Acupuncture for the management of dry eye disease

Abstract

The effectiveness of using acupuncture for dry eye disease (DED) is controversial. Thus, this systematic review investigated the effectiveness and feasibility of using acupuncture for DED in accordance with the 2020 PRISMA statement. The outcomes of interests were (1) to evaluate the efficacy of acupuncture in improving the ocular surface disease index (OSDI), Schirmer I test score, and tear breakup time from baseline to the last follow-up; (2) to determine possible complications of using acupuncture; and (3) to investigate the superiority of acupuncture over other commonly used treatments for DED. Data from 394 patients were collected. Results showed that acupuncture significantly prolonged the tear breakup time (P < 0.0001), significantly increased the Schirmer I test score ( P < 0.0001), and significantly reduced the OSDI ( P < 0.0001) from baseline to the last follow-up. Compared with the control group, the acupuncture group had significantly greater Schirmer I test score ( P < 0.0001), significantly longer tear breakup time ( P = 0.0004), and significantly lower OSDI (P = 0.002). These results suggest that acupuncture is effective and feasible in improving symptoms and signs of DED. No severe adverse effects of acupuncture were observed.

Keywords

dry eye disease / xerophthalmus / acupuncture

References

[1] YangYJ, LeeWY, KimYJ, HongYP. A meta-analysis of the efficacy of hyaluronic acid eye drops for the treatment of dry eye syndrome. Int J Environ Res Public Health 2021; 18( 5): 2383

[2] CraigJP, NelsonJD, AzarDT, BelmonteC, BronAJ, ChauhanSK, de PaivaCS, GomesJAP, HammittKM, JonesL, NicholsJJ, NicholsKK, NovackGD, StapletonFJ, WillcoxMDP, WolffsohnJS, SullivanDA. TFOS DEWS II Report Executive Summary. Ocul Surf 2017; 15( 4): 802– 812

[3] CraigJP, NicholsKK, AkpekEK, CafferyB, DuaHS, JooCK, LiuZ, NelsonJD, NicholsJJ, TsubotaK, StapletonF. TFOS DEWS II Definition and Classification Report. Ocul Surf 2017; 15( 3): 276– 283

[4] GalorA, LevittRC, FelixER, SarantopoulosCD. Understanding the true burden of dry eye disease. Expert Rev Ophthalmol 2015; 10( 5): 403– 405

[5] LempMA. Management of dry eye disease. Am J Manag Care 2008; 14(3 Suppl): S88–S101

[6] LempMA. Advances in understanding and managing dry eye disease. Am J Ophthalmol 2008; 146( 3): 350– 356.e1

[7] DownieLE, NgSM, LindsleyKB, AkpekEK. Omega-3 and omega-6 polyunsaturated fatty acids for dry eye disease. Cochrane Database Syst Rev 2019; 12( 12): CD011016

[8] ErvinAM, LawA, PuckerAD. Punctal occlusion for dry eye syndrome: summary of a Cochrane systematic review. Br J Ophthalmol 2019; 103( 3): 301– 306

[9] ZhouXQ, WeiRL. Topical cyclosporine A in the treatment of dry eye: a systematic review and meta-analysis. Cornea 2014; 33( 7): 760– 767

[10] LeeHK, RyuIH, SeoKY, HongS, KimHC, KimEK. Topical 0.1% prednisolone lowers nerve growth factor expression in keratoconjunctivitis sicca patients. Ophthalmology 2006; 113( 2): 198– 205

[11] LeeMS, ShinBC, ChoiTY, ErnstE. Acupuncture for treating dry eye: a systematic review. Acta Ophthalmol 2011; 89( 2): 101– 106

[12] ErnstE. Acupuncture—a critical analysis. J Intern Med 2006; 259( 2): 125– 137

[13] YuanJ, PurepongN, HunterRF, KerrDP, ParkJ, BradburyI, McDonoughS. Different frequencies of acupuncture treatment for chronic low back pain: an assessor-blinded pilot randomised controlled trial. Complement Ther Med 2009; 17( 3): 131– 140

[14] KavoussiB, RossBE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther 2007; 6( 3): 251– 257

[15] WangX, FanY, LanH, SongY, ShiZ, ZhangZ, LiX. The efficacy and safety of acupuncture or combined with western medicine for dry eye: a protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99( 35): e21878

[16] NeppJ, WedrichA, AkramianJ, DerbolavA, MudrichC, RiesE, SchauersbergerJ. Dry eye treatment with acupuncture. A prospective, randomized, double-masked study. Adv Exp Med Biol 1998; 438 : 1011– 1016

[17] LiuQ, LiuJ, RenC, CaiW, WeiQ, SongY, YuJ. Proteomic analysis of tears following acupuncture treatment for menopausal dry eye disease by two-dimensional nano-liquid chromatography coupled with tandem mass spectrometry. Int J Nanomedicine 2017; 12 : 1663– 1671

[18] KimTH, KangJW, KimKH, KangKW, ShinMS, JungSY, KimAR, JungHJ, LeeSD, ChoiJB, ChoiSM. Acupuncture for dry eye: a multicentre randomised controlled trial with active comparison intervention (artificial tear drop) using a mixed method approach protocol. Trials 2010; 11( 1): 107

[19] ShinMS, KimJI, LeeMS, KimKH, ChoiJY, KangKW, JungSY, KimAR, KimTH. Acupuncture for treating dry eye: a randomized placebo-controlled trial. Acta Ophthalmol 2010; 88( 8): e328– e333

[20] ZhangY, YangW. Effects of acupuncture and moxibustion on tear-film of the patients with xerophthalmia. J Tradit Chin Med 2007; 27( 4): 258– 260

[21] HowickJCI GlasziouP GreenhalghT. Carl Heneghan, Liberati A, Moschetti I, Phillips B, Thornton H, Goddard O, Hodgkinson M. The 2011 Oxford CEBM Levels of Evidence. Oxford Centre for Evidence-Based Medicine. 2011

[22] PageMJ, McKenzieJE, BossuytPM, BoutronI, HoffmannTC, MulrowCD, ShamseerL, TetzlaffJM, AklEA, BrennanSE, ChouR, GlanvilleJ, GrimshawJM, HróbjartssonA, LaluMM, LiT, LoderEW, Mayo-WilsonE, McDonaldS, McGuinnessLA, StewartLA, ThomasJ, TriccoAC, WelchVA, WhitingP, MoherD. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372( 71): n71

[23] WaltJ RM SternK. Evaluating the functional impact of dry eye: the Ocular Surface Disease Index. Drug Inf J 1997(31): 1436

[24] ChoP, LeungL, LamA, ChoiA. Tear break-up time: clinical procedures and their effects. Ophthalmic Physiol Opt 1998; 18( 4): 319– 324

[25] ChoP, YapM. Schirmer test. I. A review. Optom Vis Sci 1993; 70( 2): 152– 156

[26] DhaliwalDK, ZhouS, SamudreSS, LoNJ, RheeMK. Acupuncture and dry eye: current perspectives. A double-blinded randomized controlled trial and review of the literature. Clin Ophthalmol 2019; 13 : 731– 740

[27] GrönlundMA SteneviU LundebergT. Acupuncture treatment in patients with keratoconjunctivitis sicca: a pilot study. Acta Ophthalmol Scand 2004; 82(3 Pt 1): 283–290 doi:10.1111/j.1600-0420.2004.00254.x

[28] KimTH, KangJW, KimKH, KangKW, ShinMS, JungSY, KimAR, JungHJ, ChoiJB, HongKE, LeeSD, ChoiSM. Acupuncture for the treatment of dry eye: a multicenter randomised controlled trial with active comparison intervention (artificial teardrops). PLoS One 2012; 7( 5): e36638

[29] LeeJH, HanK, KimTH, KimAR, KwonO, KimJH, KimJE, LeeS, ShinMS, JungSY, ParkHJ, LeeS. Acupuncture for dry eye syndrome after refractive surgery: a randomized controlled pilot trial. Integr Med Res 2021; 10( 1): 100456

[30] TsengKL, LiuHJ, TsoKY, WoungLC, SuYC, LinJG. A clinical study of acupuncture and SSP (silver spike point) electro-therapy for dry eye syndrome. Am J Chin Med 2006; 34( 2): 197– 206

[31] LinZ, VasudevanB, JhanjiV, GaoTY, WangNL, WangQ, WangJ, CiuffredaKJ, LiangYB. Eye exercises of acupoints: their impact on refractive error and visual symptoms in Chinese urban children. BMC Complement Altern Med 2013; 13( 1): 306

[32] XieYM, XuS, ZhangCS, XueCC. Examination of surface conditions and other physical properties of commonly used stainless steel acupuncture needles. Acupunct Med 2014; 32( 2): 146– 154

[33] SamuelsN. Integration of hypnosis with acupuncture: possible benefits and case examples. Am J Clin Hypn 2005; 47( 4): 243– 248

[34] GongL, SunX. Treatment of intractable dry eyes: tear secretion increase and morphological changes of the lacrimal gland of rabbit after acupuncture. Acupunct Electrother Res 2007; 32( 3–4): 223– 233

[35] MüllerLJ, MarfurtCF, KruseF, TervoTM. Corneal nerves: structure, contents and function. Exp Eye Res 2003; 76( 5): 521– 542

[36] BäckerM, GrossmanP, SchneiderJ, MichalsenA, KnoblauchN, TanL, NiggemeyerC, LindeK, MelchartD, DobosGJ. Acupuncture in migraine: investigation of autonomic effects. Clin J Pain 2008; 24( 2): 106– 115

[37] YanX, ZhuT, MaC, LiuA, DongL, WangJ. A meta-analysis of randomized controlled trials on acupuncture for amblyopia. Evid Based Complement Alternat Med 2013; 2013 : 648054

[38] ZhiFY, LiuJ, MaXP, HongJ, ZhangJ, ZhangD, ZhaoY, WuLJ, YangYT, WuDY, XieC, WuLX, ZhangCH. Manual acupuncture for optic atrophy: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2019; 2019 : 1735967

[39] WorldHealth Organization. Regional Office for the Western Pacific. Standard acupuncture nomenclature : a brief explanation of 361 classical acupuncture point names and their multilingual comparative list. WHO Regional Office for the Western Pacific. 1993. Available at the WHO website

[40] WeiQB, DingN, WangJJ, WangW, GaoWP. Acupoint selection for the treatment of dry eye: a systematic review and meta-analysis of randomized controlled trials. Exp Ther Med 2020; 19( 4): 2851– 2860

[41] BottomleyA, JonesD, ClaassensL. Patient-reported outcomes: assessment and current perspectives of the guidelines of the Food and Drug Administration and the reflection paper of the European Medicines Agency. Eur J Cancer 2009; 45( 3): 347– 353

[42] SantosMS, GomesJA, Hofling-LimaAL, RizzoLV, RomanoAC, BelfortR Jr. Survival analysis of conjunctival limbal grafts and amniotic membrane transplantation in eyes with total limbal stem cell deficiency. Am J Ophthalmol 2005; 140( 2): 223– 230

[43] NaJH, JungJH, ParkJG, SongPH, SongCH. Therapeutic effects of acupuncture in typical dry eye: a systematic review and meta-analysis. Acta Ophthalmol 2021; 99( 5): 489– 498

[44] ParkJ, WhiteA, StevinsonC, ErnstE, JamesM. Validating a new non-penetrating sham acupuncture device: two randomised controlled trials. Acupunct Med 2002; 20( 4): 168– 174

[45] LindeK, NiemannK, MeissnerK. Are sham acupuncture interventions more effective than (other) placebos? A re-analysis of data from the Cochrane review on placebo effects. Forsch Komplement Med 2010; 17( 5): 259– 264

[46] KimYJ, LeeHJ, RyuJS, KimYH, JeonS, OhJY, ChoungHK, KhwargSI, WeeWR, KimMK. Prospective clinical trial of corneal reconstruction with biomaterial-free cultured oral mucosal epithelial cell sheets. Cornea 2018; 37( 1): 76– 83

[47] BaJW, WuY, LiY, XuD, ZhuW, YuJ. Updated meta-analysis of acupuncture for treating dry eye. Med Acupunct 2013; 25( 5): 317– 327

[48] YangL, YangZ, YuH, SongH. Acupuncture therapy is more effective than artificial tears for dry eye syndrome: evidence based on a meta-analysis. Evid Based Complement Alternat Med 2015; 2015 : 143858

[49] GaoWP LiuM Zhang YB. Observation on therapeutic effect of dry eye syndrome treated with acupuncture on the acupoints around the eyes. Chin Acupunct Moxibust (Zhongguo Zhen Jiu) 2010; 30( 6): 478– 480 (in Chinese)

[50] ZhangDXY SongX WangZ. Therapeutic observation of hair needle therapy for dry eye syndrome. Shanghai J Acupunct Moxibust (Shanghai Zhen Jiu Za Zhi) 2015: 1195– 1197 (in Chinese)

[51] AirdM, CobbinDM, RogersC. A study of the relative precision of acupoint location methods. J Altern Complement Med 2002; 8( 5): 635– 642

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