All About Retinitis Pigmentosa Treatment, Definition and Symptoms
Even though most ocular disease signs are quite unnoticeable, regular eye exams can help prevent the development of conditions that could bring severe consequences.
One of those diseases is retinitis pigmentosa, which is a genetic, progressive, and rare condition that affects the retina, a light-sensitive layer at the back of the eyeball. Once affected, the way that the retina responds to light is entirely changed, which can lead to many vision difficulties.
The retinitis pigmentosa treatment consists of various methods, and your ophthalmologist may give you the best option that would suit your current state.
Still, some alternative techniques, such as acupuncture, can be quite useful for stopping the progression of the RP and recovering the lost vision.
Many people are unaware of the advantages of this approach, which is why this post will reveal the positive effects acupuncture has on treating eye conditions.
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What is Retinitis Pigmentosa?
Retinitis pigmentosa (RP) is a group of progressive eye diseases that affect the retina, changing its way of responding to light.
Since it’s about a growing eye problem, people with RP will lose their vision gradually – however, the cases of total blindness are quite uncommon.
This eye condition is caused by a mutation of more than 60 genes, which means that it generally runs in families. However, the type of RP and speed of the vision loss vary from person to person and depend on their form of the condition.
Most patients will face the reduction of peripheral (side) vision and night blindness, which comes as a result of their disability to adjust well to dark and dimly lit environments.
What Causes Retinitis Pigmentosa?
Unlike most eye problems, which are caused by an injury or some other diseases, retinitis pigmentosa is an inherited disorder.
The genes associated with retinitis pigmentosa are essential for the structure and function of photoreceptors – specialized light receptor cells – found in the retina. Namely, the retina consists of two types of photoreceptors, which are:
- Rods – responsible for providing vision in low light.
- Cones – responsible for providing vision in bright light, including even color vision.
Accordingly, the mutations of those genes may lead to gradual vision loss, night blindness, and oversensitivity to bright light (photophobia). Since the rods typically break down before cones, it’s common that people with RP primarily face vision difficulties while in a dark environment. Daytime vision usually becomes reduced over time.
Three possible inheritance patterns can be described as retinitis pigmentosa causes:
- Autosomal dominant inheritance pattern: This means that one copy of an altered gene in each cell can be sufficient to cause the disorder. Most people who have this type of RP have an affected parent and other family members who have the same problem.
- Autosomal recessive pattern: If each parent of an individual carries one copy of the recessive mutated gene, that means that the signs of RP may never show, even though the individual carries the same gene.
- X-linked pattern: X-linked pattern is associated with the X chromosome, one of the two sex chromosomes. Males have only one X chromosome, which means that one altered copy of the gene in each cell can cause the condition. In females, with two X chromosomes, the mutation must occur in both copies of the gene to produce a disorder. Therefore, males usually experience more severe consequences of RP than females.
What are the Retinitis Pigmentosa Symptoms?
Due to the fact that a gene mutation causes it, people who’re affected are born with such a disorder, which is why the signs of RP can be detected at an early age.
The symptoms may be noticeable in childhood, but the speed of disease progression and its further development are individual. People usually lose most of their vision by the age of 40, but that also depends on various factors.
The most common retinitis pigmentosa symptoms are:
- Reduced night vision: As the disease progresses, you may not be able to see at night, even though your daytime vision remains fine. It may be difficult for you to adjust to the dim environment, such as movie theaters and other rooms with low light. Driving at dusk and night can also be a problem.
- Affected side vision: RP causes so-called tunnel vision. The name refers to the inability to see things below and around you, which comes as a result of gradually damaged side sight.
- Loss of central vision: Even though RP damages the peripheral vision primarily, some people may have problems with central sight as well. Such an issue can prevent patients from activities like reading and threading a needle.
- Issues with the color vision: It’s not rare that affected individuals have trouble distinguishing colors.
- Blurred vision: As the vision becomes reduced, it’s common that individuals can’t see the images clearly, but they all seem cloudy and blurry.
- Photopsia: Photopsia includes the presence of flashes of blinking, shimmering, or swirling lights in the field of vision.
- Photophobia: Photophobia reflects in discomfort and eye pain that people usually experience when they’re exposed to bright light. This is a common condition that arises due to the retina damage.
- Blindness: RP can result in blindness, which is usually not total.
How is Retinitis Pigmentosa Diagnosed?
As soon as some of the mentioned signs of RP are observed, you are advised to visit your eye doctor and do all the necessary tests that would provide a more comprehensive image of your condition.
Clinical diagnosis is usually based on the presence of night blindness and peripheral visual field defects, lesions in the retinal fundus, electroretinogram traces, and other factors that could worsen the existing signs.
The most important diagnostic method is a complete ERG (Electroretinogram) test, which detects the function of the retina.
The test will help gather all the electrical signals from the photoreceptors and other cells that work as intermediaries between the photoreceptors and the ganglion cells. Therefore, a medical practitioner will place an electrode on the cornea, found at the front of the eye, and check how all these cells respond to light.
During the test, the patient looks at the bowl that produces different amounts of light. That way, the retinal cells emit electrical signals stimulated by certain amounts of light, and ERG records the results.
All the patterns provided by the test results that seem diminished in size and delayed on time give some clues about potential damage in cells. Besides, a test can show which retinal cells are affected by a disease.
Apart from this test, your doctor can perform the examination based on the following:
- Genetic testing: This test is based on the sample of your blood or other tissues, and it aims to determine whether you have certain genes associated with this particular disease. It can also help doctors see whether gene therapy can replace a faulty gene.
- Testing of a visual field: During the visual field testing, your doctor will measure your side vision and try to find any blind spots that may be progressing.
- Optical coherence tomography: This imaging test, also known as OCT, provides valuable and detailed pictures of your retina. OCT is exceptionally convenient for diagnosing RP and determining the way it is affecting your retina.
Retinitis pigmentosa ICD 10 diagnosis code is H35.52 (Pigmentary retinal dystrophy). This code is billable, and it can be used for reimbursement purposes.
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What is the Best Treatment for Retinitis Pigmentosa?
We have already mentioned the fact that RP is a group of diseases that affect the retina – that said, its treatment may include various methods that could eventually stop the progression of this disorder.
Even though it’s not that common, some other forms of RP can develop as well:
- Usher Syndrome: Usher syndrome is a rare, inherited disease that can cause deafness in addition to vision loss in infants. It can also affect balance.
- Leber’s Congenital Amaurosis (LCA): LCA is often characterized by extremely reduced vision loss at birth, and it usually impacts the development of similar eye-related anomalies.
- Cone-Rod Dystrophy (CDR): CDR damages rods and cones, the light-sensitive cells of the retina, increasing the chances of losing the vision over time.
According to most medical researches, retinitis pigmentosa cure doesn’t exist. Namely, it’s considered that diseases caused by a defective gene can’t be reversed nor cured, but their consequences can be slightly mitigated.
However, the latest researches regarding treatment for RP have shown that the body condition is a leading factor that determines whether the defective gene is switched or not. Therefore, if the body is healthy, the gene isn’t switched on, and the eyes can remain healthy.
The data found in those researches leads us to the first treatment – acupuncture.
Acupuncture for Retinitis Pigmentosa
Based on the methods and approaches of both Eastern and Western medicine, acupuncture has been a successful technique in treating the most severe, degenerative ocular conditions for many years.
Due to an insufficient number of studies about acupuncture, many misconceptions about this therapy consistently arise. However, you should know that acupuncture is an entirely safe and effective treatment for RP.
Acupuncture provides the chance of slowing down and even stopping the development of the disease. It’s focused on finding the root of a problem, which usually stems from the health of organs – in this case, the liver.
According to Chinese medicine, the liver is the main organ responsible for visual pigments. If it’s functioning well, the chances for RP progression are significantly decreased. If it needs improvements, the combination of Chinese herbs and acupuncture can be quite helpful.
Measurable Results of a Typical Acupuncture Therapy for Retinitis Pigmentosa
Modern clinical research and Dr. Rosenfarb’s experience suggest electroacupuncture as a method that can be added to a usual acupuncture protocol since it increases the possibility of better results in treating RP.
During the session, a licensed acupuncturist will insert small, hair-thin, and stainless steel needles at various acupoints on the body, including forehead, head, ears, abdomen, lower legs, toes and the area below the eyes.
The points on the body will be treated for 10-20 minutes approximately, while the points close to the eyes will be withdrawn after a few seconds. It’s recommended to start with at least ten 20-30 minute sessions a week. Your acupuncturist will determine the number of maintenance sessions depending on your progress, but you can expect 2-4 treatments weekly.
The research conducted by the prestigious American universities showed that the condition of a particular group of people with RP has improved after the series of acupuncture treatments, and the conclusion was based upon the fact that 61% of 12 patients felt significant improvements in vision.
Those improvements were noticeable in night vision, dark adaptation, visual acuity, and Goldman visual fields. The improvements were not the same in all patients since not all of them were the same age, neither the degree of their condition was equal.
When the condition is in its early stages, the chance of restoring completely the vision is much higher. On the other hand, patients with more advanced disease stages may not be able to get their sight back to 100%, but the improvements will be significant either way.
Another factor that determines the patients’ response to therapy is the state of health and energy of the person. For instance, a person who’s young and ready to make some vital changes in their life is more likely to get better than someone weak and older.
It’s essential to say that electroacupuncture didn’t bring any adverse effects nor loss of vision, which proves that the treatment is entirely harmless. Still, you may experience some side effects such as slight dizziness and bruise around the eye.
Micro Acupuncture for Retinitis Pigmentosa
Micro Acupuncture is considered the latest treatment for retinitis pigmentosa. It is a relatively new acupuncture system developed in 1984, which focuses on 48 acupoints found only in the hands and feet.
Accordingly, Micro Acupuncture is entirely different from other types of this therapy, and it has been quite successful in treating the most severe ocular diseases for the last couple of years. It has given stellar results in improving the vision loss due to macular degeneration, glaucoma, diabetic retinopathy, Usher’s syndrome, and retinitis pigmentosa.
A typical treatment lasts for 25 minutes, and it involves the insertion of small and thin needles in hands, forehead, and feet; no needles are placed into the eyes nor around them. The amount of sessions depends on the patient’s condition and the length of time the state has existed.
The goal of Micro Acupuncture is to increase the blood flow to the eye, reduce inflammation, control ocular oxidative stress, and improve detoxification of solid and liquid waste that accumulates in the eye. That way, it impacts the creation of stem cells, critical for photoreceptor nerve repair and vascular regeneration.
Diet and Supplementation Vital for RP Treatment
Acupuncture itself can bring significant changes in vision affected by RP, but your retinitis pigmentosa specialist may suggest some vitamins and supplements that would impact the recovery.
Nutritional supplements considered vital for retinitis pigmentosa are lutein, zeaxanthin, Chinese herbs, selenium, zinc, fish oil, and all the nutrients rich in vitamin A, C, and E.
You should also include a significant dose of fruits, vegetables, and leafy greens in your diet since they are all vital antioxidants beneficial for overall health. These foods will help reduce oxidative stress and protect the body from fast disease progression and vision loss.
Argus II Retinal Prosthesis System (Bionic Eye)
Argus II Retinal Prosthesis System, also known as a bionic eye, is an electronic retinal implant designed for patients who’re at the severe stage of RP.
The surgical procedure takes several hours, while the person is under general anesthesia. To insert the implant, a surgeon will have to remove the vitreous humor and any other membranes on the retina. Eventually, the implant is attached to the retina surface with a tack.
So far, people have noticed certain improvements in their vision provided by the device. However, some adverse side effects were recorded, as well.
Retinitis Pigmentosa Gene Therapy
Gene therapy for treating RP is aimed at replacing the faulty gene found in the affected retinal cells.
It’s conducted by injecting a harmless virus that carries new genetic material into the affected region of the retina. However, it’s quite hard to identify the problematic genes, which is why this therapy may not provide the best results.
Some other options for RP treatment lie in electrostimulation therapies and cell treatments. However, none of them has given some measurable results that would contribute to medical researches about the cure for retinitis pigmentosa.
If you decide on acupuncture, you should know that the entire procedure must be done by a qualified and licensed acupuncturist who meets the particular requirements in providing needling therapies to patients with retinitis pigmentosa.
Also, don’t forget to do all the necessary eye examinations before the sessions start since that’s the best way to keep track of improvements and give your acupuncturist enough information about your condition – that way, he/she can determine the right course of your treatment.