Echothiophate (ECHO) Therapy Causes a Stir in the Low Vision Community

by Dan Roberts
November 2003
(Updated January 29, 2009)
A Connecticut ophthalmologist has been reporting success from a deceptively simple treatment on patients with Stargardt’s disease and other non-neovascular forms of retinal disease. Dr. Gerard Michael Nolan has performed the treatment, called ECHO therapy, for nearly three years on more than 200 patients at the Nolan Eye Clinic in Farmington, Connecticut, and he is now working to locate support for FDA-approved clinical trials.
Dr. Nolan, a diplomat of the American Board of Ophthalmology, is a graduate of Georgetown Medical School and completed his residency at Cornell Medical Center in New York. In a discussion with people from the MD Support email support group in early October 2003, he said, “In the course of my ophthalmic practice, I discovered that a topical drop of dilute echothiophate (ECHO) can restore lost visual acuity in some cases of chronic retinal disease. ECHO appeared to increase the capability of the few surviving neurons, endowing this reduced population with an enhanced stimulus potential. These effects need to be studied in multi-center controlled clinical trials.”
ECHO was used for 40 years for the treatment of glaucoma, but it has been replaced by better drugs for that purpose. Since it is no longer commercially available, Dr. Nolan obtained a pharmaceutical patent and filed an application for an FDA “new drug investigation.” He has also contacted potential research groups and funding resources. The FDA’s approval is necessary, because, even though Dr. Nolan’s use of diluted echothiophate is considered an off label usage of a legally marketed medication, the drug has not yet been reviewed or approved for treatment of retinal disease.
According to Dr. Nolan, the therapeutic benefits of ECHO may have previously remained hidden as the result of two key factors:
1. The dosage of the drug must be much lower than what was prescribed for glaucoma (one drop in one eye every four days, plus a drop in the other eye four days later); and
2. For best absorption, the drops must be administered before a good night’s sleep.
Several people from the MD Support group are among the many who have traveled to Connecticut for ECHO therapy. Most have returned with accounts of significant and measurable improvement in their vision. In response to the positive reports of these patients, Dr. Nolan said, “I have been encouraged every step of the way by the equally important discovery of caring and committed folks such as the MD Support group. I appreciate your key role in this quest and thank you for your confidence and support.”
MD Support will continue to follow Dr. Nolan’s progress with this effort, and we will report further developments on this site as information becomes available.
To read personal accounts of patients from the MD Support community who have undergone the treatment, see “ECHO Therapy” in the MD Support Treatment Archives.

UPDATE (1/29/09):
In early January, 2009, Wyeth Pharmaceuticals announced that, under direction of the FDA, echothiophate iodide would no longer be available to physicians for any purpose. Then, on January 23, 2009, Wyeth issued a letter to health care providers announcing that the product would again be available under a limited distribution program.
Here is the gist of the letter regarding new criteria for purchasing echothiophate:
Product may only be purchased directly from Wyeth.
Such sales are limited to one bottle per patient per month.
Wyeth is restricting shipments to either pharmacies or directly to physicians.
Pharmacies may be required to provide Wyeth with the name of the prescribing physician.
Wyeth is unable to accept stocking orders.
As a side note, Pfizer Pharmaceuticals made an offer in January 2009 to purchase Wyeth at a sum of 68 billion dollars. It is unknown at this time how that purchase will affect the availability of echothiophate.

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