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Effects of a Single OMT on Intraocular Pressure (IOP) in Ocular Hypertenive or Glaucoma Suspect Subjects (OMT4OHT)

Primary Purpose

Ocular Hypertension, Glaucoma

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
osteopathic manipulative treatment (OMT)
osteopathic manipulative treatment (OMT)
Sponsored by
University of Wisconsin, Madison
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Ocular Hypertension

Eligibility Criteria

18 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Subject inclusion criteria.

  1. Subjects will be of either sex, age 18 years or older, and of any race or eye color.
  2. Subjects with confirmed ocular hypertension (OHT) or glaucoma suspects whose IOP was ≥ 20 mmHg at two measurements separated by at least 3 months.
  3. Subjects who do not have visual field defect(s), as determined by Visual Field Analysis within the last year.
  4. Subjects who do not have abnormal cupping of the optic nerve head.
  5. Subjects who do not have narrow angles as determined by gonioscopy (must be at least angle grade 2 to 3; Shaffer Classification Scale) recorded in the subject's patient record or as determined by biomicroscopy.
  6. Subjects who have not been treated with ocular hypotensive agents (or, if they have been treated, not for at least the preceding 3 months). In essence, the subjects will have been and be undergoing "watchful waiting" by their eye care practitioner(s) because no definitive diagnosis of glaucoma requiring treatment has been made.
  7. Subjects must satisfy all informed consent requirements. 8 Subjects whose mean IOP measurements in at least one (1) eye, the same eye(s), must be:

9. Greater than or equal to 20 mmHg at the 8 AM time-point on the Screening and Enrollment Visits (1 and 2) and 10. Greater than or equal to 19 mmHg at the 10 AM, 12 Noon, and 4 PM time-points on the Screening and Enrollment Visits (1 and 2).

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Exclusion Criteria:

  1. Subjects who have had any traumatic brain injury or head trauma, which resulted in upper-spinal fusion and/or cranial bone surgery, which implanted a metal plate.
  2. Subjects who have a concurrent diagnosis of cancer or metastatic disease affecting the head and neck.
  3. Subjects who have been diagnosed with glaucoma or ocular hypertension and whose condition requires medical treatment other than "watchful waiting."
  4. Subjects who are less than 18 years old.
  5. Subjects who are lactating, pregnant, or plan to become pregnant in the time planned for the study.
  6. Subjects who have a history of chronic or recurrent severe inflammatory eye disease (e.g., scleritis, uveitis) in either eye as determined by patient history and/or examination.
  7. Subjects who have a history of clinically significant or progressive retinal disease in either eye such as retinal degeneration, diabetic retinopathy, or retinal detachment with permanent field loss as determined by patient history and/or examination.
  8. Subjects who have a history of serious ocular trauma in either eye within the past six (6) months as determined by patient history and/or examination.
  9. Subjects who have had intraocular surgery in either eye within the past six (6) months as determined by patient history and/or examination.
  10. Subjects who have had ocular laser surgery in either eye within the past three (3) months as determined by patient history and/or examination.
  11. Subjects who have a history of ocular infection or ocular inflammation in either eye within the past three (3) months as determined by patient history and/or examination.
  12. Subjects who have any abnormality preventing reliable applanation tonometry of either eye (e.g., keratoconus, corneal or conjunctival scarring).
  13. Subjects who have any abnormality preventing reliable assessment of pupil diameter in either eye (e.g., congenital pupil anomaly, posterior synechiae, anterior cleavage syndrome, afferent defects, prior surgery, etc.).
  14. Subjects who have less than a thirty (30) days stable dosing regimen before the Screening and Enrollment Visits (Visits 1 and 2) of any non-ocular medications that may affect IOP, administered by any route and used on a chronic basis. These may include, but are not limited to, alpha agonists, beta-blockers, calcium channel blockers, antimuscarinic agents, and phenothiazines.
  15. Subjects who have other treatments and/or surgeries unrelated to the eye condition scheduled in the time planned for the study.
  16. Subjects who are allergic to Latex, PABA, Proparacaine, or Fluorescein.
  17. Subjects who have had prior surgical or laser treatment for the purpose of lowering their IOP.
  18. Subjects who currently have systemic infections resulting in fever or immunosuppression.
  19. Subjects who have had previous OMT, chiropractic manipulation, massage, or other forms of manual therapy within the last 2 months.
  20. Subjects who are unable to give appropriate informed consent due to mental or other limitations.
  21. Additionally, the Principal Investigator may declare any subject ineligible for a valid medical reason.

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Sites / Locations

  • UW Dept of Ophthalmology Clinic

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

osteopathic manipulative treatment

Arm Description

osteopathic manipulative treatment (OMT)

Outcomes

Primary Outcome Measures

Intraocular pressure (IOP)
Goldman Tonometry

Secondary Outcome Measures

pupillometry
Pupillometry measures the pupil size and reactivity to light

Full Information

First Posted
May 20, 2013
Last Updated
August 14, 2014
Sponsor
University of Wisconsin, Madison
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1. Study Identification

Unique Protocol Identification Number
NCT01864642
Brief Title
Effects of a Single OMT on Intraocular Pressure (IOP) in Ocular Hypertenive or Glaucoma Suspect Subjects
Acronym
OMT4OHT
Official Title
A Study of the Effects of a Single Osteopathic Manipulative Treatment (OMT) on Intraocular Pressure (IOP)in Un-medicated Confirmed Ocular Hypertensive (OHT) or Glaucoma Suspect Subjects
Study Type
Interventional

2. Study Status

Record Verification Date
August 2014
Overall Recruitment Status
Completed
Study Start Date
July 2013 (undefined)
Primary Completion Date
May 2014 (Actual)
Study Completion Date
June 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Wisconsin, Madison

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The hypothesis is that osteopathic manipulative treatment (OMT)will significantly reduce intraocular pressure (IOP) in individuals with ocular hypertension (OHT) and glaucoma suspect patients.
Detailed Description
Glaucoma is a leading cause of irreversible blindness in the United States and the world. Approximately 2.8 million Americans have been diagnosed with glaucoma. Based on pilot studies and the clinical experience of the PI, a power analysis indicated that in order to lower IOP by 4 mm Hg 28 subjects would be needed, 14 in the experimental group and 14 in the control/comparator group. The intervention is OMT. Based on the anatomy of the eye and the dysfunctions underlying primary open angle glaucoma (POAG), the presumed mechanisms are one or the other or a combination of the following. 1) Anatomic: the OMT benefit may occur by the biomechanical restoration of drainage through the trabecular meshwork and Schlemm's canal. 2) Neurologic: the OMT may affect the parasympathetic innervations from the Edinger-Westphal fibers via the cranial nerve III as well as the sympathetic innervations arising in the T1 to T3 levels then via the superior cervical ganglion which then course to the eye. The OMT protocol takes 25-27 minutes to administer and addresses cranial, cervical, upper body, spinal and sacral structures designed to affect the anatomic, physiologic processes (e.g. lymphatic drainage from the neck and face), neurologic structures (sympathic and parasympathetic) affecting visual processes. A very similar OMT protocol was used in a study on healthy elder and resulted in improved balance and equilibrium. In that study there were no adverse outcomes reported. The control/comparator subjects will lay on the OMT table for the same 25-27 minutes in the same time periods in which experimental subjects were in the prone, lateral recumbent, and supine positions.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ocular Hypertension, Glaucoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
28 (Actual)

8. Arms, Groups, and Interventions

Arm Title
osteopathic manipulative treatment
Arm Type
Experimental
Arm Description
osteopathic manipulative treatment (OMT)
Intervention Type
Procedure
Intervention Name(s)
osteopathic manipulative treatment (OMT)
Intervention Type
Procedure
Intervention Name(s)
osteopathic manipulative treatment (OMT)
Other Intervention Name(s)
OMT is a form of manual medicine
Intervention Description
OMT is a form of manual medicine performed by osteopathic physicians
Primary Outcome Measure Information:
Title
Intraocular pressure (IOP)
Description
Goldman Tonometry
Time Frame
up to 3 days
Secondary Outcome Measure Information:
Title
pupillometry
Description
Pupillometry measures the pupil size and reactivity to light
Time Frame
measured on day one and two to assess eligibility, assess on day three at the time of the intervention, then on day 7 as last day of subject participation (up to 7 days)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject inclusion criteria. Subjects will be of either sex, age 18 years or older, and of any race or eye color. Subjects with confirmed ocular hypertension (OHT) or glaucoma suspects whose IOP was ≥ 20 mmHg at two measurements separated by at least 3 months. Subjects who do not have visual field defect(s), as determined by Visual Field Analysis within the last year. Subjects who do not have abnormal cupping of the optic nerve head. Subjects who do not have narrow angles as determined by gonioscopy (must be at least angle grade 2 to 3; Shaffer Classification Scale) recorded in the subject's patient record or as determined by biomicroscopy. Subjects who have not been treated with ocular hypotensive agents (or, if they have been treated, not for at least the preceding 3 months). In essence, the subjects will have been and be undergoing "watchful waiting" by their eye care practitioner(s) because no definitive diagnosis of glaucoma requiring treatment has been made. Subjects must satisfy all informed consent requirements. 8 Subjects whose mean IOP measurements in at least one (1) eye, the same eye(s), must be: 9. Greater than or equal to 20 mmHg at the 8 AM time-point on the Screening and Enrollment Visits (1 and 2) and 10. Greater than or equal to 19 mmHg at the 10 AM, 12 Noon, and 4 PM time-points on the Screening and Enrollment Visits (1 and 2). - Exclusion Criteria: Subjects who have had any traumatic brain injury or head trauma, which resulted in upper-spinal fusion and/or cranial bone surgery, which implanted a metal plate. Subjects who have a concurrent diagnosis of cancer or metastatic disease affecting the head and neck. Subjects who have been diagnosed with glaucoma or ocular hypertension and whose condition requires medical treatment other than "watchful waiting." Subjects who are less than 18 years old. Subjects who are lactating, pregnant, or plan to become pregnant in the time planned for the study. Subjects who have a history of chronic or recurrent severe inflammatory eye disease (e.g., scleritis, uveitis) in either eye as determined by patient history and/or examination. Subjects who have a history of clinically significant or progressive retinal disease in either eye such as retinal degeneration, diabetic retinopathy, or retinal detachment with permanent field loss as determined by patient history and/or examination. Subjects who have a history of serious ocular trauma in either eye within the past six (6) months as determined by patient history and/or examination. Subjects who have had intraocular surgery in either eye within the past six (6) months as determined by patient history and/or examination. Subjects who have had ocular laser surgery in either eye within the past three (3) months as determined by patient history and/or examination. Subjects who have a history of ocular infection or ocular inflammation in either eye within the past three (3) months as determined by patient history and/or examination. Subjects who have any abnormality preventing reliable applanation tonometry of either eye (e.g., keratoconus, corneal or conjunctival scarring). Subjects who have any abnormality preventing reliable assessment of pupil diameter in either eye (e.g., congenital pupil anomaly, posterior synechiae, anterior cleavage syndrome, afferent defects, prior surgery, etc.). Subjects who have less than a thirty (30) days stable dosing regimen before the Screening and Enrollment Visits (Visits 1 and 2) of any non-ocular medications that may affect IOP, administered by any route and used on a chronic basis. These may include, but are not limited to, alpha agonists, beta-blockers, calcium channel blockers, antimuscarinic agents, and phenothiazines. Subjects who have other treatments and/or surgeries unrelated to the eye condition scheduled in the time planned for the study. Subjects who are allergic to Latex, PABA, Proparacaine, or Fluorescein. Subjects who have had prior surgical or laser treatment for the purpose of lowering their IOP. Subjects who currently have systemic infections resulting in fever or immunosuppression. Subjects who have had previous OMT, chiropractic manipulation, massage, or other forms of manual therapy within the last 2 months. Subjects who are unable to give appropriate informed consent due to mental or other limitations. Additionally, the Principal Investigator may declare any subject ineligible for a valid medical reason. -
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hollis H King, DO, PhD
Organizational Affiliation
Univ Wisconsin Dept of Family Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
UW Dept of Ophthalmology Clinic
City
Madison
State/Province
Wisconsin
ZIP/Postal Code
53715
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Effects of a Single OMT on Intraocular Pressure (IOP) in Ocular Hypertenive or Glaucoma Suspect Subjects

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