Modulating Ocular/Retinal Blood Flow and Visual Function in Retinitis Pigmentosa

调节色素性视网膜炎的眼/视网膜血流和视觉功能

• 批准号: 8570504
• 负责人: AVA K BITTNER
• 金额: $ 4.42万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8570504
• 关键词: Acupuncture Points; Acupuncture procedure; Aftercare; Alternative Therapies; Animal Model; Area; Arteries; Basic Science; Blindness; Blood Flow Velocity; Blood flow; Brain; Ciliary Neurotrophic Factor; Clinical Research; Cross-Over Studies; Development; Disease; Disease Progression; Electric Stimulation; Electroacupuncture; Eye; Future; Goals; In Vitro; Intervention; Longitudinal Studies; Measures; Natural regeneration; Needles; Patients; Physiological; Play; Prospective Studies; Psychophysics; Randomized Controlled Trials; Reproducibility; Research; Research Project Grants; Resistance; Retinal; Retinal Cone; Retinal Degeneration; Retinitis Pigmentosa; Role; Severity of illness; Staging; Stimulus; Testing; Thick; Time; Vascular resistance; Vision; Vision Tests; Visit; Visual Acuity; Visual Fields; Work; alternative treatment; base; central retinal artery; design; dietary supplements; follow-up; functional improvement; improved; interest; neurotrophic factor; ophthalmic artery; public health relevance; research study; response

Many retinitis pigmentosa (RP) patients seek alternative therapies because of the lack of current management options beyond nutritional supplements attempting to slow disease progression. The potential for a beneficial effect on visual function in RP following electroacupuncture and/or transcorneal electrical stimulation (TES) is suggested by research on physiological changes in the eye or brain in response to these therapies. In addition, both our group and others have documented that the majority of RP patients treated with TES, acupuncture or electroacupuncture had improvements in visual function. While these findings are intriguing, the potential mechanisms that may play a role have not been explored in RP. We are interested in studying some of the most promising alternative therapies to determine whether they have a physiologically plausible basis for improving vision in RP, which would provide a scientific rationale for and guide the design of a future randomized controlled trial. A significant increase in blood flow velocity and decreased vascular resistance was measured in the retrobulbar arteries during needling of vision-related acupoints, but not for non-vision-related acupoints, in normal subjects. Thus, ocular and retinal blood flow (ORBF) could serve as an indicator of physiological changes that occur in response to electroacupuncture. We aim to characterize the temporal relationships between changes in ORBF velocity or oxygenation and either improvements or reductions in visual function in RP. We expect to find positive correlations between reductions in ORBF and vision measures within- and across subjects with varying stages of RP disease progression. We hypothesize that subjects with significantly larger improvements in RBF and more recent vision loss will be more likely to develop improvements in visual function in corresponding retinal areas after either electroacupuncture and/or TES. Specifically, we propose to: 1) Examine longitudinal, repeated measures of ORBF in RP patients with recent decline in visual function. We will determine the variability and reproducibility of ORBF velocity, OBF resistance and RBF oxygenation measures over 3 months. 2) Test for possible improvements in ORBF and visual function measures in RP patients receiving electroacupuncture and TES in a crossover trial. We will determine if the magnitude and duration of the ORBF changes post-treatment are related to RP disease severity (retinal thickness and/or sensitivity) and/or vision test changes. We will attempt to determine the temporality (i.e. lag or correspondence) between these physiological and psychophysical measures. The goal of this clinical research project is to determine if evidence exists to support the hypotheses that reductions in ORBF are associated with visual function loss across RP patients, and that their ORBF can improve after treatment with electroacupuncture and/or TES. The results of this work could provide a rationale for the development of potential management options targeted at improving ORBF, and consequently visual function, in this disease.

由于缺乏当前的治疗方法，许多视网膜色素变性（RP）患者寻求替代疗法 除了试图减缓疾病进展的营养补充剂之外的管理选择。的潜力 电针和/或经角膜电治疗后对 RP 的视觉功能有有益影响 刺激（TES）是通过对眼睛或大脑响应这些生理变化的研究而提出的。 疗法。此外，我们的小组和其他人都记录了大多数 RP 患者接受了 TES、针灸或电针疗法可以改善视功能。虽然这些发现是 有趣的是，RP 中可能发挥作用的潜在机制尚未得到探索。 我们有兴趣研究一些最有前途的替代疗法，以确定是否 他们具有改善 RP 视力的生理学合理基础，这将提供科学依据 并指导未来随机对照试验的设计。血流速度显着增加 在针刺视力相关的过程中，测量到球后动脉的血管阻力降低 正常受试者中的穴位，但不包括与视力无关的穴位。因此，眼部和视网膜的血流量 （ORBF）可以作为响应电针而发生的生理变化的指标。 我们的目标是描述 ORBF 速度或氧合变化之间的时间关系 RP 中视觉功能的改善或降低。我们期望发现之间的正相关性 不同阶段的 RP 疾病受试者内部和之间的 ORBF 和视力测量值降低 进展。我们假设 RBF 改善显着且最近的受试者 视力丧失后，相应视网膜区域的视觉功能更有可能得到改善 电针疗法和/或 TES。具体来说，我们建议： 1) 检查最近视力下降的 RP 患者的 ORBF 的纵向、重复测量 功能。我们将确定 ORBF 速度、OBF 阻力和 RBF 的可变性和再现性 3个月以上的氧合措施。 2) 测试接受 RP 治疗的患者 ORBF 和视功能测量的可能改善 交叉试验中的电针和 TES。我们将确定 ORBF 的幅度和持续时间是否 治疗后的变化与 RP 疾病严重程度（视网膜厚度和/或敏感性）和/或视力有关 测试更改。我们将尝试确定这些之间的时间性（即滞后或对应） 生理和心理物理措施。 该临床研究项目的目标是确定是否存在支持假设的证据 ORBF 的减少与 RP 患者的视功能丧失相关，并且他们的 ORBF 可以 电针和/或 TES 治疗后有所改善。这项工作的结果可以提供一个理由 开发旨在改善 ORBF 的潜在管理方案，从而实现可视化 功能，在这种疾病中。