Alsudais Ali S, Bukhari Ziad M, Alajmi Talal, Alamri Manar M, Alsuhaym Fay, Alotaibi Ahad, Alharbi Lama B, Aboud Atheer, Alshammari Basil K, Aljumaah Ahmad, Tuwir Ismail
College of Medicine, King Saud Bin Abdulaziz University, Jeddah, SAU.
Department of Ophthalmology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.
Cureus. 2024 Dec 31;16(12):e76669. doi: 10.7759/cureus.76669. eCollection 2024 Dec.
Optic nerve disorders significantly contribute to visual impairment with irreversible visual deficits. Current treatments have limited efficacy in resolving chronic visual deficits, necessitating novel therapeutic strategies. Neurorehabilitation techniques, including repetitive transorbital alternating current stimulation (rtACS), have emerged as promising approaches to restore lost visual function through the ability to modulate brain activity. However, the evidence on the effectiveness of rtACS remains inconclusive, warranting a systematic review to assess its potential as a therapeutic intervention for optic nerve-related visual deficits. This study exclusively evaluated the effectiveness of rtACS for visual field restoration in patients with optic nerve damage, including only randomized controlled trials (RCTs) that met the strict eligibility criteria. A thorough screening and data extraction process was conducted by independent reviewers, followed by a meta-analysis to assess the statistical significance and heterogeneity of the included studies. The improvement in the visual field in the rtACS compared to the sham group was the primary outcome, and visual acuity improvement was the secondary outcome. This study included three RCTs that evaluated the effects of rtACS compared to sham control in treating optic nerve damage. In regard to visual field (VF), the results revealed a significant improvement in the detection accuracy of the rtACS group compared to the control group, with a pooled mean difference of 32.06 [95% CI: 19.2, 51.2] (p=0.001, I2= 0%). The near and far vision revealed no statistically significant difference between both groups. Based on the systematic review, the use of rtACS shows a promising effect in improving the detection accuracy of the VF for patients with optic nerve damage, with a significant benefit over sham control. However, the effects on other visual outcomes were minimal, and safety data was limited. Further high-quality trials are needed to corroborate the findings and provide a more comprehensive evaluation of its efficacy and safety for treating optic nerve-related visual deficits.
视神经疾病是导致不可逆视力缺陷和视力损害的重要原因。目前的治疗方法在解决慢性视力缺陷方面效果有限，因此需要新的治疗策略。神经康复技术，包括重复经眶交流电刺激（rtACS），已成为通过调节大脑活动来恢复丧失视觉功能的有前景的方法。然而，关于rtACS有效性的证据仍然不确凿，需要进行系统评价以评估其作为视神经相关视力缺陷治疗干预措施的潜力。本研究专门评估了rtACS对视神经损伤患者视野恢复的有效性，仅纳入符合严格纳入标准的随机对照试验（RCT）。由独立评审员进行全面的筛选和数据提取过程，随后进行荟萃分析以评估纳入研究的统计学意义和异质性。与假手术组相比，rtACS组视野的改善是主要结局，视力改善是次要结局。本研究包括三项RCT，评估了rtACS与假手术对照相比治疗视神经损伤的效果。关于视野（VF），结果显示与对照组相比，rtACS组的检测准确性有显著改善，合并平均差为32.06 [95% CI：19.2，51.2]（p = 0.001，I2 = 0%）。近视力和远视力在两组之间无统计学显著差异。基于系统评价，rtACS的使用在改善视神经损伤患者VF检测准确性方面显示出有前景的效果，与假手术对照相比有显著益处。然而，对其他视觉结局的影响极小，且安全性数据有限。需要进一步的高质量试验来证实这些发现，并对视神经相关视力缺陷的治疗效果和安全性进行更全面的评估。
