An acupuncture meta-analysis for optic atrophy Seven randomized, controlled trials

OBJECTIVE: To evaluate the efficacy and safety of acupuncture for optic atrophy. DATA SOURCES: A computer-based online search was conducted in Medline (1966-2008), Embase (1986-2008), the Cochrane Library (up to 2008), Chinese Biomedical Literature Database (1975-2008), China National Knowledge Infrastructure (1994-2008), VIP Database (1989-2008), Wanfang Database (1980-2008) and the National Research Register for ongoing trials. DATA SELECTION: Randomized, controlled trials addressing acupuncture treatment for patients with optic atrophy were included in this review. Inclusion criteria evaluated all forms of acupuncture therapy, such as filiform needle, electro-acupuncture, laser-acupuncture, acupressure, and auricular-acupuncture. Comparisons between acupuncture therapy and no treatment (blank) or placebo or Chinese medicine or Western medicine, as well as between acupuncture as an adjuvant and other treatments, were included. Exclusion criteria included studies comparing different forms of acupuncture therapy, different manipulations of acupuncture, and different acupuncture prescriptions, as well as non-randomized, controlled trials and animal studies. The domain-based evaluation criteria recommended by the guidelines in Chapter 8 of the Cochrane Handbook for Systematic Reviews of Interventions 5.0.1 was used to assess quality of the included studies. According to the type of outcome index, measurement data as assessed by weighted mean difference or standardized mean difference and 95% confidence interval; numeration data was estimated by relative risk and 95% confidence interval. Heterogeneity was analyzed by Meta-analysis using RevMan 5.0 software. MAIN OUTCOME MEASURES: Improved visual acuity and visual field was sought between treatment and control groups in the included articles. RESULTS: Seven randomized, controlled trials were included after screening and application of inclusion and exclusion criteria. However, the studies were of low methodological quality and lacked comparisons between acupuncture and no treatment or placebo. Applying visual acuity as the outcome index, meta-analysis indicated: the effect of medicine combined with acupuncture was superior to the medicine alone (relative risk = 1.41, 95% confidence interval 1.14-1.70, P < 0.01), the efficacy of acupuncture was better than medicine alone (relative risk = 1.42, 95% confidence interval 1.14-1.77, P < 0.01). Using visual field as the other outcome index, meta-analysis revealed: effectiveness of acupuncture or acupuncture in combination with medicine was superior to medicine alone (relative risk = 1.47, 95% confidence interval 1.27-1.69, P < 0.01). The 7 included articles were incorporated in a sensitivity analysis, and the overall effect showed a significant difference (relative risk = 1.35, 95% confidence interval 1.16-1.56, P < 0.01). Acupuncture was not associated with any adverse events in any of the studies. CONCLUSION: Acupuncture therapy was determined to be superior to medicine in terms of improved visual acuity and visual field. However, well-designed, randomized, controlled trials with adequate controls and scientific rigor are urgently needed.