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

许多视网膜色素变性(Rp)患者寻求替代疗法，因为缺乏电流。 尝试延缓疾病进展的营养补充剂以外的管理选择。潜在的 电针和(或)经角膜电对RP患者视功能的有益影响 刺激(TES)是通过研究眼睛或大脑对这些刺激的生理变化而提出的 治疗。此外，我们的小组和其他人都证明了大多数RP患者接受了 TES、针灸或电针均能改善视功能。虽然这些发现是 耐人寻味的是，在RP中可能发挥作用的潜在机制尚未被探索。 我们有兴趣研究一些最有前景的替代疗法，以确定 他们有一个生理学上可信的基础来改善RP的视力，这将提供一个科学的理论基础 用于并指导未来随机对照试验的设计。血流速度显著增加， 视觉相关针刺时球后动脉血管阻力降低 正常受试者的穴位，但不是非视觉相关的穴位。因此，眼部和视网膜的血流 (ORBF)可以作为电针反应所发生的生理变化的指标。 我们的目标是描述ORBF血流速度或氧合变化之间的时间关系 以及视功能的改善或降低。我们希望在两国之间找到正相关 患有不同阶段RP疾病的受试者内部和跨受试者的ORBF和视力测量的减少 进步。我们假设，RBF有明显较大改善的受试者以及最近 视力丧失将更有可能在相应的视网膜区域出现视功能改善 要么是电针，要么是TES。具体来说，我们建议： 1)检查近期视力下降的RP患者的ORBF的纵向、重复测量 功能。我们将测定ORBF速度、OBF阻力和RBF的变异性和重复性 氧合测量超过3个月。 2)RP患者的ORBF和视功能测量的可能改善的测试 电针和TES的交叉试验。我们将确定ORBF的规模和持续时间 治疗后的变化与RP疾病的严重程度(视网膜厚度和/或敏感性)和/或视力有关 测试更改。我们将尝试确定它们之间的时间性(即滞后或对应 生理和心理物理措施。 这个临床研究项目的目标是确定是否有证据支持这些假说。 ORBF的减少与RP患者的视觉功能丧失有关，并且他们的ORBF可以 电针和/或TES治疗后改善。这项工作的结果可以提供一个理论基础 用于开发旨在改善ORBF的潜在管理备选方案，从而提高视觉效果 功能，在这种疾病中。

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.