Acupuncture may eventually become another optional treatment apart from patching for lazy eye, also known as amblyopia, especially among older children who have a poorer response to patching, say researchers from China in Archives of Ophthalmology. Approximately 0.3 to 5% of people globally are affected by lazy eye, the authors report as background information.
Lazy eye is a condition that appears during early childhood – the eyesight in one of the eyes does not develop as it should. In the majority of cases only one eye is affected. When a child has amblyopia their brain focuses on one eye much more than the other; in fact, the lazy eye may be ignored altogether. Lack of stimulation of that eye may result in the visual brain cells not maturing normally. Amblyopia is the most common cause of monocular blindness (partial or total blindness in one eye) in the USA.
Between one-third and a half of all lazy eye cases are caused by variations in the degree of myopia (nearsightedness) or hyperopia (farsightedness) between the two eyes (anisometropia). These variations are more effectively corrected with glasses or contact lenses when a child is aged up to seven years. Unfortunately, when the child is older, for example from 7 to 12, visual correction alone is only effective in about 30% of cases.
The addition of patching one eye – known as occlusion therapy – can improve children’s response rates considerably as long as they comply with the doctors instructions. Patching the eye brings with it emotional problems, and also a risk of reverse amblyopia.
Jianhao Zhao, M.D., of Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Shantou, China, wanted to see how effective acupuncture was compared to patching for the treatment of lazy eye. The authors wrote that acupuncture has been successfully used for dry eye and myopia treatment.
They carried out a randomized, controlled trial with 88 children. They were assigned to one of two groups:
Acupuncture Group – 43 children. They were given five treatment sessions each week, which targeted five needle insertion sites, also known as acupoints.
Patching Group – 45 children. Their good eye was patched for two hours each day. They had to do near-vision activities with their lazy eye for one hour each day. Near vision activities include reading or typing.
After a total of 15 weeks’ worth of treatment:
Visual acuity improved by 2.3 lines in the Acupuncture Group
Visual acuity improved by 1.8 lines in the Patching Group
75.6% (31) of the children in the Acupuncture Group experienced an improvement of at least two lines
66.7% (28) of the children in the Patching Group experienced an improvement of at least two lines
In the Acupuncture Group lazy eye was considered as resolved in 41.5% of cases
In the Patching Group lazy eye was considered as resolved in 16.7% of cases
No serious side effects were detected in either group. In both groups, treatment was well tolerated, the authors wrote. The Acupuncture Group children had their treatment after school so that their studies were not disrupted.
The authors wrote:
“Although the treatment effect of acupuncture appears promising, the mechanism underlying its success as a treatment for amblyopia remains unclear.”
The authors believe that well targeted acupuncture may alter the activity of the part of the brain that receives data from the eyes – the visual cortex. They add that the treatment may also enhance blood flow to the eye and surrounding tissues. The generation of compounds that support the growth of retinal nerves may also be stimulated.
The researchers concluded:
“The findings from this report indicate that the treatment effect of acupuncture for amblyopia is equivalent to the treatment effect of patching for amblyopia. However, only patients with anisometropic amblyopia were involved in our study and the follow-up period was relatively short. Moreover, acupuncture itself is a very complicated system of therapy.
Differences exist among acupuncturists, and there are divergent manipulation modes, stimulation parameters, treatment styles and subjective sensations evoked by acupuncture stimulation. Because of the good results obtained in our study, the acupoints that we used could be considered for use in clinical practice.”
“Randomized Controlled Trial of Patching vs Acupuncture for Anisometropic Amblyopia in Children Aged 7 to 12 Years”
Jianhao Zhao, MD; Dennis S. C. Lam, MD, FRCOphth; Li Jia Chen, PhD; Yunxiu Wang, BMed; Chongren Zheng, DEpid; Qiaoer Lin, DN; Srinivas K. Rao, FRCS; Dorothy S. P. Fan, FRCS; Mingzhi Zhang, MD; Ping Chung Leung, MD; Robert Ritch, MD, FRCOphth
Arch Ophthalmol. 2010;128(12):1510-1517. doi:10.1001/archophthalmol.2010.306