Effect of auricular acupressure combined with acupuncture for juvenile pseudomyopia

Abstract

This retrospective study investigated the effect of auricular acupressure combined with acupuncture for juvenile pseudomyopia (JPM). In this retrospective study, we collected and analyzed a total of 66 eligible records of subjects with JPM. They were allocated into a treatment group (n = 33) and a control group (n = 33). All participants in both groups received auricular acupressure. Additionally, children in the treatment group also underwent acupuncture. The primary outcome was naked visual acuity (VA). It was performed using a standard E visual acuity chart. The secondary outcome was visual fatigue symptoms, as assessed by the College of Optometrists in Vision Development Quality of Life (COVD-QoL) questionnaire. All outcomes were analyzed before and after treatment. There were no significant differences regarding the naked VA and COVD-QoL scores before and after treatment between the 2 groups. However, there were significant differences regarding on naked VA (P < .01) and COVD-QoL scores (P < .01) within 2 groups compared before and after treatment. The findings of this study showed that both APP plus acupuncture and APP alone benefit children with JPM.

1. Introduction

Myopia is a common disorder that has become a public health issue worldwide.^[1] It is especially common among the juvenile population, occurring from 6 to 8 years old, developing rapidly from 13 to 16 years of age, and stabilizing after 16 years old.^[2] Its prevalence is reported to be 60% in China, and its incidence ranges from 60 to 80% in China and Singapore.^[3–5] In addition, its prevalence is increasing annually in China, and it is predicted that its prevalence in children and adolescents aged 3 to 19 will increase to 84% by 2050.^[6]

Pseudomyopia is a prestage of reversible myopia.^[7] It is a state of eye fatigue which is commonly resulted from unhealthy eye use. If adolescents with pseudomyopia cannot be identified at an early stage, it can lead to organic eye pathology and develop into true myopia.^[7] Therefore, it is important to treat juvenile pseudomyopia (JPM) effectively and timely. JPM was defined as having blurred distance vision and being prone to visual fatigue with normal near visual acuity (VA) and abnormal distance VA, distance VA can be corrected to normal using the ciliary muscle paralysis test with atropine.

According to acupuncture theory, acupoints are believed to reflect organ disorders.^[8–10] Stimulation at acupoints can locally or distantly modulate organ physiology.^[11–19] Acupuncture at acupoints and auricular acupressure can treat a variety of disorders, such as neck pain, neuropathic pain, stroke rehabilitation, Alzheimer disease, Parkinson disease, dysmenorrhea, depression and anxiety.^{[14,16,20–25]} Most importantly, they have also been reported to effectively manage myopia.^[26,27] However, data on the management of APP plus acupuncture in JPM are limited. Therefore, this retrospective study aimed to investigate the effects and safety of APP and acupuncture in JPM.

2. Methods

2.1. Ethical approval

This retrospective study was approved by the Ethics Medical Committee of The Second Affiliated Hospital of Xi’an Medical University (No.X2Y201902) and Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine (SZFYIEC-PJ-2019-04). The informed consent was waived because all data we collected from the completed case records.

2.2. Study design

This study retrospectively selected and analyzed the 66 eligible patient records. All patients were admitted to The Second Affiliated Hospital of Xi’an Medical University and Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from August 2019 and December 2022. They were assigned to either treatment group (n = 33) or a control group (n = 33). All the patients in both groups received auricular acupressure (AAP). In addition, the patients in the treatment group also received acupuncture treatment. We collected the outcomes and baseline data before and after the treatment.

2.3. Eligibility criteria

The inclusion criteria were as follows: All children were diagnosed with JPM based on the diagnostic standard of pseudomyopia adopted from the diagnostic standard of Theory and Methods of Optometry^[28]; age between 6 and 11 years; and Presence of blurred distance vision and susceptibility to visual fatigue.^[29]

The exclusion criteria were as follows: Age <6 years or more than 11 years; Vision disorder secondary to other diseases; Accompanying other related managements; and Insufficient information on patient records.

2.4. Intervention modality

All participants in both groups received AAP at bilateral auricular acupoints of Shenmen (Gate of Spirit), Yan (Eye), Xin (Heart), Mu1 (Vision 1), and Mu 2 (Vision 2). Taping stimulation was manipulated by their figures 3 times daily, each time for 10 minutes, over the selected auricular acupoints. They were treated weekly for 5 days for a total of 2 weeks.

In addition, participants in the treatment group received acupuncture at bilateral Cuanzhu (BL 2), Yuyao (EX-NH 4), Tongziliao (GB 1), and Hegu (LI 4) for 20 minutes daily once weekly for 2 weeks.

2.5. Outcome measurements

The primary outcome was naked VA. It was performed using a standard E visual acuity chart. The secondary outcome was visual fatigue symptoms. It was assessed by the College of Optometrists in Vision Development Quality of Life (COVD-QoL) questionnaire. All outcome data were analyzed before and after treatment.

2.6. Statistical analysis

Statistical analysis was carried out by SAS (version 9.2; SAS Institute Inc., Cary, North Carolina). Independent sample t test was employed to analyze the difference in naked VA and COVD-QoL between the treatment and control groups before and after treatment. A 2-side value of P < .05 was considered as having statistically significant.

3. Results

The general characteristics of the participants are presented in Table 1. No significant differences were found in age, gender, affected eyes, degree of myopia, number of children wearing glasses, and disease duration between the 2 groups in this study (Table 1).

Table 1.

Patient characteristics in both groups.

Characteristics	Treatment group (n = 33)	Control group (n = 33)	P value
Age (yr)	8.2 (1.8)	7.9 (2.0)	.52
Gender
Male	17 (51.5)	19 (57.6)	.62
Female	16 (48.5)	14 (42.4)
Affected eyes	64 (97.0)	66 (100.0)	.49
Degree of myopia	4.64 (0.38)	4.67 (0.40)	75
No. of children using glasses	11 (33.3)	13 (39.4)	.61
Disease duration (mo)	8.3 (2.4)	9.0 (2.6)	.26

Data are present as mean ± standard deviation or number (%).

As for naked VA, there were no significant differences in naked VA before (P = .58, Table 2) and after (P = .64, Table 2) treatment between the 2 groups. However, there were significant differences in the naked VA after treatment the treatment and control groups (P < .01, Table 2).

Table 2.

Comparison of distance naked VA between the two groups.

VA	Treatment group (n = 33)	Control group (n = 33)	P value
Before treatment	0.70 (0.15)	0.71 (0.14)	.58
posttreatment	0.96 (0.18)	0.95 (0.17)	.64
Change from prior treatment	0.26 (0.21, 0.32)*	0.24 (0.20, 0.29)*

Note: Data are present as mean ± standard or mean (range)

VA = visual acuity.

^*P < .01.

Regarding visual fatigue symptoms, there were no significant differences in COVD-QoL scores before (P = .72, Table 3) and after (P = .63, Table 3) treatment between the 2 groups. However, significant differences in COVD-QoL scores were found after treatment in both treatment and control groups (P < .01, Table 3).

Table 3.

Comparison of COVD-QoL between the two groups.

COVD-QoL	Treatment group (n = 33)	Control group (n = 33)	P value
Before treatment	35.5 (8.1)	34.8 (7.5)	.72
posttreatment	18.0 (4.9)	17.7 (5.2)	.63
Change from prior treatment	−17.5 (−21.2, −14.8)	−17.1 (−20.5, −14.4)*

Note: Data are present as mean ± standard or mean (range).

COVD-QoL = College of Optometrists in Vision Development Quality of Life.

^*P < .01.

4. Discussion

Several previous studies have explored the effects and safety of acupuncture or APP in myopia.^[30–33] One study investigated the clinical effects of myopia in children treated with abdominal acupuncture compared to auricular point sticking.^[30] The results showed that abdominal acupuncture showed more promising improvement in the visual levels than auricular point sticking.^[30] One study assessed effect of APP on the management of children with myopia.^[31] The findings showed that when combined with external medical application, APP can enhance myopia.^[31] The other 2 trials compared the effect of myopia control between low-concentration atropine eye drops plus APP and atropine alone.^[32,33] Their results showed that APP combined with low-concentration topical atropine benefit for myopia control.^[32,33] However, there is limited evidence on the APP plus acupuncture for the treatment of JPM.

This study examined the impact of combining AAP with acupuncture treatment in contrast to solely administering AAP for children with JPM. The researchers found that there were no notable variations in the VA or COVD-QoL scores between the 2 groups. However, it was observed that the average naked VA after treatment was significantly more improved than before treatment in both the treatment group and the control group. Moreover, when compared to their previous treatment, the symptoms of visual fatigue, as indicated by the COVD-QoL scores, showed greater improvement after the current treatment in both groups. These findings conclusively suggest that both combining AAP with acupuncture and solely administering AAP can bring about beneficial effects for children suffering from JPM.

This study had several limitations. First, the retrospective nature of this study means that it relied on past data and may have been subject to biases or inaccuracies in the documentation. As a result, the reliability and validity of the findings may be compromised. Second, the small sample size used in this study raises concerns about the statistical power and generalizability of the results. With a limited number of participants, the study may not have been able to detect small or subtle effects and may not represent the broader population accurately. It is important to conduct future studies with larger sample sizes to obtain more robust and reliable results. Third, collecting case records exclusively from 2 hospitals introduces a potential selection bias. The findings of this study may not be representative of other hospitals or regions, as healthcare practices and patient populations can vary across different settings. Therefore, caution must be exercised when generalizing these results to other healthcare facilities or geographical locations. Given these limitations, it is recommended that future research endeavors address these shortcomings and employ more rigorous study designs. Conducting prospective studies, with larger and more diverse samples from multiple healthcare institutions, would enhance the validity and generalizability of the findings.

5. Conclusion

The results of this study showed that both AAP and APP plus acupuncture benefit children with JPM.

Author contributions

Conceptualization: Yan-Ni Zhu, Yuan-Yuan Chen, Ping Cao.

Data curation: Yan-Ni Zhu, Ting Zou, Ping Cao.

Formal analysis: Ping Cao.

Investigation: Ping Cao.

Methodology: Ting Zou.

Project administration: Ping Cao.

Resources: Yan-Ni Zhu, Yuan-Yuan Chen.

Software: Yuan-Yuan Chen, Ting Zou.

Supervision: Ping Cao.

Validation: Yan-Ni Zhu, Yuan-Yuan Chen, Ting Zou, Ping Cao.

Visualization: Yan-Ni Zhu, Yuan-Yuan Chen, Ting Zou, Ping Cao.

Writing – original draft: Yan-Ni Zhu, Ping Cao.

Writing – review & editing: Yan-Ni Zhu, Yuan-Yuan Chen, Ting Zou, Ping Cao.