Perspectives Spring 2015

PERSPECTIVES • SPRING 2015 18 MEDICAL SONOGRAPHY Fort Lauderdale INTERPROFESSIONAL COLLABORATIVE RESEARCH PROJECT Optometry and Sonography The National Institutes of Health is currently funding a three-arm, double- blind, randomized controlled clinical trial at NSU to assess the efficacy of elec- tro-acupuncture and/or transcorneal electrical stimulation (TES) as potential treatments aimed at improving vision loss in patients with retinitis pigmentosa (RP). RP is an inherited or genetic retinal disorder that affects roughly 1 in 4,000 people and can start at any age. RP is characterized by slowly progressive dam- age to the photoreceptors, which results in loss of vision at night and in the pe- ripheral visual field, and has secondary effects of reduced blood flow in the retrobulbar blood vessels, specifically the posterior ciliary arteries, central retinal artery, and the ophthalmic artery. Currently, there is no curative or proven treatment for RP, and manage- ment options are limited to nutritional supplements attempting to slow disease progression. After being diagnosed with a disabling, chronic disease such as RP, there is nothing more disheartening to the patient than to hear that nothing can be done to treat it. RP patients are motivated to try alternative therapies to attempt to slow, halt, or reverse the dis- ease process. Dr. Ava Bittner from NSU’s College of Optometry is the principal investiga- tor of this research project and has spent much of her career performing research to help patients with conditions resulting in low vision or blindness. She was inter- ested in investigating physiological changes in blood flow that may be cor- related with improvements in vision that may occur in response to the interven- tions she is studying. To address this topic, Dr. Bittner invited Medical Sonography Program faculty members to take part in this investigational study by performing pre- and post-treatment color Doppler imaging studies of the ar- teries located in the retrobulbar area of the eye. Jorge Han, M.D., RDMS, RDCS, RVT, program director of the Medical Sonography Program at NSU’s main campus, and medical sonography faculty members Patricia Vargas and Deborah Mendelsohn, are taking part in this re- search project. The medical sonography faculty members are involved in measur- ing the blood-flow velocities of the afore- mentioned retrobulbar arteries. All three faculty members are registered vascular sonographers and have taken pride in advancing their careers by increasing their involvement in interprofessional re- lationships. The measurement of retrob- ulbar blood flow to the eyes is not routinely performed in clinical practice, so this is a novel application of ultra- sound instrumentation. The research team will examine the reliability and va- lidity of these measurements in patients with this retinal disease. The study procedures also involve ex- tensive vision testing performed by Dr. Bittner, which is repeated at two baseline visits prior to the intervention. After completion of the therapy over a two- or six-week period for acupuncture or TES, respectively, the participants return for follow-up testing to determine if there have been any significant changes in vi- sion or blood flow. After completion of the follow-up testing, participants in the placebo sham control group have the op- tion to crossover and may elect to receive one of the two active treatments. The clinical trial will enroll 24 people with RP and is expected to be completed by the end of August 2015. There are many significant and inno- vative aspects of this research. Measures of retrobulbar ocular blood flow will be obtained longitudinally in RP patients using state-of-the-art instrumentation (color Doppler imaging ultrasound) to determine how changes over time corre- spond to blood-flow changes in the mac- ular capillaries within the eye, or visual function, and may also aid in our under- standing of RP pathophysiology. Detec- tion of changes in functional and physiological abnormalities (i.e., vision and blood flow to/within the eye) may aid in the monitoring of RP disease pro- gression before anatomic abnormalities in the retinal photoreceptors (rods and cones) are measurable. We anticipate that our findings may translate to the val- idation of new, noninvasive, and objec- tive methods to monitor RP. This work would not be possible without the suc- cessful collaboration of two allied health professions teaming up to pursue a com- mon goal. This research seeks to determine if there is sufficient evidence to eventually shift clinical practice paradigms by ex- amining the potential for alternative therapies to improve visual function and blood flow in a disease whose manage- ment options are extremely limited. The research team is studying relatively inex- pensive alternative therapies that involve minimal risk and may have the potential to improve visual function, thus improv- ing RP patients’ quality of life while other promising treatments such as stem cells, gene therapies, and pharmacologic agents are developed for this currently untreatable and blinding eye disease. By Ava Bittner, Associate Professor, O.D., Ph.D., College of Optometry, Deborah Mendelsohn, M.S., RDMS, RDCS, RVT, Assistant Professor/Clinical Coordinator, Medical Sonography, and Patricia Vargas, M.H.Sc., RVT, Assistant Professor/Clinical Coordinator, Medical Sonography