Acupuncture for glaucoma

 

Abstract

Background

Glaucoma is a multifactorial optic neuropathy in which there is an acquired loss of retinal ganglion cells at levels beyond normal age-related loss and corresponding atrophy of the optic nerve. Although there are many existing treatments, glaucoma is a chronic condition. Some patients may seek complementary or alternative medicine such as acupuncture to supplement their regular treatment. The underlying plausibility of acupuncture is that disorders related to the flow of Chi (the traditional Chinese concept translated as vital force or energy) can be prevented or treated by stimulating the relevant points on the body surface.

Objectives

The objective of this review was to assess the effectiveness and safety of acupuncture in people with glaucoma.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2010, Issue 3), MEDLINE (January 1950 to March 2010), EMBASE (January 1980 to March 2010), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to March 2010), ZETOC (January 1993 to March 2010), Allied and Complementary Medicine Database (AMED) (January 1985 to March 2010), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the National Center for Complementary and Alternative Medicine web site (NCCAM) (http://nccam.nih.gov). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 23 March 2010 with the exception of NCCAM which was last searched on 14 July 2010. We also handsearched Chinese medical journals at Peking Union Medical College Library in April 2007.

Although the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Chinese Acupuncture Trials Register, the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), and the Chinese Biological Database (CBM) were searched for the original review, we did not search these databases for the 2010 review update.

Selection criteria

We planned to include randomized and quasi-randomized clinical trials in which one arm of the study involved acupuncture treatment.

Data collection and analysis

Two authors independently evaluated the search results against the inclusion and exclusion criteria. Discrepancies were resolved by discussion.

Main results

We found no randomized clinical trials and subsequently no meta-analysis was conducted. Evidence was limited to a few case series of small sample size.

Authors' conclusions

At this time, it is impossible to draw reliable conclusions from the available data to support the use of acupuncture for the treatment of glaucoma. Since most glaucoma patients currently cared for by ophthalmologists do not use non-traditional therapy, the clinical practice decisions will have to be based on physician judgement and patients' value given this lack of data in the literature.

 

Plain language summary

Acupuncture as a treatment modality for patients with glaucoma

Glaucoma is a leading cause of blindness worldwide. Although there are many existing treatments, including the use of eye drops, laser treatment, and a variety of surgical procedures, some patients may seek complementary or alternative medicine such as acupuncture to supplement their regular treatment. This review aimed to evaluate available evidence of the effectiveness and safety of acupuncture in treating patients with glaucoma. We did not find any randomized clinical trials on the subject. The limited information from a few case series highlights the gap in the existing evidence. At this point, the effectiveness of acupuncture as a therapeutic modality for glaucoma could not be established.

 

摘要

背景

用針灸治療青光眼

青光眼是一種多因性的視神經病變，其為後天視網膜神經節細胞喪失以外之正常老年性的喪失與視神經萎縮。雖然現在有許多的治療方式，但青光眼是一種慢性的狀態。有些病患也許會尋求互補的或替代醫療如針灸，以補充他們的常規治療。針灸的基本可信性是其可以經由身體表面相關的穴道刺激，以預防或治療與Chi(傳統的中國概念將之轉換為生命力或能量)流動有關的疾病。

目標

這篇回顧的目的是評估青光眼患者針灸的效果與安全性。

搜尋策略

我們在2006年2月檢索the Cochrane Central Register of Controlled Trials (CENTRAL)，MEDLINE，EMBASE， LILACS，ZETOC，CINAHL，AMED (Allied and Complementary Medicine Database)，TCMLARS (Traditional Chinese Medical Literature Analysis and Retrieval System)，CBM (Chinese Biological Database)，the Chinese Acupuncture Trials Register及the National Center for Complementary及Alternative Medicine網站(http://nccam.nih.gov/)。我們也在2007年4月人工檢索北京聯合醫學院圖書館的Chinese medical journals。

選擇標準

我們計畫納入其中一隻手臂有針灸治療的隨機及類隨機臨床試驗。

資料收集與分析

兩名作者分別依納入及排除標準來評估檢索結果。經由討論解決不一致的評估結果。

主要結論

我們沒有發現隨機臨床試驗，因此沒有進行統合分析。證據受限於少量的小樣本病例序列。

作者結論

在這種情況下，無法從取得的資料中作出可信的結論以支持使用針灸來治療青光眼。由於大部分的青光眼病患目前是經由眼科醫師照護，其不使用非傳統的療法，因此臨床作法的決策將必須依據醫師的判斷及病患的價值關，這些文獻中所缺少的資料。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

以針灸作為青光眼病患的治療模式。在世界各地，青光眼是造成失明的主因。雖然現在有許多的療法，包括使用眼睛滴劑，雷射治療及各種的手術方式，有些病患會尋求完整的或替代醫療如針灸，以補充他們的常規治療。這篇回顧的目的為評估以針灸治療青光眼病患之效果與安全性的證據。我們沒有發現任何關於主題的隨機臨床試驗。少量病例序列的有限資訊突顯了現有證據的不足。在這點上，無法確立以針灸作為治療青光眼之治療模式的效果。