Optimal acupuncture protocol improving symptoms of typical dry eye syndrome: meta-analysis and systematic review

Joon-Gon Park; Bong Hyo Lee; Ji-Ho Na; Ji-Hyeo Jung; Chang-Hyun Song

doi:10.1016/j.heliyon.2023.e18226

Optimal acupuncture protocol improving symptoms of typical dry eye syndrome: meta-analysis and systematic review

Heliyon. 2023 Jul 13;9(7):e18226. doi: 10.1016/j.heliyon.2023.e18226. eCollection 2023 Jul.

Authors

Joon-Gon Park¹, Bong Hyo Lee^{1

2}, Ji-Ho Na¹, Ji-Hyeo Jung¹, Chang-Hyun Song^{1

3}

Affiliations

¹ College of Korean Medicine, Daegu Haany University, Gyeongsan, 38610, Republic of Korea.
² Department of Acupuncture, Moxibustion and Acupoint, College of Korean Medicine, Daegu Haany University, Daegu, 42158, Republic of Korea.
³ Department of Anatomy and Histology, College of Korean Medicine, Daegu Haany University, Gyeongsan, 38610, Republic of Korea.

Abstract

Previous meta-analyses have shown a superiority of acupuncture over artificial tear for treating typical dry eye syndrome (DES). However, given that the acupuncture protocols were quite diverse in the randomized controlled trials (RCTs) included in the meta-analyses, it is necessary to establish the acupuncture guidelines. Thus, the optimal acupuncture protocol involved in improvements of tear-film breakup time (BUT) or Schirmer tear test (STT) was examined by meta-analyses for RCTs in patients with typical DES. Eight databases until Jun 2018 were searched for 21 RCTs (n = 1542 eyes) comparing effectiveness of acupuncture versus artificial tear control. Indirect comparison of Bucher analysis was used to find specific acupoints (SAPs) improving BUT or STT by comparing the outcomes between subgroups of the RCTs including and excluding certain SAPs. Meta-analysis was examined for the outcomes in subgroups of the RCTs based on the number of SAPs, and network meta-analysis was for multiple pairwise comparisons across the protocols using the SAPs to yield relative effects. The Bucher analyses identified nine SAPs with positive effects on BUT or STT, and the positive relations of two SAPs involved in improvements of both BUT and STT suggested potential combinations of three ('KI3-LI4-SP6' or 'KI3-GB14-ST2') or four SAPs ('KI3-BL1-EX-HN7-SP6'). Subgroup meta-analyses showed the SAP-depending improvements of BUT or STT in the subgroups including more than three SAPs, compared with the artificial tear control. Meta-regression and network meta-analyses revealed significant correlations between the number of SAPs and the improvements of BUT and STT, and demonstrated that acupuncture using four SAPs for 21-30 days, particularly at two-three times per week, can be optimal for improving the symptoms of typical DES. These results provide useful information for guiding acupuncture in clinical trials for DES.

Keywords: Acupuncture protocol; Artificial tear; Keratoconjunctivitis sicca; Meridian; Schirmer; Tear-film breakup time; Xerophthalmia.