on comfort and objective findings.
Good practice: Get surgeon clearance, note baselines (comfort, VA as appropriate, IOP/VF if relevant), and set a monitoring cadence. If you’re not comfortable with immediate post-op application, defer—there’s still plenty to do once tissues stabilize.
Skip/stop if: active bleeding, suspected infection, wound dehiscence, severe pain, worsening vision, or if the surgeon advises against it.
Clinical take-home: coMra is often very useful for post-surgery recovery when applied correctly—stay adjunct, go slow, and watch the trend.
9) Any absolute contraindications?
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Open eyes: Never expose open eyes to the laser. Ocular work is over the eye (closed lids) only.
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Pacemakers / neurostimulators: Do not treat within 30 cm (~12 in) of pacemakers, ICDs, or neurostimulators. Exception: if a cardiologist/electrophysiologist explicitly directs otherwise for a specific patient, follow their guidance; otherwise, err on the side of distance.
10) Will this interfere with my medications or topical therapy?
coMra is non-pharmacologic and generally coexists well with meds. Keep all prescribed therapies in place and continue your normal review cadence. If anything changes unexpectedly, reassess and adjust like any other adjunct.
11) How do I document coMra in the chart?
Include indication, protocol name/areas, session time, patient response, and objective measures (VF trend, contrast, comfort scales). Link to your clinic’s Clinical Brief page or internal SOP for consistency.
12) What should patients feel during/after a session?
During: Most people feel nothing. coMra is non-thermal and does not zap, tingle, or sting. A small subset of “energy-sensitive” patients may notice a subtle presence or perceive mild warmth—that’s a sensation, not tissue heating. Either way is normal.
After: Effects are often subtle and delayed. Many notice changes minutes to ~30–60 minutes later—e.g., calm, less eye tension, easier focusing/reading, or a headache easing without a clear “moment” of change. Some get immediate relief; others feel no obvious change that day—track the trend across sessions.
If discomfort shows up: It should be mild and short-lived. Rather than stopping outright, you can reduce dwell/cadence, switch to hover, or shift briefly to systemic support (e.g., hemispheres, carotids) and return to local work once comfortable. If symptoms are more than mild or persist >24–48h, modify the plan and co-manage as needed.
12a) If I don’t feel anything, is it working? What about “no pain, no gain”?
coMra is non-thermal and typically not felt—no zap, tingle, or sting. Relief often emerges gradually as the system re-coordinates. Feeling nothing during a session is normal and doesn’t predict outcome.
Mindset note: “Pill for an ill” and “no pain, no gain” expectations can get in the way. Be your own best health detective—not grimly determined, but curious. Notice small, “insignificant” shifts as you go about your day (e.g., less squinting, longer reading tolerance, fewer headaches on screens, easier focus shifts, softer eye tension, better sleep). These micro-shifts add up. Judge by the trend across sessions, not a single “felt” moment.
Tip: Jot a one-line note after each day or session; patterns become clear quickly.
13) Can patients do this at home between visits?
Yes, for select cases with clear instructions and check-ins. Home use supports consistency and adherence. Provide a simple handout/checklist, then review progress at follow-ups.
14) How does this affect visual field testing schedules?
Keep your existing VF schedule. If you’re initiating a block of coMra, consider a baseline, a mid-block snapshot (optional), and a post-block assessment to evaluate trend—not to over-interpret single-test noise.
15) What about APD, perfusion, or SPCA flow—should I be measuring those?
Use the tools you already trust. For many clinics, functional outcomes (VF trend, contrast, symptom scales) are most practical. If you track perfusion metrics, keep protocols consistent so your before/after comparisons mean something.
16) How long is a session and how do I fit it into clinic flow?
Ocular protocols are brief and can be batched with VT/rehab or slotted pre-dispense / post-exam. Many clinics start with a 10–20 min block including setup, treatment, and notes.
17) If this works, why haven’t I seen it in my standard toolbox?
Short answer: Adoption varies by country and specialty.
- In some systems (e.g., Russia), ophthalmology references such as the national glaucoma guideline (E. A. Egorov, ed., 2013; later editions) include low-level laser therapy, magnetic field therapy, colour phototherapy, ultrasound, and microcurrent as recognized modalities in eye care.
- In North America/EU, these tools more often live in rehab/integrative or research contexts than in standard ophthalmic pathways—uptake tracks with training, reimbursement, and device/regulatory norms.
Where coMra fits: coMra integrates those radiances at lower individual power into a single coherent signal with practical protocols. Our Case Gallery and Research Digests translate this body of work for clinicians who haven’t trained in the individual modalities.
18) What if a patient has a complex neuro/vascular history?
Co-manage. Start conservatively, prioritize comfort and function, and keep all standard monitoring in place. Document better/worse/unchanged after the first few sessions and decide on continuation accordingly.
19) Does this replace vision therapy or microcurrent, syntonics, etc.?
No—coMra is designed to complement, not replace, other therapies. In practice, clinics often find it potentiates adjacent work by supporting energy, perfusion, and rhythmic regulation—so VT, syntonics, microcurrent, or manual/rehab work can “land” more easily.
How to layer it:
- Before VT / rehab sessions to prime tissue and comfort.
- Alongside syntonics in the same block or alternating days.
- With microcurrent/manual work as a gentle pre/post support.
With medications: coMra is non-pharmacologic and is sometimes used to improve comfort/adherence when side-effects are burdensome. This is case-by-case; continue all meds and make any adjustments only with the managing clinician (OD/MD).
Charting tip: record co-administered modality, timing (pre/alongside/post), and patient response so you can see what combinations help most.
20) What are the biggest implementation pitfalls?
- Trying too many variations at once—standardize first, then personalize.
- Not documenting subjective changes—add a 1–10 comfort/strain scale.
- Expecting dramatic changes in a few visits for longstanding disease—set expectations and track trends.
Patient read-along (optional handout text)
(Click to Expand)
What is coMra? A gentle, non-drug therapy that uses very low-power light, gentle ultrasound, and magnetic fields in a coordinated way to support your eye’s natural healing processes.
Will I feel anything? Usually nothing or mild warmth/pressure. Many people feel more relaxed afterward.
Does it replace my drops or doctor visits? No. It’s in addition to your current care. Keep using your prescribed treatments and come to all follow-ups.
How soon will I notice a difference? Some feel comfort changes quickly; functional changes are tracked over weeks with your regular tests. Your clinician will review progress with you.
Is it safe? Used correctly, it’s well tolerated. Tell your clinician about surgeries, implants, medications, or any new symptoms before sessions.