Improvement in Visual Function in Patients with Inherited Diseases of the Retina Following Acupuncture Treatment

Abstract

Background: The aim of this pilot study was to examine the short-term effect on visual function of acupuncture treatment in a cohort of patients with inherited diseases of the retina. Patients and Methods: A prospective pilot study was performed on 14 patients (10 ♀, 4 ♂; mean age: 43.43 y (± 19.72 y)), with the clinically and electrophysiologically confirmed diagnosis of inherited disease of the retina. Acupuncture treatment consisted of needle application to the body and ears and was performed following a standardized protocol. The treatment was scheduled for 10 half-hour sessions over five weeks. Visual function was measured before acupuncture, between acupuncture treatments and after the end of treatment. Objective measurements included best corrected visual acuity (ETDRS charts), contrast vision (CSV-1000, Vector Vision) and Goldmann perimetry (isopters 3IIIe; Haag-Streit). Subjective evaluation was based on evaluation questionnaires. To exclude the effect of variability on the psychophysical tests, a non-acupuncture control group (Nr: 8; 5 ♀, 3 ♂; mean age: 38.56 y (± 9.08 y)) was taken for comparison. Results: All patients with inherited diseases of the retina showed general improvement in objective visual functions, with post-/pre- acupuncture improvement in: visual acuity (p = 0.031, left eyes), contrast vision (p = 0.015 and p = 0.041; both eyes) and widening of the temporal radius of the visual field (0.013; left eyes). Subjectively, all patients reported better daytime, color and contrast vision, better visual focus and less visual tiredness. In addition, some general symptoms, such as longer sleep-onset time, feeling cold, and migraine/headache attacks were significantly reduced. Conclusions: The acupuncture protocol improved visual function in our patients with inherited diseases of the retina and was well tolerated. Nevertheless, the long-term effect of this complementary therapy remains to be evaluated.

Zusammenfassung

Hintergrund: Das Ziel dieser Pilotstudie ist die Untersuchung des Kurzzeiteffektes auf die Sehfunktion durch Akupunkturbehandlung in einer Kohortengruppe von vererbten Netzhauterkrankungen. Material und Methoden: Es wurde eine Pilotstudie mit 14 Patienten (10 ♀, 4 ♂; Durchschnittsalter: 43.43 J. (± 19.72 J.)) mit klinisch und elektrophysiologisch bestätigter Diagnose einer vererbten Netzhauterkrankung durchgeführt. Die Akupunkturbehandlung (Körper- und Ohrakupunktur) wurde nach einem standardisierten Protokoll durchgeführt. Es wurden zehn 30-minütige Behandlungen über fünf Wochen angesetzt. Der Effekt vor, während und nach Akupunktur wurde durch objektive Beurteilung der Sehfunktionen beurteilt, so mittels bester korrigierter Sehkraft (ETDRS Charts), Kontrastsehen (CSV-1000, Vector Vision), Goldmann-Perimetrie (Isopter 3/III e; Haag-Streit) und subjektiver Beurteilung (durch Fragebögen). Um den Effekt der Variabilität auf die psychophysischen Testergebnisse auszuschliessen, wurde eine Kontrollgruppe ohne Akupunkturbehandlung (Nr: 8; 5 ♀, 3 ♂; Durchschnittsalter: 38.56 J. (± 9.08 J.)) zum Vergleich herangezogen. Ergebnisse: Alle Patienten mit vererbten Netzhauterkrankungen zeigten eine allgemeine Verbesserung der Sehkraft (p = 0.031, linke Augen), des Kontrastsehens (p = 0.015 und p = 0.041; beide Augen) und eine Vergrösserung des temporalen Radius im Gesichtsfeld (0.013; linke Augen). Zusätzlich verbesserten sich einzelne Allgemeinsymptome wie eine verlängerte Einschlafzeit, ein allgemeines Kältegefühl sowie Migräne- und Kopfschmerzanfälle deutlich. Schlussfolgerung: Das oben beschriebene Akupunktur-Protokoll verbesserte bei unseren Patienten mit vererbten Netzhauterkrankungen die Sehfunktion und wurde gut toleriert. Zur Beurteilung des Langzeiteffektes bedarf es einer weiteren Evaluierung.

Key words

acupuncture - contrast vision - Flammer syndrome - inherited retinal diseases - visual function - perimetry

Schlüsselwörter

Akupunktur - Kontrastsehen - Flammer-Syndrom - vererbte Netzhauterkrankungen - Sehfunktion - Perimetrie

• References

• 1 Ammann F, Klein D, Franceschetti A. Genetic and epidemiological investigations on pigmentary degeneration of the retina and allied disorders in Switzerland. J Neurol Sci 1965; 2: 183-196
• 2 Puech B, Kostrubiec B, Hache JC et al. Epidemiology and prevalence of hereditary retinal dystrophies in the Northern France. J Fr Ophtalmol 1991; 14: 153-164
• 3 Hamel C. Retinitis pigmentosa. Orphanet J Rare Dis 2006; 11: 40
• 4 Hamel CP. Cone rod dystrophies. Orphanet J Rare Dis 2007; 1: 7
• 5 Michaelides M, Hunt DM, Moore AT. The genetics of inherited macular dystrophies. J Med Genet 2003; 40: 641-650
• 6 Berger W, Kloeckener-Gruissem B, Neidhardt J. The molecular basis of human retinal and vitreoretinal diseases. Prog Retin Eye Res 2010; 29: 335-375
• 7 Marc RE, Jones BW, Watt CB et al. Neural remodeling in retinal degeneration. Prog Retin Eye Res 2003; 22: 607-655
• 8 Marc RE, Jones BW. Retinal remodeling in inherited photoreceptor degenerations. Mol Neurobiol 2003; 28: 139-147
• 9 Cottet S, Schorderet DF. Mechanisms of apoptosis in retinitis pigmentosa. Curr Mol Med 2009; 9: 375-383
• 10 Grunwald JE, Maguire AM, Dupont J. Retinal hemodynamics in retinitis pigmentosa. Am J Ophthalmol 1996; 122: 502-508
• 11 Wolf S, Pöstgens H, Bertram B et al. Hemodynamic findings in patients with retinitis pigmentosa. Klin Monbl Augenheilkd 1991; 199: 325-329
• 12 Beutelspacher SC, Serbecic N, Barash H et al. Retinal blood flow velocity measured by retinal function imaging in retinitis pigmentosa. Graefes Arch Clin Exp Ophthalmol 2011; 249: 1855-1858
• 13 Zhang Y, Harrison JM, Nateras OS et al. Decreased retinal-choroidal blood flow in retinitis pigmentosa as measured by MRI. Doc Ophthalmol 2013; 126: 187-197
• 14 Cellini M, Lodi R, Possati GL et al. Color Doppler ultrasonography in retinitis pigmentosa. Preliminary study. J Fr Ophtalmol 1997; 20: 659-663
• 15 Falsini B, Anselmi GM, Marangoni D et al. Subfoveal choroidal blood flow and central retinal function in retinitis pigmentosa. Invest Ophthalmol Vis Sci 2011; 52: 1064-1069
• 16 Konieczka K, Ritch R, Traverso CE et al. Flammer syndrome. EPMA J 2014; 5: 11
• 17 Todorova MG, Josifova T, Konieczka K. Endothelin-1 Plasma Levels in Patients with both Retinitis Pigmentosa and Flammer Syndrome. Klin Monbl Augenheilkd 2015; 232: 514-518
• 18 Flammer J, Konieczka K, Flammer AJ. The primary vascular dysregulation syndrome: implications for eye diseases. EPMA J 2013; 4: 14
• 19 Flammer J, Mozaffarieh M. Autoregulation, a balancing act between supply and demand. Can J Ophthalmol 2008; 43: 317-321
• 20 Flammer J, Konieczka K, Bruno RM et al. The eye and the heart. Eur Heart J 2013; 34: 1270-1278
• 21 Konieczka K, Flammer AJ, Todorova M et al. Retinitis pigmentosa and ocular blood flow. EPMA J 2012; 3: 17
• 22 Liang XB, Liu XY, Li FQ et al. Long-term high-frequency electro-acupuncture stimulation prevents neuronal degeneration and up-regulates BDNF mRNA in the substantia nigra and ventral tegmental area following medial forebrain bundle axotomy. Brain Res Mol Brain Res 2002; 108: 51-59
• 23 Takamoto K, Hori E, Urakawa S et al. Cerebral hemodynamic responses induced by specific acupuncture sensations during needling at trigger points: a near-infrared spectroscopic study. Brain Topogr 2010; 23: 279-291
• 24 Chung KF, Yeung WF, Yu YM et al. Acupuncture for residual insomnia associated with major depressive disorder: a placebo- and sham-controlled, subject- and assessor-blind, randomized trial. J Clin Psychiatry 2015; 76: e752-760
• 25 Yao HJ, Song HT, Mo YP et al. Effects of electroacupuncture on circadian rhythm of temperature and melatonin in depression rats model induced by chronic stress. Zhongguo Zhen Jiu 2014; 34: 685-689
• 26 Kiser AK, Dagnelie G. Reported effects of non-traditional treatments and complementary and alternative medicine by retinitis pigmentosa patients. Clin Exp Optom 2008; 91: 166-176
• 27 Bittner AK, Gould JM, Rosenfarb A et al. A pilot study of an acupuncture protocol to improve visual function in retinitis pigmentosa patients. Clin Exp Optom 2014; 97: 240-247
• 28 Bock M, Andrassi M, Belitsky L, Lorenz B. A comparison of two multifocal ERG systems. Doc Ophthalmol 1998; – 1999; 97: 157-178
• 29 Seiple W, Clemens CJ, Greenstein VC, Carr RE, Holopigian K. Test-retest reliability of the multifocal electroretinogram and humphrey visual fields in patients with retinitis pigmentosa. Doc Ophthalmol 2004; 109: 255-272
• 30 Todorova MG, Palmowski-Wolfe AM, Schoetzau A et al. A Comparison between the Pulsed Rising Amplitude Perimetry and the Normal Staircase Strategy in Standard Automated Perimetry. J Clin Exp Ophthalmol 2013; 4: 3
• 31 Manni L, Albanesi M, Guaragna M et al. Neurotrophins and acupuncture. Auton Neurosci 2010; 157: 9-17
• 32 Chao MV, Rajagopal R, Lee FS. Neurotrophin signalling in health and disease. Clin Sci (Lond ) 2006; 110: 167-173
• 33 Connor B, Dragunow M. The role of neuronal growth factors in neurodegenerative disorders of the human brain. Brain Res Brain Res Rev 1998; 27: 1-39
• 34 Kim WS, Kim IS, Kim SJ et al. Effect of electroacupuncture on motor recovery in a rat stroke model during the early recovery stage. Brain Res 2009; 1248: 176-183
• 35 Allen SJ, Dawbarn D. Clinical relevance of the neurotrophins and their receptors. Clin Sci (Lond ) 2006; 110: 175-191
• 36 Apfel SC, Kessler JA. Neurotrophic factors in the therapy of peripheral neuropathy. Baillieres Clin Neurol 1995; 4: 593-606
• 37 Amendola T, Fiore M, Aloe L. Postnatal changes in nerve growth factor and brain derived neurotrophic factor levels in the retina, visual cortex, and geniculate nucleus in rats with retinitis pigmentosa. Neurosci Lett 2003; 345: 37-40
• 38 Pagani L, Manni L, Aloe L. Effects of electroacupuncture on retinal nerve growth factor and brain-derived neurotrophic factor expression in a rat model of retinitis pigmentosa. Brain Res 2006; 1092: 198-206
• 39 Wen R, Tao W, Luo L et al. Regeneration of cone outer segments induced by CNTF. Adv Exp Med Biol 2012; 723: 93-99
• 40 Konieczka K, Fränkl S, Todorova MG et al. Unstable oxygen supply and glaucoma. Klin Monbl Augenheilkd: 2014; 231: 121-126
• 41 Komeima K, Rogers BS, Campochiaro PA. Antioxidants slow photoreceptor cell death in mouse models of retinitis pigmentosa. J Cell Physiol 2007; 213: 809-815
• 42 Todorova MG, Türksever C, Schorderet DF et al. Retinal vessel oxygen saturation in patients suffering from inherited diseases of the retina. Klin Monbl Augenheilkd 2014; 231: 447-452
• 43 Todorova MG, Türksever C, Schötzau A et al. Metabolic and functional changes in retinitis pigmentosa: comparing retinal vessel oximetry to full-field electroretinography, electrooculogram and multifocal electroretinography. Acta Ophthalmol 2015;
• 44 Türksever C, Valmaggia C, Orgül S et al. Retinal vessel oxygen saturation and its correlation with structural changes in retinitis pigmentosa. Acta Ophthalmol 2014; 92: 454-460
• 45 Ma Y, Kawasaki R, Dobson LP et al. Quantitative analysis of retinal vessel attenuation in eyes with retinitis pigmentosa. Invest Ophthalmol Vis Sci 2012; 53: 4306-4314