Reversal of Vision Loss in Age-Related Macular Degeneration Using Medical Acupuncture — A Proof-of-Concept Report
Presented at the XVIII International Congress of Eye Research Beijing, China, 28 September 2008
Alston C. Lundgren, MD
Abstract
Age-related macular degeneration (AMD) is the major cause of vision loss in the over age 50 population in USA. The AREDS Study has demonstrated the benefits of high- dose antioxidant supplements in slowing the progression of AMD. Intravitreal injections of anti-VEGF antibodies (ranaibizumab) have been shown to stabilize vision in exudative AMD, but vision improvement was found in only 34% of these patients. The efficacy and the safety of medical acupuncture were evaluated in an analysis of AMD patients (both dry and wet form with non-active and disciform lesions.) Patients underwent conventional therapy as well as receiving a standardized protocol of medical acupuncture treatments combining a number of different techniques. These techniques include Canadian Neuroanatomic Acupuncture, German Ear Acupuncture, Chinese and Japanese Scalp Acupuncture and French Energetics.
The primary efficacy endpoint was mean change from baseline visual acuity using both distant and near ETDRS eye charts.
150 individual patients (268 eyes) with dry AMD and 68 individual patients (97 eyes) with wet AMD were treated between November 2007 and August 2008. Mean intake distant visual acuity was 26 letters for those with dry AMD (25 letters equals Snellen 20/80) and 15 letters for those with wet AMD (15 letters equals Snellen 20/125.) Mean intake near acuity was 32 letters (Snellen 20/115) for dry and 20 letters (Snellen 20/200) for wet AMD. 88.1% of dry eyes improved while 9.6% lost visual acuity. 84.5% of wet eyes improved while 13.4% lost vision. When visual acuities for near and distant tests for both eyes were combined, 93% of individuals had gains in vision for both wet and dry varieties of AMD.
The mean number of treatments per patient for both dry and wet AMD eyes was 4. The net overall improvement in visual acuity for patients with dry AMD was 5.8 letters for distant vision and 4.5 letters for near vision. Patients with wet AMD improved 5.5 letters for distant vision and 4.3 letters for near vision.
Additionally, there were consistent improvements in contrast sensitivity as measured by Pelli-Robson charts, color discrimination as measured by isochromatic charts and subjective vision as measured by VF-14 questionnaires. The only side effects were periorbital ecchymoses which always self-resolved.
Medical acupuncture administered in addition to conventional therapy provided significant visual acuity benefit to patients with both dry and wet AMD and was well tolerated. No serious ocular or non-ocular side effects were observed.
Statistical Significance
Patients sometimes test better and sometimes test worse on eye charts on different days. Literature supports an individual having test-to-test variation as being +/-1 1/2 lines in either direction with a 95% confidence level. 18, 19 That implies that 1 1/2 lines equals 2 standard deviations. Thus one standard deviation is 0.75 lines on a logMAR chart like the ETDRS ones.
The Central Limit Theorem addresses the standard deviation of a group. The standard deviation of a group comprised of N individuals each having standard deviation of d is equal to d divided by the square root of N. 20
For groups of the sizes reported, the standard deviation is on the order of 1/10th line. The probability of the measured improvements occurring by chance is p < .001. That makes the reported results extremely significant.
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