A pilot study of an acupuncture protocol to improve visual function in retinitis pigmentosa patients

Abstract

Background: Patients with retinitis pigmentosa are motivated to try complementary or integrative therapies to slow disease progression. Basic science, clinical research and retinitis pigmentosa patients' self-reports support the hypothesis that acupuncture may improve visual function.

Methods: A prospective, case series, pilot study enrolled 12 adult patients with RP treated at an academic medical centre with a standardised protocol that combined electroacupuncture to the forehead and below the eyes and acupuncture to the body, at 10 half-hour sessions over two weeks. Pre- and post-treatment tests included Early Treatment Diabetic Retinopathy Study visual acuity (VA), Pelli-Robson contrast sensitivity (CS), Goldmann visual fields, and dark-adapted full-field stimulus threshold (FST)(n = 9). Scotopic Sensitivity Tester-1 (SST-1) dark-adaptometry was performed on the last two subjects.

Results: Six of 12 subjects had measurable, significant visual function improvements after treatment. Three of nine subjects tested with the FST had a significant 10.3 to 17.5 dB (that is, 13- to 53-fold) improvement in both eyes at one week after acupuncture, maintained for at least 10 to 12 months, which was well outside typical test-retest variability (95% CI: 3-3.5 dB) previously found in retinitis pigmentosa. SST-1 dark-adaptation was shortened in both subjects tested on average by 48.5 per cent at one week (range 36 to 62 per cent across 10 to 30 dB), which was outside typical coefficients of variation of less than 30 per cent previously determined in patients with retinitis pigmentosa and normals. Four of the five subjects with psychophysically measured scotopic sensitivity improvements reported subjective improvements in vision at night or in dark environments. One subject had 0.2 logMAR improvement in VA; another had 0.55 logCS improvement. Another subject developed more than 20 per cent improvement in the area of the Goldmann visual fields. The acupuncture protocol was completed and well tolerated by all, without adverse events or visual loss.

Conclusions: Acupuncture entails minimal risk, if administered by a well-trained acupuncturist and may have significant, measurable benefits on residual visual function in patients with retinitis pigmentosa, in particular scotopic sensitivity, which had not previously been studied. These preliminary findings support the need for future controlled studies of potential mechanisms.

Keywords: acupuncture; low vision; retinitis pigmentosa.

© 2013 The Authors. Clinical and Experimental Optometry © 2013 Optometrists Association Australia.

Figures

Figure 1

Line graph indicating full-field stimulus threshold (FST) dark-adapted sensitivity for each subject across visits, with the mean and 95% confidence intervals (CI) for three measures at each time. Subject ID numbers are indicated to the right of their corresponding results. The previously reported normal range is indicated in the grey shaded area

Figure 2

Scotopic Sensitivity Tester (SST)-1 dark-adaptation curve data for subjects 11 and 12, drawn with black and red lines, respectively. Each curve represents the detection time at the pre-treatment or one or six weeks after treatment, at the stimulus intensities plotted along the ordinate. Data from normally sighted controls are drawn with thin black lines; each curve represents one individual's mean detection time across four visits

Figure 3

Spectral domain optical coherence tomography (SD-OCT) images from subjects 3 (left panels) and 8 (right panels) with a cross-section obtained through the fovea, demonstrating intraretinal cystoid macular oedema at the pre-treatment visit (top panels) that diminished after treatment (lower panels)