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Editors Selection IGR 11-3

Medical Treatment: Acupuncture review

Comment by Minguang He on:

21985 Analysis on literature of acupuncture and moxibustion treatment of intractable eye diseases, Xu H; Liu J; Xu SW et al., Zhongguo Zhen Jiu, 2008; 28: 625-628

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This paper was published in a Chinese journal called Zhongguo Zhen Jiu ‐ the English name of the journal is Chinese Acupuncture.Xu et al. (1679) attempted to review the literature and then summarize the information into four parts: how to choose acupuncture points, treatment protocol, treatment efficacy and possible mechanism. The articles included were all published in Chinese journals in the Chinese language. Interestingly, the authors only select the publications that involve the treatment of retinitis pigmentosa, age-related macular degeneration, glaucoma and optic atrophy ‐ the authors called them 'intractable', because no effective treatments are available. Basic acupuncture treatment requires inserting acupuncture needles into selected acupuncture points through the skin ‐ these acupuncture points are distributed widely along the 'meridians'. Although the selections of these 'points' for the selected eye diseases vary in the literatures, in general, the points located near the eyes are commonly selected. Some practitioners also chose the points on a certain meridian, such as the 'liver meridian', which could be very far from the eyes. In the traditional Chinese medicine, the practitioners pay more attention to the interactions among different organ systems rather than only focusing on isolated organ function. The goal of acupuncture is to balance the functions of different organ systems and then eventually improve the function of target organ.

Alternative treatment options to potentially improve visual function may deserve more attention and further studies with robust design

Surprisingly,all literature reported very high success rates of the treatment ‐ the % of 'treatment being effective' could be as high as '78.26 to 90% for glaucoma, 86.49 to 90% for AMD and 47.3 to 94.1% for optic atrophy.' The outcomes that commonly selected were visual acuity, visual field as well as IOP (if for glaucoma). Recently the ERG, VEP, EOG were also chosen as the outcomes. However, as pointed out in the review paper, the interpretation of the results should be very cautious: among 101 studies reported, none of them used randomized clinical trial, a control group was included in only one study, a few of them showed clear disease definitions and inclusion / exclusion criteria. In addition, some researchers questioned that certain countries produce only positive results (Vickers A, et al. Control Clin Trial 1998; 19: 159). However, given the fact that the selected diseases lack highly effective treatment with western medicine, the alternative treatment options to potentially improve visual function may deserve more attention and further studies with robust design.

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