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Li J, Zhou W, Liang L, Li Y, Xu K, Li X, Huang Z, Jin Y. Noninvasive electrical stimulation as a neuroprotective strategy in retinal diseases: a systematic review of preclinical studies. J Transl Med 2024; 22:28. [PMID: 38184580 PMCID: PMC10770974 DOI: 10.1186/s12967-023-04766-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/27/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Electrical activity has a crucial impact on the development and survival of neurons. Numerous recent studies have shown that noninvasive electrical stimulation (NES) has neuroprotective action in various retinal disorders. OBJECTIVE To systematically review the literature on in vivo studies and provide a comprehensive summary of the neuroprotective action and the mechanisms of NES on retinal disorders. METHODS Based on the PRISMA guideline, a systematic review was conducted in PubMed, Web of Science, Embase, Scopus and Cochrane Library to collect all relevant in vivo studies on "the role of NES on retinal diseases" published up until September 2023. Possible biases were identified with the adopted SYRCLE's tool. RESULTS Of the 791 initially gathered studies, 21 articles met inclusion/exclusion criteria for full-text review. The results revealed the neuroprotective effect of NES (involved whole-eye, transcorneal, transscleral, transpalpebral, transorbital electrical stimulation) on different retinal diseases, including retinitis pigmentosa, retinal degeneration, high-intraocular pressure injury, traumatic optic neuropathy, nonarteritic ischemic optic neuropathy. NES could effectively delay degeneration and apoptosis of retinal neurons, preserve retinal structure and visual function with high security, and its mechanism of action might be related to promoting the secretion of neurotrophins and growth factors, decreasing inflammation, inhibiting apoptosis. The quality scores of included studies ranged from 5 to 8 points (a total of 10 points), according to SYRCLE's risk of bias tool. CONCLUSION This systematic review indicated that NES exerts neuroprotective effects on retinal disease models mainly through its neurotrophic, anti-inflammatory, and anti-apoptotic capabilities. To assess the efficacy of NES in a therapeutic setting, however, well-designed clinical trials are required in the future.
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Affiliation(s)
- Jiaxian Li
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China
| | - Wei Zhou
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China
| | - Lina Liang
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China.
| | - Yamin Li
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China
| | - Kai Xu
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China
| | - Xiaoyu Li
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China
| | - Ziyang Huang
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China
| | - Yu Jin
- Department of Eye Function Laboratory, Eye Hospital, China Academy of Chinese Medical Sciences, 33 Lugu Road, Shijingshan District, Beijing, 100040, People's Republic of China
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Liu F, Zhang M, Xiong G, Han X, Lee VWH, So KF, Chiu K, Xu Y. Trans-Sclera Electrical Stimulation Improves Retinal Function in a Mouse Model of Retinitis Pigmentosa. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111917. [PMID: 36431052 PMCID: PMC9693292 DOI: 10.3390/life12111917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
Retinitis pigmentosa (RP) is a photoreceptor-degenerating disease with no effective treatment. Trans-corneal electrical stimulation has neuroprotective effects in degenerating retinas, but repeated applications cause corneal injury. To avoid the risk of corneal damage, here we tested whether repetitive trans-sclera electrical stimulation (TsES) protects degenerating retinas in rd10 mice, a model of RP. At postnatal day 20 (P20), the right eyes of rd10 mice were exposed to 30 min of TsES daily or every other day till P25, at the amplitude of 50 or 100 μA, with zero current as the sham. Immunostaining, multi-electrode-array (MEA) recording, and a black-and-white transition box were applied to examine the morphological and functional changes of the treated retina. Functionally, TsES modified the retinal light responses. It also reduced the high spontaneous firing of retinal ganglion cells. TsES at 100 μA but not 50 μA increased the light sensitivities of ganglion cells as well as their signal-to-noise ratios. TsES at 100 μA increased the survival of photoreceptors without improving the visual behavior of rd10 mice. Our data suggest that repetitive TsES improves the retinal function of rd10 mice at the early degenerating stage, therefore, it might be an effective long-term strategy to delay retinal degeneration in RP patients.
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Affiliation(s)
- Feng Liu
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Key Laboratory of CNS Regeneration (Ministry of Education), Jinan University, 601 West Huangpu Ave., Guangzhou 510632, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Mengrong Zhang
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Key Laboratory of CNS Regeneration (Ministry of Education), Jinan University, 601 West Huangpu Ave., Guangzhou 510632, China
| | - Guoyin Xiong
- Department of Ophthalmology, The University of Hong Kong, Hong Kong SAR, China
| | - Xiu Han
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Key Laboratory of CNS Regeneration (Ministry of Education), Jinan University, 601 West Huangpu Ave., Guangzhou 510632, China
| | | | - Kwok-Fai So
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Key Laboratory of CNS Regeneration (Ministry of Education), Jinan University, 601 West Huangpu Ave., Guangzhou 510632, China
- Department of Ophthalmology, The University of Hong Kong, Hong Kong SAR, China
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong 226019, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China
| | - Kin Chiu
- Department of Ophthalmology, The University of Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China
- Correspondence: (K.C.); (Y.X.); Tel.: +852-28315356 (K.C.); +86-20-85227086 (Y.X.); Fax: +852-28170491 (K.C.); +86-20-85223563 (Y.X.)
| | - Ying Xu
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Key Laboratory of CNS Regeneration (Ministry of Education), Jinan University, 601 West Huangpu Ave., Guangzhou 510632, China
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong 226019, China
- Correspondence: (K.C.); (Y.X.); Tel.: +852-28315356 (K.C.); +86-20-85227086 (Y.X.); Fax: +852-28170491 (K.C.); +86-20-85223563 (Y.X.)
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3
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Lu Z, Zhou M, Guo T, Liang J, Wu W, Gao Q, Li L, Li H, Chai X. An in-silico analysis of retinal electric field distribution induced by different electrode design of trans-corneal electrical stimulation. J Neural Eng 2022; 19. [PMID: 36044887 DOI: 10.1088/1741-2552/ac8e32] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/31/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Trans-corneal electrical stimulation (TcES) produces therapeutic effects on many ophthalmic diseases non-invasively. Existing clinical TcES devices use largely variable design of electrode distribution and stimulation parameters. Better understanding of how electrode configuration paradigms and stimulation parameters influence the electric field distribution on the retina, will be beneficial to the design of next-generation TcES devices. APPROACH In this study, we constructed a realistic finite element human head model with fine eyeball structure. Commonly used DTL-Plus and ERG-Jet electrodes were simulated. We then conducted in silico investigations of retina observation surface (ROS) electric field distributions induced by different return electrode configuration paradigms and different stimulus intensities. MAIN RESULTS Our results suggested that the ROS electric field distribution could be modulated by re-designing TcES electrode settings and stimulus parameters. Under far return location (FRL) paradigms, either DTL-Plus or ERG-Jet approach could induce almost identical ROS electric field distribution regardless where the far return was located. However, compared with the ERG-Jet mode, DTL-Plus stimulation induced stronger nasal lateralization. In contrast, ERG-Jet stimulation induced relatively stronger temporal lateralization. The ROS lateralization can be further tweaked by changing the DTL-Plus electrode length. SIGNIFICANCE These results may contribute to the understanding of the characteristics of DTL-Plus and ERG-Jet electrodes based electric field distribution on the retina, providing practical implications for the therapeutic application of TcES.
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Affiliation(s)
- Zhuofan Lu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Address: 800 Dongchuan Road, Minhang District, Shanghai, Shanghai, 200240, CHINA
| | - Meixuan Zhou
- Shanghai Jiao Tong University, Shanghai 200240, Shanghai, 200240, CHINA
| | - Tianruo Guo
- GSBME, University of New South Wales, Graduate School of Biomedical Engineering, University of New South Wales, NSW 2052, Sydney, Australia, Sydney, New South Wales, 2052, AUSTRALIA
| | - Junling Liang
- Shanghai Jiao Tong University, Address: 800 Dongchuan Road, Minhang District, Shanghai Shanghai, CN 200240, Shanghai, 200240, CHINA
| | - Weilei Wu
- Shanghai Jiao Tong University, School of Biomedical Engineering Shanghai Jiao Tong University , Shanghai Jiao Tong University, 800 Dongchuan Road, Minhang District, Shanghai Shanghai, CN 200240, Shanghai, 200240, CHINA
| | - Qi Gao
- Shanghai Jiao Tong University, Address: 800 Dongchuan Road, Minhang District, Shanghai, Shanghai, 200240, CHINA
| | - Liming Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, Shanghai, 200240, CHINA
| | - Heng Li
- Shanghai Jiao Tong University, Address: 800 Dongchuan Road, Minhang District, Shanghai Shanghai, CN 200240, Shanghai, 200240, CHINA
| | - Xinyu Chai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, Shanghai, 200240, CHINA
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Battaglini L, Di Ponzio M, Ghiani A, Mena F, Santacesaria P, Casco C. Vision recovery with perceptual learning and non-invasive brain stimulation: Experimental set-ups and recent results, a review of the literature. Restor Neurol Neurosci 2022; 40:137-168. [PMID: 35964213 DOI: 10.3233/rnn-221261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vision is the sense which we rely on the most to interact with the environment and its integrity is fundamental for the quality of our life. However, around the globe, more than 1 billion people are affected by debilitating vision deficits. Therefore, finding a way to treat (or mitigate) them successfully is necessary. OBJECTIVE This narrative review aims to examine options for innovative treatment of visual disorders (retinitis pigmentosa, macular degeneration, optic neuropathy, refractory disorders, hemianopia, amblyopia), especially with Perceptual Learning (PL) and Electrical Stimulation (ES). METHODS ES and PL can enhance visual abilities in clinical populations, inducing plastic changes. We describe the experimental set-ups and discuss the results of studies using ES or PL or their combination in order to suggest, based on literature, which treatment is the best option for each clinical condition. RESULTS Positive results were obtained using ES and PL to enhance visual functions. For example, repetitive transorbital Alternating Current Stimulation (rtACS) appeared as the most effective treatment for pre-chiasmatic disorders such as optic neuropathy. A combination of transcranial Direct Current Stimulation (tDCS) and visual training seems helpful for people with hemianopia, while transcranial Random Noise Stimulation (tRNS) makes visual training more efficient in people with amblyopia and mild myopia. CONCLUSIONS This narrative review highlights the effect of different ES montages and PL in the treatment of visual disorders. Furthermore, new options for treatment are suggested. It is noteworthy to mention that, in some cases, unclear results emerged and others need to be more deeply investigated.
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Affiliation(s)
- Luca Battaglini
- Department of General Psychology, University of Padova, Italy.,Centro di Ateneo dei Servizi Clinici Universitari Psicologici (SCUP), University of Padova, Padova, Italy.,Neuro.Vis.U.S, University of Padova, Padova, Italy
| | - Michele Di Ponzio
- Department of General Psychology, University of Padova, Italy.,Istituto di Neuroscienze, Florence, Italy
| | - Andrea Ghiani
- Department of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Federica Mena
- Department of General Psychology, University of Padova, Italy
| | | | - Clara Casco
- Department of General Psychology, University of Padova, Italy.,Centro di Ateneo dei Servizi Clinici Universitari Psicologici (SCUP), University of Padova, Padova, Italy.,Neuro.Vis.U.S, University of Padova, Padova, Italy
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5
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Liu J, Ma AK, So KF, Lee VW, Chiu K. Mechanisms of electrical stimulation in eye diseases: A narrative review. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2022; 2:100060. [PMID: 37846384 PMCID: PMC10577855 DOI: 10.1016/j.aopr.2022.100060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/14/2022] [Accepted: 05/01/2022] [Indexed: 10/18/2023]
Abstract
Background In the last two decades, electrical stimulation (ES) has been tested in patients with various eye diseases and shows great treatment potential in retinitis pigmentosa and optic neuropathy. However, the clinical application of ES in ophthalmology is currently limited. On the one hand, optimization and standardization of ES protocols is still an unmet need. On the other hand, poor understanding of the underlying mechanisms has hindered clinical exploitation. Main Text Numerous experimental studies have been conducted to identify the treatment potential of ES in eye diseases and to explore the related cellular and molecular mechanisms. In this review, we summarized the in vitro and in vivo evidence related to cellular and tissue response to ES in eye diseases. We highlighted several pathways that may be utilized by ES to impose its effects on the diseased retina. Conclusions Therapeutic effect of ES in retinal degenerative diseases might through preventing neuronal apoptosis, promoting neuronal regeneration, increasing neurotrophic factors production in Müller cells, inhibiting microglial activation, enhancing retinal blood flow, and modulating brain plasticity. Future studies are suggested to analyse changes in specific retinal cells for optimizing the treatment parameters and choosing the best fit ES delivery method in target diseases.
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Affiliation(s)
- Jinfeng Liu
- Department of Ophthalmology, The University of Hong Kong, SAR, Hong Kong, China
| | | | - Kwok Fai So
- Department of Ophthalmology, The University of Hong Kong, SAR, Hong Kong, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, SAR, Hong Kong, China
- Department of Psychology, The University of Hong Kong, SAR, Hong Kong, China
- Guangdong-Hong Kong-Macau Institute of Central Nervous System Regeneration, Jinan University, Guangzhou, China
| | - Vincent W.H. Lee
- Department of Ophthalmology, The University of Hong Kong, SAR, Hong Kong, China
| | - Kin Chiu
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, SAR, Hong Kong, China
- Department of Psychology, The University of Hong Kong, SAR, Hong Kong, China
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6
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Sanie-Jahromi F, Azizi A, Shariat S, Johari M. Effect of Electrical Stimulation on Ocular Cells: A Means for Improving Ocular Tissue Engineering and Treatments of Eye Diseases. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6548554. [PMID: 34840978 PMCID: PMC8612806 DOI: 10.1155/2021/6548554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/25/2021] [Accepted: 11/08/2021] [Indexed: 01/09/2023]
Abstract
Tissue engineering is biomedical engineering that uses suitable biochemical and physicochemical factors to assemble functional constructs that restore or improve damaged tissues. Recently, cell therapies as a subset of tissue engineering have been very promising in the treatment of ocular diseases. One of the most important biophysical factors to make this happen is noninvasive electrical stimulation (ES) to target ocular cells that may preserve vision in multiple retinal and optic nerve diseases. The science of cellular and biophysical interactions is very exciting in regenerative medicine now. Although the exact effect of ES on cells is unknown, multiple mechanisms are considered to underlie the effects of ES, including increased production of neurotrophic agents, improved cell migration, and inhibition of proinflammatory cytokines and cellular apoptosis. In this review, we highlighted the effects of ES on ocular cells, especially on the corneal, retinal, and optic nerve cells. Initially, we summarized the current literature on the in vitro and in vivo effects of ES on ocular cells and then we provided the clinical studies describing the effect of ES on ocular complications. For each area, we used some of the most impactful articles to show the important concepts and results that advanced the state of these interactions. We conclude with reflections on emerging new areas and perspectives for future development in this field.
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Affiliation(s)
- Fatemeh Sanie-Jahromi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Azizi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Shariat
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadkarim Johari
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Liu J, Tong K, Lin Y, Lee VWH, So KF, Shih KC, Lai JSM, Chiu K. Effectiveness of Microcurrent Stimulation in Preserving Retinal Function of Blind Leading Retinal Degeneration and Optic Neuropathy: A Systematic Review. Neuromodulation 2021; 24:992-1002. [PMID: 33984873 DOI: 10.1111/ner.13414] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/29/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To systematically identify and summarize the effectiveness and the parameters of electrical stimulation (ES) for the preservation of visual function in major retinal degeneration and optic neuropathy. MATERIALS AND METHODS A systematic review of clinical studies, using ES therapy in patients with blind leading retinal degenerations, including retinitis pigmentosa (RP), age-related macular degeneration (AMD), glaucoma, retinal vein occlusion (RVO), retinal artery occlusion (RAO), and optic neuropathy was conducted. PubMed, EMBASE, Cochrane Library, and Web of Science were searched for relevant interventional studies including randomized controlled trials (RCTs) and observational studies. RESULTS A total of 10 RCTs and 15 observational studies were included. Transcorneal ES (TcES), transpalpebral ES (TpES), transdermal ES (TdES), and repetitive transorbital alternating current stimulation (rtACS) were used for the treatment of the patients. ES using 20 Hz biphasic pulses with current strength at 150%-200% of individual electrical phosphene threshold (EPT) for RP patients showed improved retinal function detected by visual acuity (VA), visual field (VF), or electrical retinal graphs (ERG). rtACS on patients with optic neuropathy showed significant preservation of VA and VF. Clinical studies on AMD, RAO, and glaucoma indicated promising protective effects of ES on the visual function, though the amount of evidence is limited. CONCLUSIONS ES treatment has promising therapeutic effects on RP and optic neuropathy. More large-scale RCT studies should be conducted to elucidate the potential of ES, especially on AMD, RAO, and glaucoma. A comparison of the effects by different ES methods in the same disease populations is still lacking. Parameters of the electric current and sensitive detection method should be optimized for the evaluation of ES treatment effects in future studies.
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Affiliation(s)
- Jinfeng Liu
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kelvin Tong
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Youhong Lin
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Vincent W H Lee
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kwok Fai So
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China.,Guangdong HongKong Macau Institute of CNS Regeneration: Guangdong, Guangzhou, China
| | - Kendrick Co Shih
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jimmy S M Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kin Chiu
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
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8
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Miura G, Sugawara T, Kawasaki Y, Tatsumi T, Nizawa T, Baba T, Hanaoka H, Yamamoto S. Clinical Trial to Evaluate Safety and Efficacy of Transdermal Electrical Stimulation on Visual Functions of Patients with Retinitis Pigmentosa. Sci Rep 2019; 9:11668. [PMID: 31406205 PMCID: PMC6690905 DOI: 10.1038/s41598-019-48158-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/09/2019] [Indexed: 11/22/2022] Open
Abstract
To evaluate the safety and efficacy of transdermal electrical stimulation (TdES) with skin electrodes on improving the visual functions of patients with retinitis pigmentosa (RP), twenty eyes of 10 patients with RP underwent TdES (10-ms biphasic pulses, 20 Hz, 30 min) 6 times at 2 week intervals. All patients were stimulated bilaterally with 1.0 mA pulses. The primary endpoint was safety, and the secondary endpoints were the changes in the best-corrected visual acuity (BCVA), visual fields determined by the Humphrey field analyzer (HFA) 10-2 and Goldmann perimetry, and answers to the Visual Function Questionnaire-25. All of the 10 enrolled patients completed the study according to the protocol. No adverse events related to the treatments were reported during the follow-up examinations. The mean BCVA and Early Treatment Diabetic Retinopathy Study visual acuity were significantly improved after the TdES (P = 0.0078 and P = 0.001, respectively). The mean deviation of the HFA 10-2 was also significantly improved (P = 0.0076). We conclude that TdES with skin electrode is a safe therapeutic option and should be considered as a treatment option for patients with RP.
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Affiliation(s)
- Gen Miura
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Takeshi Sugawara
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Tomoaki Tatsumi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomohiro Nizawa
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
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Pardue MT, Allen RS. Neuroprotective strategies for retinal disease. Prog Retin Eye Res 2018; 65:50-76. [PMID: 29481975 PMCID: PMC6081194 DOI: 10.1016/j.preteyeres.2018.02.002] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/14/2018] [Accepted: 02/20/2018] [Indexed: 12/20/2022]
Abstract
Diseases that affect the eye, including photoreceptor degeneration, diabetic retinopathy, and glaucoma, affect 11.8 million people in the US, resulting in vision loss and blindness. Loss of sight affects patient quality of life and puts an economic burden both on individuals and the greater healthcare system. Despite the urgent need for treatments, few effective options currently exist in the clinic. Here, we review research on promising neuroprotective strategies that promote neuronal survival with the potential to protect against vision loss and retinal cell death. Due to the large number of neuroprotective strategies, we restricted our review to approaches that we had direct experience with in the laboratory. We focus on drugs that target survival pathways, including bile acids like UDCA and TUDCA, steroid hormones like progesterone, therapies that target retinal dopamine, and neurotrophic factors. In addition, we review rehabilitative methods that increase endogenous repair mechanisms, including exercise and electrical stimulation therapies. For each approach, we provide background on the neuroprotective strategy, including history of use in other diseases; describe potential mechanisms of action; review the body of research performed in the retina thus far, both in animals and in humans; and discuss considerations when translating each treatment to the clinic and to the retina, including which therapies show the most promise for each retinal disease. Despite the high incidence of retinal diseases and the complexity of mechanisms involved, several promising neuroprotective treatments provide hope to prevent blindness. We discuss attractive candidates here with the goal of furthering retinal research in critical areas to rapidly translate neuroprotective strategies into the clinic.
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Affiliation(s)
- Machelle T Pardue
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA; Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive, Atlanta, GA, 30332, USA.
| | - Rachael S Allen
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA
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Electrical Stimulation as a Means for Improving Vision. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 186:2783-2797. [PMID: 27643530 DOI: 10.1016/j.ajpath.2016.07.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 12/31/2022]
Abstract
Evolving research has provided evidence that noninvasive electrical stimulation (ES) of the eye may be a promising therapy for either preserving or restoring vision in several retinal and optic nerve diseases. In this review, we focus on minimally invasive strategies for the delivery of ES and accordingly summarize the current literature on transcorneal, transorbital, and transpalpebral ES in both animal experiments and clinical studies. Various mechanisms are believed to underlie the effects of ES, including increased production of neurotrophic agents, improved chorioretinal blood circulation, and inhibition of proinflammatory cytokines. Different animal models have demonstrated favorable effects of ES on both the retina and the optic nerve. Promising effects of ES have also been demonstrated in clinical studies; however, all current studies have a lack of randomization and/or a control group (sham). There is thus a pressing need for a deeper understanding of the underlying mechanisms that govern clinical success and optimization of stimulation parameters in animal studies. In addition, such research should be followed by large, prospective, clinical studies to explore the full potential of ES. Through this review, we aim to provide insight to guide future research on ES as a potential therapy for improving vision.
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Manthey AL, Liu W, Jiang ZX, Lee MHK, Ji J, So KF, Lai JSM, Lee VWH, Chiu K. Using Electrical Stimulation to Enhance the Efficacy of Cell Transplantation Therapies for Neurodegenerative Retinal Diseases: Concepts, Challenges, and Future Perspectives. Cell Transplant 2017; 26:949-965. [PMID: 28155808 DOI: 10.3727/096368917x694877] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Disease or trauma-induced loss or dysfunction of neurons in any central nervous system (CNS) tissue will have a significant impact on the health of the affected patient. The retina is a multilayered tissue that originates from the neuroectoderm, much like the brain and spinal cord. While sight is not required for life, neurodegeneration-related loss of vision not only affects the quality of life for the patient but also has societal implications in terms of health care expenditure. Thus, it is essential to develop effective strategies to repair the retina and prevent disease symptoms. To address this need, multiple techniques have been investigated for their efficacy in treating retinal degeneration. Recent advances in cell transplantation (CT) techniques in preclinical, animal, and in vitro culture studies, including further evaluation of endogenous retinal stem cells and the differentiation of exogenous adult stem cells into various retinal cell types, suggest that this may be the most appropriate option to replace lost retinal neurons. Unfortunately, the various limitations of CT, such as immune rejection or aberrant cell behavior, have largely prevented this technique from becoming a widely used clinical treatment option. In parallel with the advances in CT methodology, the use of electrical stimulation (ES) to treat retinal degeneration has also been recently evaluated with promising results. In this review, we propose that ES could be used to enhance CT therapy, whereby electrical impulses can be applied to the retina to control both native and transplanted stem cell behavior/survival in order to circumvent the limitations associated with retinal CT. To highlight the benefits of this dual treatment, we have briefly outlined the recent developments and limitations of CT with regard to its use in the ocular environment, followed by a brief description of retinal ES, as well as described their combined use in other CNS tissues.
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