Transcorneal electrical stimulation for patients with retinitis pigmentosa: a prospective, randomized, sham-controlled exploratory study.

PURPOSE To assess the safety of transcorneal electrical stimulation (TES) and explore its efficacy in various subjective and objective parameters of visual function in patients with retinitis pigmentosa (RP). METHODS Twenty-four patients in this prospective, randomized, partially blinded, good-clinical-practice study underwent TES (5-ms biphasic pulses; 20 Hz; DTL electrodes) 30 minutes per week for 6 consecutive weeks. The patients were randomly assigned to one of three groups: sham, 66%, or 150% of individual electrical phosphene threshold (EPT). Visual acuity (VA), visual field (VF; kinetic, static), electroretinography (Ganzfeld, multifocal), dark-adaptation (DA), color discrimination, and EPTs were assessed at all visits or four times, according to the study plan. RESULTS TES using DTL electrodes was tolerated well; all patients finished the study. Two adverse (foreign body sensation), but no serious adverse events were encountered. There was a tendency for most functional parameters to improve (8/18) or to remain constant (8/18) in the 150% group. VF area and scotopic b-wave amplitude reached statistical significance (P < 0.027 and P < 0.001, respectively). Only desaturated color discrimination and VF mean sensitivity decreased. There was no obvious trend in the 66% group. CONCLUSIONS TES was found to be safe in RP patients. Positive trends were discovered, but due to the small sample size of this exploratory study, statistical significance was reached only for VF area and scotopic b-wave amplitude. Further studies with larger sample sizes and longer duration are needed to confirm the findings and to define optimal stimulation parameters. (ClinicalTrials.gov number, NCT00804102.).

[1]  M. Bach,et al.  ISCEV Standard for full-field clinical electroretinography (2008 update) , 2009, Documenta Ophthalmologica.

[2]  Y. Hata,et al.  Neuroprotective effect of transcorneal electrical stimulation on the acute phase of optic nerve injury. , 2007, Investigative ophthalmology & visual science.

[3]  Alfred Stett,et al.  Subretinal electronic chips allow blind patients to read letters and combine them to words , 2010, Proceedings of the Royal Society B: Biological Sciences.

[4]  Dyonne T Hartong,et al.  Retinitis pigmentosa , 2009 .

[5]  G. Y. McLean,et al.  Retinal expression of Fgf2 in RCS rats with subretinal microphotodiode array. , 2009, Investigative ophthalmology & visual science.

[6]  Alfred Stett,et al.  Neuroprotective effect of transretinal electrical stimulation on neurons in the inner nuclear layer of the degenerated retina , 2009, Brain Research Bulletin.

[7]  B. W. Nicholson,et al.  A randomized trial of vitamin A and vitamin E supplementation for retinitis pigmentosa. , 1993, Archives of ophthalmology.

[8]  Prof. Dr. H. Dor Beiträge zur Electrotherapie der Augenkrankheiten , 1873, Albrecht von Graefes Archiv für Ophthalmologie.

[9]  R. Massof,et al.  How strong is the evidence that nutritional supplements slow the progression of retinitis pigmentosa? , 2010, Archives of ophthalmology.

[10]  Nick Tyler,et al.  Effect of gene therapy on visual function in Leber's congenital amaurosis. , 2008, The New England journal of medicine.

[11]  Y. Fukuda,et al.  Transcorneal electrical stimulation rescues axotomized retinal ganglion cells by activating endogenous retinal IGF-1 system. , 2005, Investigative ophthalmology & visual science.

[12]  R. Schuchard,et al.  The Artificial Silicon Retina Microchip for the Treatment of Retinitis Pigmentosa: 2 to 4 1/2 Year Update , 2005 .

[13]  D. Farnsworth Investigation on corrective training of color blindness. , 1947, The Sight-saving review.

[14]  Chris A Johnson,et al.  Comparison of the new perimetric GATE strategy with conventional full-threshold and SITA standard strategies. , 2009, Investigative ophthalmology & visual science.

[15]  K. Bowman,et al.  A METHOD FOR QUANTITATIVE SCORING OF THE FARNSWORTH PANEL D‐15 , 1982, Acta ophthalmologica.

[16]  R. Iezzi,et al.  Chronic intravitreous infusion of ciliary neurotrophic factor modulates electrical retinal stimulation thresholds in the RCS rat. , 2008, Investigative ophthalmology & visual science.

[17]  Kei Shinoda,et al.  Transcorneal electrical stimulation of retina to treat longstanding retinal artery occlusion , 2007, Graefe's Archive for Clinical and Experimental Ophthalmology.

[18]  R. R. Hocking Methods and Applications of Linear Models: Regression and the Analysis of Variance , 2003 .

[19]  D. Hunt,et al.  Restoration of photoreceptor ultrastructure and function in retinal degeneration slow mice by gene therapy , 2000, Nature Genetics.

[20]  A. Y. Chow,et al.  Possible sources of neuroprotection following subretinal silicon chip implantation in RCS rats , 2005, Journal of neural engineering.

[21]  Eberhart Zrenner,et al.  Phosphenes electrically evoked with DTL electrodes: a study in patients with retinitis pigmentosa, glaucoma, and homonymous visual field loss and normal subjects. , 2006, Investigative ophthalmology & visual science.

[22]  P. Lanthony,et al.  The desaturated panel D-15 , 1978, Documenta Ophthalmologica.

[23]  P E King-Smith,et al.  A quantitative scoring technique for panel tests of color vision. , 1988, Investigative ophthalmology & visual science.

[24]  Takashi Fujikado,et al.  Effect of Transcorneal Electrical Stimulation in Patients with Nonarteritic Ischemic Optic Neuropathy or Traumatic Optic Neuropathy , 2006, Japanese Journal of Ophthalmology.

[25]  G. Trick,et al.  Improved electrode for electroretinography. , 1979, Investigative ophthalmology & visual science.

[26]  Donald C. Hood,et al.  ISCEV guidelines for clinical multifocal electroretinography (2007 edition) , 2007, Documenta Ophthalmologica.

[27]  Hai-dong Xu,et al.  Neuroprotective effect of transcorneal electrical stimulation on light-induced photoreceptor degeneration , 2009, Experimental Neurology.

[28]  Takashi Fujikado,et al.  Transcorneal electrical stimulation promotes the survival of photoreceptors and preserves retinal function in royal college of surgeons rats. , 2007, Investigative ophthalmology & visual science.

[29]  Eberhart Zrenner,et al.  Gene expression profiling of the retina after transcorneal electrical stimulation in wild-type Brown Norway rats. , 2011, Investigative ophthalmology & visual science.

[30]  M. S. Humayun,et al.  Preliminary Results from Argus II Feasibility Study: A 60 Electrode Epiretinal Prosthesis , 2009 .

[31]  Weng Tao,et al.  Ciliary neurotrophic factor (CNTF) for human retinal degeneration: phase I trial of CNTF delivered by encapsulated cell intraocular implants. , 2006, Proceedings of the National Academy of Sciences of the United States of America.

[32]  O. Mimura,et al.  Axonal regeneration induced by repetitive electrical stimulation of crushed optic nerve in adult rats , 2009, Japanese Journal of Ophthalmology.

[33]  T. Fujikado,et al.  Optimal parameters of transcorneal electrical stimulation (TES) to be neuroprotective of axotomized RGCs in adult rats. , 2010, Experimental eye research.

[34]  A. Y. Chow,et al.  Neuroprotection of photoreceptors in the RCS rat after implantation of a subretinal implant in the superior or inferior retina. , 2006, Advances in experimental medicine and biology.