J. Acupunct. Tuina. Sci.
2013, 11 (6): 358-362
DOI: 10.1007/s11726-013-0732-z
Clinical Study on Acupuncture for Quality of Life in
Patients with Age-related Macular Degeneration
Xia Yong1, Liu Rui2, Sun Jing-jin1,
Xin Shi-en3, Cui Hua-shun3,
Liu Shi-min1
1 Acupuncture and Tuina College,
Shanghai University of Traditional
Chinese Medicine, Shanghai
201203, China
2 Eye and ENT Hospital of Fudan
University, Shanghai 200031,
China
3 Shuguang Hospital Affiliated to
Shanghai University of Traditional
Chinese Medicine, Shanghai
200021, China
Author: Xia Yong, M.D., associate
professor
Corresponding Author: Liu Shi-min,
M.D., associate professor.
E-mail: liusmin@sina.com
● 358 ●︱© Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2013
CLINICAL STUDY
CLC Number: R246.82 Document Code: A
Abstract
Objective: To observe the effect of acupuncture on the quality of life in
patients with age-related macular degeneration (AMD).
Methods: A total of 47 dry AMD cases (94 eyes) were randomly allocated
into three groups, 22 cases (44 eyes) in the acupuncture group, 15 cases
(30 eyes) in the Western medicine group and 10 cases (20 eyes) in the
control group. Cases in the acupuncture group were treated with
acupuncture, cases in the Western medicine group with vitamin C and E
and cases in the control group received no treatment except for
out-patient follow-up.
Results: Acupuncture could significantly improve eye symptoms of dry
AMD cases including blurred vision, drastic decrease in visual acuity,
distorted vision, central scotomas, visual fatigue and dry eyes as well as
other systemic symptoms related to macular degeneration.
Conclusion: Acupuncture can substantially improve the quality of life in
patients with dry AMD.
Key Words
Acupuncture Therapy; Age-related Macular Degeneration; Quality of Life
Age-related macular degeneration (AMD), also known as senile macular
degeneration, is a major cause of blindness in older adults (>50 years) [1]. This
condition is often associated with aging[2] and genetic factors[3-7]. AMD is a
chronic eye condition that results in a drastic decrease in the center of the
visual field (the macula), affecting one or both eyes and causing progressive
visual impairment or even permanent blindness if left untreated. This study
observed the impact of acupuncture on quality of life in AMD patients, using
scores of eye symptoms and systemic symptoms of traditional Chinese
medicine (TCM) as indexes.
1 Clinical Data
1.1 Diagnostic criteria
This is based on the diagnostic criteria for dry AMD stipulated by the
Ocular Fundus Diseases Group, National Academy of Ophthalmology in
1986 and the criteria in the Ophthalmology[8]. Aged above 50; significant
decrease in visual acuity; macular changes such as depigmentation or
pigmentary alterations, drusen, beaten-bronze appearance, atrophic spots; and
absence of macular hemorrhage or fluorescence leakage.
1.2 Differential diagnosis
Peripheral drusen: Drusen is located outside the macular region (not
inside).
Myopic degeneration: Other than atrophic changes in macular region,
J. Acupunct. Tuina. Sci. 2013, 11 (6): 358-362
severe myopia is often accompanied by typical changes
of optic nerve papilla and absence of drusen.
Central serous chorioretinopathy (CSC): Aged below
50, eminence of central serous retina, detachment of
pigment epithelium, stippled atrophy of pigment
epithelium and absence of drusen.
Hereditary macular degeneration: Aged below 50,
absence of drusen and having a family history.
Toxic retinopathy: Poisoning by chloroquine can
cause stippled depigmentation coupled with
pigmentation (Bull’s eye maculopathy), absence of
drusen and having a history of drug administration.
1.3 Inclusion criteria
Aged >50 and disease duration >4 months; willing to
sign the informed consent and agreed to participate in
this clinical study; and discontinued other therapies
over 3 months before joining this study.
1.4 Exclusion and rejection criteria
Those who failed to meet the above inclusion criteria;
having received other therapies that may affect
evaluation of this study; having other medical
conditions during the study; having incomplete data;
failed to stick to the treatment protocol and failed to
examine observation indexes according to the protocol.
1.5 Study subjects
Forty-seven cases (94 eyes) were recruited in the
study from the outpatient departments of Shanghai
Acupuncture and Meridian Research Institute and
Shuguang Hospital Affiliated to Shanghai University of
Traditional Chinese Medicine (eastern section) as well
as Eye and ENT Hospital of Fudan University. These
cases were grouped by a randomized, controlled and
blinded clinical trial design. After signing the informed
consent, they were randomly allocated into three
groups, an acupuncture group of 22 cases (44 eyes), a
Western medicine group of 15 cases (30 eyes) and a
control group of 10 cases (20 eyes). During the clinical
trial, the researchers, practitioners and statistical
personnel were separated. There were no significant
differences in general materials among the three groups
(P>0.05), indicating that they were comparable (table 1).
Table 1. Inter-group comparison of general materials
Gender (case) Age Duration
Groups n
Male Female ( x ±s, year) ( x ±s, month)
Acupuncture 22 12 10 60.45±3.85 5.22±0.56
WM 15 8 7 61.06±2.77 4.36±0.48
Control 10 4 6 60.56±3.23 5.13±0.39
Note: WM=Western medicine group
1.6 Statistical method
The SPSS 18.0 version software was used for
statistical management, ( x ±s) for expression of
© Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2013︱● 359
measurement data, and Q-test was conducted.
2 Treatment Methods
2.1 Acupuncture group
Points: Jingming (BL 1), Shangming (Extra, locates at
midpoint of the supraorbital arch), Neitongziliao [(Extra,
locates at superior to the eyeball, lateral border between
the eyeball and supraorbital wall and at the same level
with Tongziliao (GB 1)], Jianming (Extra, locates at
approximately 0.4 cun below the inner canthus), (Fig.1),
Chengqi (ST 1), Qiuhou (EX-HN 7) and Taichong
(LR 3). Jingming (BL 1), Shangming (Extra) and
Neitongziliao (Extra) were used as one group of points;
Jianming (Extra), Chengqi (ST 1) and Qiuhou
(EX-HN 7) as another group, the two groups were used
alternately, one group for each treatment).
Method: Locations of above points are based on
Nomenclature and Location of Acupuncture Points
(GB/T 12346-2006)[9]. Stainless steel filiform needles of
0.25 mm in diameter and 40 or 50 mm in length were
used for the treatment. Points around the eye socket
were punctured 1.5-2 cun, coupled with mild lifting,
thrusting and rotating manipulation until the
appearance of an intense soreness and distension
behind the eyeballs. Reducing manipulation by lifting,
thrusting and rotating was applied to Taichong (LR 3)
and other adjunct points. The needles were retained for
30 min. The treatment was done twice a week, 2
months for a course of treatment.
Fig.1 Periocular points
2.2 Western medicine group
Cases in Western medicine group took Vitamin C
0.2 g and Vitamin E 0.1 g for each dose, 3 doses a day,
and 2 months for a course of treatment.
2.3 Control group
No intervention measures were taken in the control
group except for 2-month outpatient follow-up.
●
 J. Acupunct. Tuina. Sci. 2013, 11 (6): 358-362

3 Therapeutic Efficacy Observation After treatment, TCM symptoms in the acupuncture

3.1 Observation indexes
3.1.1 Scoring of eye symptoms
The eye symptoms (blurred vision, drastic decrease
in visual acuity, distorted vision, central scotomas, visual
fatigue, seeing things in changed colors and dry eyes)
were scored.
Method: For the first visit, each symptom was scored
3; after three months of treatment, unimproved
symptoms remained 3, somewhat improvement scored
2, substantial improvement scored 1 and total absence
of symptoms scored 0.
3.1.2 Scoring of TCM symptoms
The scoring method was same as that of eye
symptoms.
3.2 Treatment results
3.2.1 Comparison of TCM symptoms among the three
groups
group were substantially improved, but not in the
Western medicine group and the control group. This
indicated that acupuncture obtained better overall
effects than Western medicine (table 2).
3.2.2 Comparison of eye symptoms among the three
groups
After treatment, except for seeing things in changed
colors, other eye symptoms were significantly improved
in the acupuncture group (P<0.05) but not in the
Western medicine group and the control group
(P>0.05). After treatment, except for seeing things in
changed colors, there were significant differences
between the acupuncture group and the other two
groups (P<0.05) and there were no significant
differences between the Western medicine group and
control group (P>0.05), indicating that except for seeing
things in changed colors, acupuncture obtained better
effects than the other two in improving other eye
symptoms (table 3).

Table 2. Inter-group comparison of TCM symptoms before and after treatment ( x ±s, point)
Acupuncture group Western medicine group Control group
TCM symptoms
Before After Before After Before After
n n n
treatment treatment treatment treatment treatment treatment
Tastelessness (no thirsty) 13 3.00±0.00 2.03±0.011)2) 10 3.00±0.00 3.00±0.00 13 3.00±0.00 3.00±0.00
Thirsty with a desire to drink water 6 3.00±0.00 2.00±0.011)2) 5 3.00±0.00 3.00±0.00 6 3.00±0.00 3.00±0.00
1)2)
Dry stools 11 3.00±0.00 2.04±0.02 9 3.00±0.00 3.00±0.00 11 3.00±0.00 3.00±0.00
1)2)
Poor memory 21 3.00±0.00 1.60±0.01 14 3.00±0.00 3.00±0.00 21 3.00±0.00 3.00±0.00
Dizziness 19 3.00±0.00 1.58±0.011)2) 13 3.00±0.00 3.00±0.00 19 3.00±0.00 3.00±0.00
1)2)
Headache 12 3.00±0.00 2.00±0.01 10 3.00±0.00 3.00±0.00 12 3.00±0.00 3.00±0.00
1)2)
Lumbar and knee soreness/weakness 21 3.00±0.00 1.51±0.03 14 3.00±0.00 3.00±0.00 21 3.00±0.00 3.00±0.00
Poor appetite 18 3.00±0.00 1.78±0.011)2) 13 3.00±0.00 3.00±0.00 18 3.00±0.00 3.00±0.00
1)2)
Dry, bitter mouth 11 3.00±0.00 1.59±0.02 11 3.00±0.00 3.00±0.00 11 3.00±0.00 3.00±0.00
1)2)
Frequent urination 20 3.00±0.00 1.00±0.01 13 3.00±0.00 3.00±0.00 20 3.00±0.00 3.00±0.00
1)2)
Tinnitus 15 3.00±0.00 2.00±0.01 12 3.00±0.00 3.00±0.00 15 3.00±0.00 3.00±0.00
Insomnia 20 3.00±0.00 1.59±0.011)2) 13 3.00±0.00 3.00±0.00 20 3.00±0.00 3.00±0.00
1)2)
Dream-disturbed sleep 17 3.00±0.00 1.43±0.02 10 3.00±0.00 3.00±0.00 17 3.00±0.00 3.00±0.00
1)2)
Palpitations 12 3.00±0.00 2.31±0.01 12 3.00±0.00 3.00±0.00 12 3.00±0.00 3.00±0.00
Gastric distension 9 3.00±0.00 2.42±0.011)2) 5 3.00±0.00 3.00±0.00 9 3.00±0.00 3.00±0.00
1)2)
Hot drink preference 8 3.00±0.00 2.49±0.01 8 3.00±0.00 3.00±0.00 8 3.00±0.00 3.00±0.00
1)2)
Loose stools 8 3.00±0.00 2.49±0.01 7 3.00±0.00 3.00±0.00 8 3.00±0.00 3.00±0.00
Spontaneous sweating 15 3.00±0.00 1.99±0.011)2) 10 3.00±0.00 3.00±0.00 15 3.00±0.00 3.00±0.00
Sallow face 13 3.00±0.00 2.22±0.011)2) 11 3.00±0.00 3.00±0.00 13 3.00±0.00 3.00±0.00
1)2)
Night sweats 9 3.00±0.00 2.42±0.01 9 3.00±0.00 3.00±0.00 9 3.00±0.00 3.00±0.00
1)2)
Low back pain 14 3.00±0.00 2.04±0.02 11 3.00±0.00 3.00±0.00 14 3.00±0.00 3.00±0.00
Note: Intra-group comparison with score of before treatment, 1) P<0.05; compared with the results after treatment of the Western
medicine group and the control group, 2) P<0.05

● 360 ●︱© Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2013
J. Acupunct. Tuina. Sci. 2013, 11 (6): 358-362

Table 3. Inter-group comparison of eye symptoms before and after treatment ( x ±s, point)
Acupuncture group Western medicine group Control group
Items Affected Before After Affected Before After Affected Before After
eyes treatment treatment eyes treatment treatment eyes treatment treatment
Blurred vision 44 3.00±0.00 2.00±0.031)2) 30 3.00±0.00 2.90±0.04 20 3.00±0.00 3.00±0.00
1)2)
DVD 32 3.00±0.00 1.00±0.01 25 3.00±0.00 3.00±0.00 16 3.00±0.00 3.00±0.00
1)2)
Distorted vision 10 3.00±0.00 1.00±0.02 8 3.00±0.00 3.00±0.00 6 3.00±0.00 3.00±0.00
Central scotomas 32 3.00±0.00 1.00±0.011)2) 20 3.00±0.00 3.00±0.00 14 3.00±0.00 3.00±0.00
1)2)
Visual fatigue 36 3.00±0.00 1.00±0.02 30 3.00±0.00 3.00±0.00 18 3.00±0.00 3.00±0.00
STCC 8 3.00±0.00 2.50±0.03 6 3.00±0.00 3.00±0.00 4 3.00±0.00 3.00±0.00
1)2)
Dry eyes 24 3.00±0.00 1.00±0.01 18 3.00±0.00 3.00±0.00 12 3.00±0.00 3.00±0.00
Note: DVD=Drastic vision decrease; STCC=Seeing things in changed colors; intra-group comparison with score of before treatment,
1) P<0.05; compared with the results after treatment of the Western medicine group and the control group, 2) P<0.05

3.3 Adverse events during treatment
During treatment, 10 of 22 cases (male/female
ratio=1:9) in the acupuncture group experienced
bleeding and hematoma in the orbital region, no
adverse events occurred in the Western medicine
group and the control group.
4 Discussion
Common symptoms of AMD cases include blurred
vision, dramatic decrease in visual acuity, distorted
vision, central scotomas, visual fatigue, seeing things in
changed colors and dry eyes. According to this clinical
study, after treatment, acupuncture could substantially
improve eye symptoms except for seeing things in
changed colors and thus increased the patients’ quality
of life. Patients came with the help of a family member
for the first visit due to severe eye discomfort but could
come independently after a period of treatment.
Seeing things in changed colors means an inability to
distinguish normal colors. It is similar to color
blindness or weakness and has always been an
intractable eye condition. This clinical study has shown
that acupuncture didn’t work well for seeing things in
changed colors. Further research is still needed in this
aspect.
Since visual function is closely associated with
Zang-Fu organs and meridians, we’ve also observed
other systemic symptoms related to macular
degeneration such as headache, dizziness, poor
memory, poor appetite, dry bitter mouth, dry stools,
frequent urination and lumbar and knee
soreness/weakness. After treatment, the above
symptoms in the acupuncture group were substantially
improved compared with the Western medicine group
and the control group. This indicates that acupuncture
can obtain better overall effects for AMD.
Normal functions of the eyes rely on qi nourishment
of the five Zang and six Fu organs. Of points selected in
this clinical study, Jingming (BL 1) is a major local point
for eye problems with its distinctive effects of
unblocking collaterals and sharpening the eyes.
Chengqi (ST 1) activates qi and blood and is also a
major point for eye problems. Other local points,
Shangming (Extra), Neitongziliao (Extra), Jianming
(Extra) and Qiuhou (EX-HN 7), were combined to
circulate qi and blood around the eyes. Taichong (LR 3)
was used for systemic regulation[10-14].
Due to increased vascular fragility and longer clotting
time in elderly females, acupuncture may easily cause
bleeding and hematoma. As a result, it should be
cautious in needling points around the orbit in those
patients[15].
Conflict of Interest
There is no potential conflict of interest in this article.
Acknowledgments
This work was supported by Scientific Research Fund
of Traditional Chinese Medicine from Shanghai
Municipal Health Bureau (2010L001A).
Statement of Informed Consent
All of the study subjects knew this clinical trial and
signed the informed consent.
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Translator: Han Chou-ping
Received Date: August 15, 2013