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.

许多视网膜色素变性（RP）患者寻求替代疗法，因为缺乏电流 除了营养补充剂之外，还可以选择其他管理方法来减缓疾病进展。的潜力 电针和/或经角膜电刺激对RP患者视功能的有益作用 刺激（TES）是通过对眼睛或大脑响应于这些刺激的生理变化的研究提出的。 治疗此外，我们的小组和其他人都有记录表明，大多数RP患者接受 TES、针刺或电针均能改善视功能。虽然这些发现是 有趣的是，可能发挥作用的潜在机制尚未在RP中探索。 我们有兴趣研究一些最有前途的替代疗法，以确定是否 他们有一个生理上合理的基础，改善视力的RP，这将提供一个科学的理由， 并指导未来随机对照试验的设计。血流速度显著增加， 在针刺视觉相关的眼球后动脉时，测量到血管阻力降低。 穴位，但不为非视觉相关的穴位，在正常人。因此，眼睛和视网膜的血流 （ORBF）可以作为一个指标的生理变化，发生在响应电针。 我们的目的是描述ORFF速度或氧合变化之间的时间关系 以及RP中视觉功能的改善或降低。我们希望发现， 不同阶段RP疾病受试者内和受试者间的OBF和视力指标降低 进展我们假设，在RBF和更近的时间里， 视力丧失将更有可能在相应的视网膜区域发展视觉功能的改善， 电针和/或TES。具体而言，我们建议： 1)检查近期视力下降的RP患者的ORFF纵向重复测量 功能我们将确定OBF速度，OBF阻力和RBF的可变性和再现性 氧合测量超过3个月。 2)在接受RP治疗的患者中测试ORBF和视功能测量的可能改善 电针和TES的交叉试验。我们将确定ORFF的大小和持续时间 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。我们将试图确定这些之间的时间性（即滞后或对应） 生理和心理物理测量。 这个临床研究项目的目标是确定是否存在证据来支持这些假设 在RP患者中，ORBF的减少与视功能丧失相关，并且他们的ORBF可以 在电针和/或TES治疗后改善。这项工作的结果可以提供一个理由， 用于开发旨在改善ORBF的潜在管理选项， 在这种疾病中，