Intervention Review

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Acupuncture for glaucoma

  1. Simon K Law1,*,
  2. Tianjing Li2

Editorial Group: Cochrane Eyes and Vision Group

Published Online: 31 MAY 2013

Assessed as up-to-date: 18 APR 2013

DOI: 10.1002/14651858.CD006030.pub3


How to Cite

Law SK, Li T. Acupuncture for glaucoma. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD006030. DOI: 10.1002/14651858.CD006030.pub3.

Author Information

  1. 1

    University of California, Los Angeles, Jules Stein Eye Institute, Los Angeles, California, USA

  2. 2

    Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA

*Simon K Law, Jules Stein Eye Institute, University of California, Los Angeles, 100 Stein Plaza 2-235, Los Angeles, California, 90095, USA. Law@jsei.ucla.edu.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 31 MAY 2013

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Characteristics of included studies [ordered by study ID]
Her 2010

MethodsStudy design: RCT.

Number randomized (total and per group): 33 participants in total; 16 participants (28 glaucoma eyes) in the auricular acupressure group and 17 participants (32 glaucoma eyes) in the sham group.

Number analyzed (total and per group): 33 participants in total; 16 participants (28 glaucoma eyes) in the auricular acupressure group and 17 participants (32 glaucoma eyes) in the sham group.

Exclusions and loss to follow-up: 0.

Study follow-up: 8 weeks.


ParticipantsCountry: Taiwan.

Age (mean ± SD, range), years: 73.6 ± 9.1 in the acupressure group, 76.3 ± 10.5 in the sham group.

Gender: 3/16 in the acupressure group and 4/17 in the sham group are female.

Inclusion criteria: (1) age 30 years or older and (2) history of unilateral or bilateral glaucoma or ocular hypertension that has been treated for at least 1 year.

Exclusion criteria: (1) laser trabeculoplasty in the past; (2) filtering surgery for glaucoma in the past; (3) persistent ocular inflammation within the past 1 year; (4) start of or adjustment to the use of any systemic medication that affects the IOP within 3 months; (5) end-stage glaucoma with impending phthisis bulbi; (6) no detectable IOP because of poor psychological condition.


InterventionsTreatment or intervention 1: auricular acupressure.

Control or intervention 2: sham group.

General procedures (e.g., pre-op or post-op tests, medications, procedures):

"Patients in the acupressure group received ‘stimulator tapping’ and massage of the auricular points (kidney, liver, and eye) over the right ear at our first course of outpatient clinic. Tapping stimulation was administered using a 1-mm alloy ball (Magrain; Sakamura, Kyoto, Japan) designed for acupressure, which was applied to the surface of the auricular acupoints. Subsequently, over a 4-week period, patients regularly massaged their ears using thumb and index finger (squeezing each side of the ear with inward pressure from opposing finger and thumb) twice per day for 9 minutes each time (3 minutes/each point). A regular follow-up was performed and the side for tapping, left ear or right ear, was alternated weekly. After 4 weeks of follow-up, tapping of the acupoints was discontinued and no further massages were given. The investigators re-evaluated IOP, uncorrected visual acuity, and best corrected visual acuity at the 8-week follow-up conducted at the clinic. Patients in the sham group received stimulator tapping but no massage at the sham auricular points (wrist, shoulder, and jaw). All other treatment modalities were the same as those for the acupressure group."


OutcomesPrimary outcome(s): IOP and visual acuity with or without glasses were measured.

Secondary outcome(s): N/A.

Measurements taken, specify intervals at which outcomes assessed: "IOP was measured with a Goldmann applanation tonometer (Haag-Streit AG, Koeniz, Switzerland). Visual acuity was examined with a 6-m visual acuity chart. The glaucomatous eyes were used for analysis of IOP, as were eyes with better than 0.01 (decimal) visual acuity. All visual acuity data were transformed to the LogMAR (MAR¼minimal angle resolution) form for analysis."

Unit of analysis (individual or eye): eye or individual (1 eye per person was used for the analysis).

Other issues with outcome assessment (e.g., quality control for outcomes if any): N/A.


NotesStudy dates: N/A.

Funding source(s): National Science Counsel of Taiwan (NSC 97-2320-B-039-022-MY3 and NSC 98-2815-C-039-097-B), Department of Health, Executive Yuan, Taiwan (DOH98-TD-F-113-098011), and China Medical University (CMU98-CT-10), Taichung, Taiwan,

Publication language: English.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskMethod used to generate random sequence was not described in the article. After contacting the author, we received the following information: "We used computer to generate 40 (our original expected patient collection numbers) simple randomized allocation sequences. We then assigned patients to 'control' or 'trial' group according to their clinic visit order. So we knew the next patient would be assigned to which group, but we didn't know who would be the next one (patient's visit order was arranged by the clinic assistant, who didn't know the randomized allocation sequences). The patient him-/herself would not know which group he/she would be assigned."

Allocation concealment (selection bias)Low riskMethod used to conceal allocation was not described in the article. We considered that allocation was adequately concealed after contacting the authors because "patient's visit order was arranged by the clinic assistant, who didn't know the randomized allocation sequences."

Blinding of participants and personnel (performance bias)
All outcomes
Low riskMasking of participants and personnel was not described in the article. After contacting the author, we received the information that "patients were blinded of their treatment group whereas the outcome assessors were not blinded."

Blinding of outcome assessment (detection bias)
All outcomes
High riskSee above.

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo loss to follow-up was reported.

Selective reporting (reporting bias)Unclear riskOriginal protocol was not available.

Other biasLow riskNo other bias was identified.

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Jiang 1996Not a randomized controlled trial.

Kumar 1994Nonrandomized comparative study; acupuncture as defined in this review was not used.

Nesterov 1997Nonrandomized comparative study; acupuncture as defined in this review was not used.

Xu 2012Not a randomized controlled trial.

 
Characteristics of studies awaiting assessment [ordered by study ID]
Hu 1995

MethodsFifty Chinese patients (61 eyes) were included. Twenty-five patients (32 eyes) were assigned to acupuncture plus "Western medicine," and 25 patients (29 eyes) were assigned to "Western medicine" only.

ParticipantsPatients with acute angle-closure glaucoma.

InterventionsGroup 1: acupuncture (acupuncture 30 minutes once daily for 5-7 days) plus "Western medicine" (did not specify the drug name or the usage).

Group 2: pilocarpine 1% eye drop plus carbonic anhydrase inhibitor (did not specify the usage).

OutcomesIntraocular pressure (IOP) (time points measured were not reported in the article).

Notes

Huo 2009

MethodsNinety-six Chinese patients (166 eyes) were included. Forty-four patients (77 eyes) were assigned to pricking blood treatment, and 52 patients (89 eyes) were assigned to timolol.

ParticipantsPatients with primary open-angle glaucoma.

InterventionsGroup 1: pricking blood at Neiyingxiang (EX-HN9).

Group 2: timolol maleate 0.5% eye drop (did not specify the usage).

OutcomesIntraocular pressure (IOP) (time points measured were not reported in the article).

Notes

Wu 2010

MethodsSixty Chinese patients (120 eyes) were included. Thirty patients (60 eyes) were assigned to acupuncture and 30 patients (60 eyes) were assigned to timolol.

ParticipantsPatients with primary open-angle glaucoma.

InterventionsGroup 1: acupuncture for 20 minutes.

Group 2: timolol eye drop twice daily (did not report the concentration of timolol or the duration of use).

OutcomesIntraocular pressure (IOP), visual acuity, visual field loss, and cup/disc ratio (time points measured were not reported in the article).

Notes

Zhang 1995

MethodsOne hundred forty-eight Chinese patients (246 eyes) were included. Ninety-six patients (166 eyes) were assigned to pricking blood therapy, and 52 patients (80 eyes) were assigned to pilocarpine.

ParticipantsPatients with chronic primary glaucoma and chronic angle-closure glaucoma.

InterventionsGroup 1: pricking blood at Erjianxue.

Group 2: pilocarpine 1% eye drop once (did not specify the duration of therapy).

OutcomesIntraocular pressure (IOP) (time points measured were not reported in the article).

Notes

Zhang 2003

MethodsOne hundred ninety-eight Chinese patients (204 eyes) were included. One hundred eight patients (111 eyes) were assigned to acupuncture with manipulation, and 90 patients (93 eyes) were assigned to acupuncture without manipulation.

ParticipantsPatients with acute angle-closure glaucoma.

InterventionsGroup 1: acupuncture with manipulation.

Group 2: acupuncture without manipulation.

OutcomesAqueous flow (F value at 3, 6, and 12 months).

Notes

Zhang 2009

MethodsForty-nine Chinese patients (86 eyes) were included. Forty-three eyes were assigned to acupuncture, and 43 eyes were assigned to timolol.

ParticipantsPatients with primary open-angle glaucoma.

InterventionsGroup 1: acupuncture.

Group 2: timolol 0.5% eye drop twice daily.

OutcomesIntraocular pressure (IOP) at 6 months.

Notes

Zhou 2007

MethodsForty-four Chinese patients (60 eyes) were included. Twenty-two patients (30 eyes) were assigned to acupuncture, and 22 patients (30 eyes) were assigned to no treatment.

ParticipantsPatients had undergone glaucoma surgery.

InterventionsGroup 1: acupuncture.

Group 2: no treatment.

OutcomesVisual acuity, visual field (time points measured were not reported in the article).

Notes

 
Characteristics of ongoing studies [ordered by study ID]
JPRN 2009

Trial name or titleAcupuncture for Glaucoma.

MethodsThis is an interventional, parallel, randomized study.

ParticipantsInclusion criteria: patients with glaucoma treated for at least one year with ocular hypotensive medication.

Exclusion criteria: laser trabeculoplasty, any ocular surgery; inflammation within one year; other abnormal ocular condition; or starting or adjusting the use of any systemic medication affecting intraocular pressure (IOP) within three months.

InterventionsPatients will be randomly assigned to either standard treatment or standard treatment plus acupuncture.

Outcomes1. IOP.

2. Blood flow volume of eyeball.

Starting date27/10/2009.

Contact informationt-seki@m.tains.tohoku.ac.jp

NotesRecruitment status: not yet recruiting.