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J. Acupunct. Tuina. Sci.

2013, 11 (6): 358-362


DOI: 10.1007/s11726-013-0732-z
CLINICAL STUDY

Clinical Study on Acupuncture for Quality of Life in


Patients with Age-related Macular Degeneration

Xia Yong1, Liu Rui2, Sun Jing-jin1, CLC Number: R246.82 Document Code: A
Xin Shi-en3, Cui Hua-shun3,
Liu Shi-min1 Abstract
Objective: To observe the effect of acupuncture on the quality of life in
1 Acupuncture and Tuina College, patients with age-related macular degeneration (AMD).
Shanghai University of Traditional
Chinese Medicine, Shanghai Methods: A total of 47 dry AMD cases (94 eyes) were randomly allocated
201203, China into three groups, 22 cases (44 eyes) in the acupuncture group, 15 cases
2 Eye and ENT Hospital of Fudan (30 eyes) in the Western medicine group and 10 cases (20 eyes) in the
University, Shanghai 200031, control group. Cases in the acupuncture group were treated with
China
3 Shuguang Hospital Affiliated to
acupuncture, cases in the Western medicine group with vitamin C and E
Shanghai University of Traditional and cases in the control group received no treatment except for
Chinese Medicine, Shanghai out-patient follow-up.
200021, China Results: Acupuncture could significantly improve eye symptoms of dry
AMD cases including blurred vision, drastic decrease in visual acuity,
distorted vision, central scotomas, visual fatigue and dry eyes as well as
other systemic symptoms related to macular degeneration.
Conclusion: Acupuncture can substantially improve the quality of life in
patients with dry AMD.
Key Words
Acupuncture Therapy; Age-related Macular Degeneration; Quality of Life

Age-related macular degeneration (AMD), also known as senile macular


degeneration, is a major cause of blindness in older adults (>50 years) [1]. This
condition is often associated with aging[2] and genetic factors[3-7]. AMD is a
chronic eye condition that results in a drastic decrease in the center of the
visual field (the macula), affecting one or both eyes and causing progressive
visual impairment or even permanent blindness if left untreated. This study
observed the impact of acupuncture on quality of life in AMD patients, using
scores of eye symptoms and systemic symptoms of traditional Chinese
medicine (TCM) as indexes.

1 Clinical Data

1.1 Diagnostic criteria


This is based on the diagnostic criteria for dry AMD stipulated by the
Ocular Fundus Diseases Group, National Academy of Ophthalmology in
1986 and the criteria in the Ophthalmology[8]. Aged above 50; significant
decrease in visual acuity; macular changes such as depigmentation or
pigmentary alterations, drusen, beaten-bronze appearance, atrophic spots; and
absence of macular hemorrhage or fluorescence leakage.
Author: Xia Yong, M.D., associate
1.2 Differential diagnosis
professor Peripheral drusen: Drusen is located outside the macular region (not
Corresponding Author: Liu Shi-min, inside).
M.D., associate professor. Myopic degeneration: Other than atrophic changes in macular region,
E-mail: liusmin@sina.com
● 358 ●︱© Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2013
J. Acupunct. Tuina. Sci. 2013, 11 (6): 358-362

severe myopia is often accompanied by typical changes measurement data, and Q-test was conducted.
of optic nerve papilla and absence of drusen.
Central serous chorioretinopathy (CSC): Aged below
2 Treatment Methods
50, eminence of central serous retina, detachment of
pigment epithelium, stippled atrophy of pigment
epithelium and absence of drusen. 2.1 Acupuncture group
Hereditary macular degeneration: Aged below 50, Points: Jingming (BL 1), Shangming (Extra, locates at
absence of drusen and having a family history. midpoint of the supraorbital arch), Neitongziliao [(Extra,
Toxic retinopathy: Poisoning by chloroquine can locates at superior to the eyeball, lateral border between
cause stippled depigmentation coupled with the eyeball and supraorbital wall and at the same level
pigmentation (Bull’s eye maculopathy), absence of with Tongziliao (GB 1)], Jianming (Extra, locates at
drusen and having a history of drug administration. approximately 0.4 cun below the inner canthus), (Fig.1),
1.3 Inclusion criteria Chengqi (ST 1), Qiuhou (EX-HN 7) and Taichong
Aged >50 and disease duration >4 months; willing to (LR 3). Jingming (BL 1), Shangming (Extra) and
sign the informed consent and agreed to participate in Neitongziliao (Extra) were used as one group of points;
this clinical study; and discontinued other therapies Jianming (Extra), Chengqi (ST 1) and Qiuhou
over 3 months before joining this study. (EX-HN 7) as another group, the two groups were used
alternately, one group for each treatment).
1.4 Exclusion and rejection criteria
Method: Locations of above points are based on
Those who failed to meet the above inclusion criteria; Nomenclature and Location of Acupuncture Points
having received other therapies that may affect (GB/T 12346-2006)[9]. Stainless steel filiform needles of
evaluation of this study; having other medical 0.25 mm in diameter and 40 or 50 mm in length were
conditions during the study; having incomplete data; used for the treatment. Points around the eye socket
failed to stick to the treatment protocol and failed to were punctured 1.5-2 cun, coupled with mild lifting,
examine observation indexes according to the protocol. thrusting and rotating manipulation until the
1.5 Study subjects appearance of an intense soreness and distension
Forty-seven cases (94 eyes) were recruited in the behind the eyeballs. Reducing manipulation by lifting,
study from the outpatient departments of Shanghai thrusting and rotating was applied to Taichong (LR 3)
Acupuncture and Meridian Research Institute and and other adjunct points. The needles were retained for
Shuguang Hospital Affiliated to Shanghai University of 30 min. The treatment was done twice a week, 2
Traditional Chinese Medicine (eastern section) as well months for a course of treatment.
as Eye and ENT Hospital of Fudan University. These
cases were grouped by a randomized, controlled and
blinded clinical trial design. After signing the informed
consent, they were randomly allocated into three
groups, an acupuncture group of 22 cases (44 eyes), a
Western medicine group of 15 cases (30 eyes) and a
control group of 10 cases (20 eyes). During the clinical
trial, the researchers, practitioners and statistical
personnel were separated. There were no significant
differences in general materials among the three groups
(P>0.05), indicating that they were comparable (table 1).

Table 1. Inter-group comparison of general materials


Gender (case) Age Duration
Groups n
Male Female ( x ±s, year) ( x ±s, month) Fig.1 Periocular points
Acupuncture 22 12 10 60.45±3.85 5.22±0.56
2.2 Western medicine group
WM 15 8 7 61.06±2.77 4.36±0.48
Cases in Western medicine group took Vitamin C
Control 10 4 6 60.56±3.23 5.13±0.39 0.2 g and Vitamin E 0.1 g for each dose, 3 doses a day,
Note: WM=Western medicine group and 2 months for a course of treatment.
2.3 Control group
1.6 Statistical method
No intervention measures were taken in the control
The SPSS 18.0 version software was used for group except for 2-month outpatient follow-up.
statistical management, ( x ±s) for expression of

© Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2013︱● 359 ●
J. Acupunct. Tuina. Sci. 2013, 11 (6): 358-362

3 Therapeutic Efficacy Observation After treatment, TCM symptoms in the acupuncture


group were substantially improved, but not in the
Western medicine group and the control group. This
3.1 Observation indexes
indicated that acupuncture obtained better overall
3.1.1 Scoring of eye symptoms effects than Western medicine (table 2).
The eye symptoms (blurred vision, drastic decrease 3.2.2 Comparison of eye symptoms among the three
in visual acuity, distorted vision, central scotomas, visual
groups
fatigue, seeing things in changed colors and dry eyes)
were scored. After treatment, except for seeing things in changed
Method: For the first visit, each symptom was scored colors, other eye symptoms were significantly improved
3; after three months of treatment, unimproved in the acupuncture group (P<0.05) but not in the
symptoms remained 3, somewhat improvement scored Western medicine group and the control group
2, substantial improvement scored 1 and total absence (P>0.05). After treatment, except for seeing things in
of symptoms scored 0. changed colors, there were significant differences
3.1.2 Scoring of TCM symptoms between the acupuncture group and the other two
groups (P<0.05) and there were no significant
The scoring method was same as that of eye differences between the Western medicine group and
symptoms. control group (P>0.05), indicating that except for seeing
3.2 Treatment results things in changed colors, acupuncture obtained better
3.2.1 Comparison of TCM symptoms among the three effects than the other two in improving other eye
groups symptoms (table 3).

Table 2. Inter-group comparison of TCM symptoms before and after treatment ( x ±s, point)
Acupuncture group Western medicine group Control group
TCM symptoms
Before After Before After Before After
n n n
treatment treatment treatment treatment treatment treatment
Tastelessness (no thirsty) 13 3.00±0.00 2.03±0.011)2) 10 3.00±0.00 3.00±0.00 13 3.00±0.00 3.00±0.00
Thirsty with a desire to drink water 6 3.00±0.00 2.00±0.011)2) 5 3.00±0.00 3.00±0.00 6 3.00±0.00 3.00±0.00
1)2)
Dry stools 11 3.00±0.00 2.04±0.02 9 3.00±0.00 3.00±0.00 11 3.00±0.00 3.00±0.00
1)2)
Poor memory 21 3.00±0.00 1.60±0.01 14 3.00±0.00 3.00±0.00 21 3.00±0.00 3.00±0.00
Dizziness 19 3.00±0.00 1.58±0.011)2) 13 3.00±0.00 3.00±0.00 19 3.00±0.00 3.00±0.00
1)2)
Headache 12 3.00±0.00 2.00±0.01 10 3.00±0.00 3.00±0.00 12 3.00±0.00 3.00±0.00
1)2)
Lumbar and knee soreness/weakness 21 3.00±0.00 1.51±0.03 14 3.00±0.00 3.00±0.00 21 3.00±0.00 3.00±0.00
Poor appetite 18 3.00±0.00 1.78±0.011)2) 13 3.00±0.00 3.00±0.00 18 3.00±0.00 3.00±0.00
1)2)
Dry, bitter mouth 11 3.00±0.00 1.59±0.02 11 3.00±0.00 3.00±0.00 11 3.00±0.00 3.00±0.00
1)2)
Frequent urination 20 3.00±0.00 1.00±0.01 13 3.00±0.00 3.00±0.00 20 3.00±0.00 3.00±0.00
1)2)
Tinnitus 15 3.00±0.00 2.00±0.01 12 3.00±0.00 3.00±0.00 15 3.00±0.00 3.00±0.00
Insomnia 20 3.00±0.00 1.59±0.011)2) 13 3.00±0.00 3.00±0.00 20 3.00±0.00 3.00±0.00
1)2)
Dream-disturbed sleep 17 3.00±0.00 1.43±0.02 10 3.00±0.00 3.00±0.00 17 3.00±0.00 3.00±0.00
1)2)
Palpitations 12 3.00±0.00 2.31±0.01 12 3.00±0.00 3.00±0.00 12 3.00±0.00 3.00±0.00
Gastric distension 9 3.00±0.00 2.42±0.011)2) 5 3.00±0.00 3.00±0.00 9 3.00±0.00 3.00±0.00
1)2)
Hot drink preference 8 3.00±0.00 2.49±0.01 8 3.00±0.00 3.00±0.00 8 3.00±0.00 3.00±0.00
1)2)
Loose stools 8 3.00±0.00 2.49±0.01 7 3.00±0.00 3.00±0.00 8 3.00±0.00 3.00±0.00
Spontaneous sweating 15 3.00±0.00 1.99±0.011)2) 10 3.00±0.00 3.00±0.00 15 3.00±0.00 3.00±0.00
Sallow face 13 3.00±0.00 2.22±0.011)2) 11 3.00±0.00 3.00±0.00 13 3.00±0.00 3.00±0.00
1)2)
Night sweats 9 3.00±0.00 2.42±0.01 9 3.00±0.00 3.00±0.00 9 3.00±0.00 3.00±0.00
1)2)
Low back pain 14 3.00±0.00 2.04±0.02 11 3.00±0.00 3.00±0.00 14 3.00±0.00 3.00±0.00
Note: Intra-group comparison with score of before treatment, 1) P<0.05; compared with the results after treatment of the Western
medicine group and the control group, 2) P<0.05

● 360 ●︱© Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2013
J. Acupunct. Tuina. Sci. 2013, 11 (6): 358-362

Table 3. Inter-group comparison of eye symptoms before and after treatment ( x ±s, point)
Acupuncture group Western medicine group Control group
Items Affected Before After Affected Before After Affected Before After
eyes treatment treatment eyes treatment treatment eyes treatment treatment
Blurred vision 44 3.00±0.00 2.00±0.031)2) 30 3.00±0.00 2.90±0.04 20 3.00±0.00 3.00±0.00
1)2)
DVD 32 3.00±0.00 1.00±0.01 25 3.00±0.00 3.00±0.00 16 3.00±0.00 3.00±0.00
1)2)
Distorted vision 10 3.00±0.00 1.00±0.02 8 3.00±0.00 3.00±0.00 6 3.00±0.00 3.00±0.00
Central scotomas 32 3.00±0.00 1.00±0.011)2) 20 3.00±0.00 3.00±0.00 14 3.00±0.00 3.00±0.00
1)2)
Visual fatigue 36 3.00±0.00 1.00±0.02 30 3.00±0.00 3.00±0.00 18 3.00±0.00 3.00±0.00
STCC 8 3.00±0.00 2.50±0.03 6 3.00±0.00 3.00±0.00 4 3.00±0.00 3.00±0.00
1)2)
Dry eyes 24 3.00±0.00 1.00±0.01 18 3.00±0.00 3.00±0.00 12 3.00±0.00 3.00±0.00
Note: DVD=Drastic vision decrease; STCC=Seeing things in changed colors; intra-group comparison with score of before treatment,
1) P<0.05; compared with the results after treatment of the Western medicine group and the control group, 2) P<0.05

3.3 Adverse events during treatment this clinical study, Jingming (BL 1) is a major local point
During treatment, 10 of 22 cases (male/female for eye problems with its distinctive effects of
ratio=1:9) in the acupuncture group experienced unblocking collaterals and sharpening the eyes.
bleeding and hematoma in the orbital region, no Chengqi (ST 1) activates qi and blood and is also a
adverse events occurred in the Western medicine major point for eye problems. Other local points,
group and the control group. Shangming (Extra), Neitongziliao (Extra), Jianming
(Extra) and Qiuhou (EX-HN 7), were combined to
4 Discussion circulate qi and blood around the eyes. Taichong (LR 3)
was used for systemic regulation[10-14].
Common symptoms of AMD cases include blurred Due to increased vascular fragility and longer clotting
vision, dramatic decrease in visual acuity, distorted time in elderly females, acupuncture may easily cause
vision, central scotomas, visual fatigue, seeing things in bleeding and hematoma. As a result, it should be
changed colors and dry eyes. According to this clinical cautious in needling points around the orbit in those
study, after treatment, acupuncture could substantially patients[15].
improve eye symptoms except for seeing things in
changed colors and thus increased the patients’ quality
of life. Patients came with the help of a family member Conflict of Interest
for the first visit due to severe eye discomfort but could There is no potential conflict of interest in this article.
come independently after a period of treatment. Acknowledgments
Seeing things in changed colors means an inability to
This work was supported by Scientific Research Fund
distinguish normal colors. It is similar to color
of Traditional Chinese Medicine from Shanghai
blindness or weakness and has always been an
Municipal Health Bureau (2010L001A).
intractable eye condition. This clinical study has shown
that acupuncture didn’t work well for seeing things in Statement of Informed Consent
changed colors. Further research is still needed in this All of the study subjects knew this clinical trial and
aspect. signed the informed consent.
Since visual function is closely associated with
Zang-Fu organs and meridians, we’ve also observed
other systemic symptoms related to macular
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● 362 ●︱© Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2013