The Dry Eye Zone

Rebecca's Blog


Acupuncture systematic review

Those of you keeping your eye on acupuncture as a possibility might be interested in this report. It's a review of 19 acupuncture studies involving a total of 1,126 patients.

Here are a few take-homes:

  • Acupuncture plus artificial tears improved Schirmer more than it did tear break-up time

  • Treatment longer than 1 month was more effective than shorter

  • Treatment LESS than three times a week worked better than more frequent treatment

  • Acupuncture worked better than artificial tears but varied a lot. (We dry eye patients know all about how much dry eye treatments vary... but not too many studies bother to point this out. The key word you want to look for is "heterogeneity". That is probably more descriptive, in general, of dry eye disease than any other single term.)

BMC Complement Altern Med. 2018 May 3;18(1):145. doi: 10.1186/s12906-018-2202-0.
Optimizing acupuncture treatment for dry eye syndrome: a systematic review.
Kim BH, Kim MH, Kang SH, Nam HJ.

In a former meta-analysis review, acupuncture was considered a potentially effective treatment for dry eye syndrome (DES), but there were heterogeneities among the outcomes. We updated the meta-analysis and conducted subgroup analysis to reduce the heterogeneity and suggest the most effective acupuncture method based on clinical trials.

We searched for randomized controlled trials (RCTs) in 10 databases (MEDLINE, EMBASE, CENTAL, AMED, SCOPUS, CNKI, Wangfang database, Oriental Medicine Advanced Searching Integrated System (OASIS), Koreamed, J-stage) and searched by hand to compare the effects of acupuncture and artificial tears (AT). We also conducted subgroup analysis by (1) method of intervention (acupuncture only or acupuncture plus AT), (2) intervention frequency (less than 3 times a week or more than 3 times a week), (3) period of treatment (less than 4 weeks or more than 4 weeks), and (4) acupoints (BL1, BL2, ST1, ST2, TE23, Ex-HN5). The Bucher method was used for subgroup comparisons.

Nineteen studies with 1126 patients were included. Significant improvements on the Schirmer test (weighted mean difference[WMD], 2.14; 95% confidence interval[CI], 0.93 to 3.34; p = 0.0005) and break up time (BUT) (WMD, 0.98; 95% CI, 0.79 to 1.18; p < 0.00001) were reported. In the subgroup analysis, acupuncture plus AT treatment had a weaker effect in BUT but a stronger effect on the Schirmer test and a better overall effect than acupuncture alone. For treatment duration, treatment longer than 1 month was more effective than shorter treatment. With regard to treatment frequency, treatment less than three times a week was more effective than more frequent treatment. In the acupoint analysis, acupuncture treatment including the BL2 and ST1 acupoints was less effective than treatment that did not include them. None of those factors reduced the heterogeneity.

Acupuncture was more effective than AT in treating DES but showed high heterogeneity. Intervention differences did not influence the heterogeneity.