OPT Visionary - Summer 2014

PAGE 29 following treatment. Her husband reached out to Dr. Bittner, urging that it had to be studied as part of research to determine the potential effects and help inform other interested RP patients. In the past 15-plus years, over 400 RP pa- tients had received acupuncture from Dr. Rosenfarb, but possible effects on vision had not yet been systematically documented by an eye care provider. Dr. Rosenfarb was very re- ceptive to sharing his electroacupuncture pro- tocol and trained another acupuncturist, Jeff Gould, who administered it to 19 RP subjects enrolled in a pilot study and extensively tested by Dr. Bittner while she was at the Johns Hop- kins Wilmer Eye Institute. The acupuncture protocol consists of a stan- dard set of needled points applied to all patients, located on the head, abdomen, hands, feet, arms, and legs, as well as electro stimulation in- volving a weak current applied to the needles located around the eyes (above the brow and below the eyes—not in the eyes), at 10 half- hour sessions over a two-week period. The preliminary research revealed that the acupuncture protocol was well tolerated, without adverse events or loss of vision. All subjects in- dicated they would be willing to repeat the treat- ment series in the future if it helped their vision. The study measured significant improvements in dark-adapted sensitivity in some of the par- ticipants, correlating with subjectively better vi- sion at night and in dim environments. These findings were published last fall in the peer-reviewed journal Clinical and Experimental Optometry and served as preliminary data to help successfully obtain additional funding from the National Eye Institute to continue to study electroacupuncture for RP, as well as transcorneal electrical stimulation, in an upcom- ing three-arm, small-scale, randomized con- trolled trial currently being planned at NSUCO. INNOVATIVE ELEMENTS OF THIS RESEARCH Do we dare take the road less traveled? Ab- solutely! And here’s how we plan to do it care- fully and systematically. In order to explore physiological parameters that may contribute to retinal or visual changes in RP participants who will receive the study’s therapeutic inter- ventions, we will measure blood-flow velocity and resistance in RP patients’ retinal vessels. We will use two methods to study retinal vas- cular physiology. The first involves novel instrumentation using a fundus camera to obtain vascular flow meas- urements in real time that was developed by a biomedical engineer, Dr. Jessica Ramella- Roman, at Florida International University in Miami, while the other approach involves math- ematical analysis of the retinal vascular network characteristics from fundus photo images, which was developed by Dr. David Meadows, CEO of Sentinel Diagnostic Imaging. In addition, re- peated measures of retrobulbar ocular blood flow will be obtained in RP patients using state- of-the-art instrumentation available through the NSU Medical Sonography Program (color Doppler imaging ultrasound) to determine any changes following the interventions and whether they correspond to changes in visual function or retinal blood flow. We will apply a low-risk intervention—elec- troacupuncture—specifically developed for RP based on clinical experience. Successful treat- ment of other chronic diseases, such as lower back pain, with electroacupuncture has been at- tributed to increasing blood flow to surrounding nerves (sciatic), but improving blood flow as a potential mechanism has not been previously evaluated in RP. We will also use another noninvasive inter- vention—transcorneal electrical stimulation— which is supported by previous basic and clini- cal research as a means to potentially modify ocular and retinal blood flow and/or visual func- tion in RP. This proposal seeks to eventually shift clinical practice paradigms by examining the potential for alternative therapies to improve visual function in a disease whose management options are extremely limited. IT TAKES A VILLAGE TO ADDRESS COMPLEX RESEARCH QUESTIONS Dr. Bittner had to bring together several people with different expertise to complete the proposed study. Below is a diagram depicting the various players involved in this research endeavor, which includes study team mem- bers from NSUCO, as well as faculty mem- bers from another program at NSU and other academic institutions. Electroacupuncture and transcorneal electri- cal stimulation are relatively inexpensive alter- native therapies that involve minimal risk if administered by highly qualified and trained practitioners. The Foundation Fighting Blind- ness featured two blog articles on the front page of its Web site www.blindness.org last Novem- ber describing Dr. Bittner’s acupuncture study findings and future research directions. Thus, it is evident this work is already receiving promi- nent attention and is quickly becoming a hot topic of discussion for its potential to help pa- tients who have always previously been told that nothing can be done. The NSUCO research team has obtained IRB approval for the randomized controlled trial and aims to determine whether these alternative therapies may have the potential to improve vi- sual function, thus improving RP patients’ qual- ity of life while other promising treatments such as stem cells, gene therapies, and pharmaco- logic agents are developed.