Acupuncture Therapy For Dry Eye:a Systematic Review

Background:Dry eye is an ocular surface complaint with global prevalence across populations. The discomforts, involving dryness. foreign body sensation and ocular fatigue, significantly affect vision-associated life quality.Artificial tear is the basic treatment acting as lubricants, replacement of deficient tear constituents, etc. Its long-term use will inversely lead to discomforts. Thus, it lacks efficient treatment with less adverse effects for dry eye.Acupuncture is widely used in the treatment of dry eye. Clinical reports have reported the positive effect and safety of acupuncture for dry eye. However, there are insufficient high-quality evidence to support the efficacy and safet)’of acupuncture for treating dry eye.Objective:To evaluate the efficacy of acupuncture for dry eye by searching the Randomized Controlled Trials (RCTs) of acupuncture for dry eye(except Sjogren’s syndrome)and including the RCTs in which the comparisons are acupuncture or acupuncture combined with drugs Versus (VS) drugs.Methods:1. Literature search:①We drafted search strategy according to Cochrane Eye and Vision Group.②Search methods were including electronic search, handsearch and websites complement search. Language was limited to Chinese and English. We electronically searched The Cochrane Library(Issue1,2012),PubMed(1980to Mar.2012), MEDLINE(1966to Mar.2012), Ovid EBM Database(1991toMar.2012),CBMdisc (1978to Mar.2012), VIP(1989to Mar.2012), CNKI(1979to Mar.2012),and Wangfang Database(1989to Mar.2012.03). And we handsearched four traditional Chinese medicine journals to obtain randomized controlled trials (RCTs) about acupuncture for dry eye. Finally, the following websites were searched for complement:http://scholar.google.com/.http://www.controlled-trials.com, http://www.Clinic-altrials.gov.2. Literature quality assessment: ①We included randomized controlled trials which met the diagnostic criteria, inclusion criteria and exclusion criteria. If methodologies or results of the searched literatures could not be understood clearly, email or telephone would be used to contact the original authors to obtain such information. The studies those not meet the inclusion criteria were excluded.②Two reviewer extracted data and assessed the data’s quality independently. Conflict was resolved by discussion or by a third reviewer.③According to the Cochrane Handbook for Systematic Reviews of Interventions (5.1.0),we assessed the quality of included trials.3. Statistical Analysis:The statistical analysis was managed by RevMan5.1.0software provided by Cochrane Collaboration.①Meta-analysis was used to the homogeneous studies including the test for heterogeneity, the calculation and testing for combined effect.②Description analysis was applied to the heterogeneous studies. Results:1.78papers were searched including49Chinese papers and29English ones.8RCTs involving380patients met the inclusion criteria.2. There were1medium quality study.7low quality studies.4of the included studies employed improvement of symptoms as main outcomes. In secondary outcomes.7studies reported tear secretion (Schirmer Ⅰ Test,S1T); all studies had the break-up time of tears (BUT) and2studies described the cornea fluorescent staining(CFS).3(1) Meta-analysis:①Meta-analysis was carried out with6studies for SIT. The results indicated that acupuncture alone or acupuncture with artificial tears was significantly prior to artificial tears in increasing tear secretion of patients with dry eye (WMD5.79,95%CI5.33to6.25),(WMD2.75.95%CI2.30to3.20).②Meta-analysis was applied in7studies for BUT. Acupuncture with artificial tears or acupuncture were superior to artificial tears in increasing tear film stability of patients with dry eye (WMD2.76.95%CI1.37to4.14),(WMD0.72.95%CI0.18to1.26),(WMD1.60.95%CI0.26to2.95).3(2) Descriptive analysis:③For improvement of symptoms, descriptive analyses were employed because of the heterogeneity. The results showed that acupuncture alone or acupuncture with artificial tears was probably more effective than artificial tears.②The result of the descriptive analysis for SIT revealed thunder-fire moxibustion with artificial tears and artificial tears alone had the same efficacy in increasing tear secretion of patients with dry eye.③The result of the descriptive analysis for BUT (<9s) indicated artificial tears was superior to acupuncture in increasing tear film stability of patients with dry eye.④The results of the descriptive analyses for CFS explained that acupuncture alone or acupuncture with artificial tears and artificial tears had the same efficacy for the ocular surface damage.Conclusions:1. Acupuncture or acupuncture with artificial tears is a effective treatment method to dry eye. which is superior to artificial tears in improving the symptoms, increasing the tear secretion and tear film stability.2. Due to the deficiencies in the design and heterogeneity of studies, differences in efficacy are insufficient evidences, and its results have to be treated with caution.