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.
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.
Modern clinical research in China and Dr Rosenfarb’s experience suggests that adding electroacupuncture to an acupuncture protocol improves the probability of positive results in retinitis pigmentosa.9 The protocol consists of 10 sessions in a two-week period (five 30-minute sessions per week). We used an electroacupuncture device, namely the transcutaneous electrical nerve stimulator unit (TENS, Lhasa OMS Inc, Weymouth, MA, USA) to deliver 15 Hz continuous wave stimulation and attached the leads to four of the acupuncture points located on the forehead and below the eye. The established protocol indicates the specific pre-selected points for all participants, needling depths and manipulation techniques. The standard points for all subjects are located around the eyes (that is, forehead/temples), on the head, ears, abdomen, hands, arms, lower legs and toes. The acupuncture points are: GV-20, GV-24, yin tang, tai yang, BL-2 to yu yao with electrostimulation, qiu hou to yi ming with electrostimulation, ST-2, GB-20, ear (Eye 1, Eye 2, Eye, Liver), CV-12, CV-6, ST-25, LI-12, LI-3, HT-8 and BL-67. Additionally, the following proximate point combinations were palpated and of each pair, the one that was more sensitive was selected for needling: LV-8/KD-10, SP-6/KD-7, LV-2/LV-3. An IR 3000 heat lamp was placed over the abdomen to warm acupuncture points in that area, which is thought to increase the response of the overall treatment. The heat lamp was used in nine of 12 subjects for five to 30 minutes per session, depending on varying individual sensitivities to the heat.
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.
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.
Author: Ava K Bittner, OD PhD,* Jeffrey M Gould, MEd LAc,† Andy Rosenfarb, ND LAc,§ Collin Rozanski,* and Gislin Dagnelie, PhD*