A recent systematic review and meta-analysis published in PLOS ONE examined the efficacy of acupuncture in treating age-related macular degeneration (AMD), a leading cause of vision loss in older adults. The study analyzed nine randomized controlled trials (RCTs) with a total of 508 participants, assessing the impact of acupuncture on visual acuity, central macular thickness (CMT), and overall treatment effectiveness. Findings suggest that acupuncture significantly improves best-corrected visual acuity (BCVA) and reduces retinal swelling, indicating potential therapeutic benefits for AMD patients.
The study found that patients receiving acupuncture demonstrated superior clinical efficacy compared to control groups. The relative risk (RR) for clinical improvement was 1.29 (95% confidence interval [CI]: 1.17–1.42), indicating a 29% greater likelihood of positive outcomes with acupuncture intervention. Additionally, BCVA improved significantly, with a standardized mean difference (SMD) of 0.95 (95% CI: 0.26–1.64), demonstrating a clear advantage over conventional treatments alone. [1]
Moreover, acupuncture was associated with a reduction in central macular thickness (CMT), a critical factor in AMD progression. A pooled analysis of three RCTs reported a mean difference (MD) of -32.74 μm (95% CI: -60.96 to -4.55), indicating a measurable decrease in retinal swelling following acupuncture treatment.
The observed benefits of acupuncture for AMD appear to be mediated through multiple physiological mechanisms, including:
- Enhanced Ocular Microcirculation – Acupuncture may improve retinal blood flow by modulating vascular function and increasing oxygenation of macular tissues.
- Regulation of Vascular Endothelial Growth Factor (VEGF) – Elevated VEGF levels contribute to neovascularization in wet AMD. Acupuncture has been shown to modulate VEGF expression, potentially reducing pathological vessel growth.
- Neuroprotective Effects – Acupuncture may exert protective effects on retinal neurons by modulating inflammatory cytokine levels and oxidative stress markers.
The reviewed studies utilized a combination of periocular and systemic acupuncture points to address both local and systemic factors affecting vision. The most commonly applied acupoints included:
Periocular Points
- Qiuhou (EX-HN7) – Located along the infraorbital border, this point is commonly used for retinal disorders and optic nerve atrophy.
- Taiyang (EX-HN5) – Positioned at the temple region, used to alleviate ocular tension and improve retinal perfusion.
Systemic Points
- Zusanli (ST36) – Found on the lower leg, this point is used to enhance systemic circulation and energy metabolism.
- Sanyinjiao (SP6) – Located above the medial malleolus, this point is chosen to regulate liver and kidney function, both of which influence eye health in traditional Chinese medicine (TCM).
Needling Techniques & Stimulation Methods
Standardized needling procedures were applied across the studies, with variations in insertion depth, gauge selection, and stimulation methods:
- Needle Gauge: Fine filiform needles, typically 0.20–0.25 mm in diameter, were used to minimize discomfort and maximize precision.
- Insertion Depth: Periocular points were needled at a depth of 0.5–1.0 cun (approximately 12–25 mm), avoiding direct penetration of sensitive ocular structures.
- Stimulation Methods: Manual manipulation techniques, including mild rotation and lifting-thrusting methods, were used to elicit the deqi sensation—often described as a dull ache or tingling, indicating qi activation.
- Needle Retention Time: Needles were retained for 20–30 minutes per session.
Treatment Frequency & Duration
The reviewed trials implemented treatment protocols ranging from two to three sessions per week over a four-to-12-week period. Most studies conducted a total of 10 to 36 treatment sessions, with higher frequencies generally correlating with better clinical outcomes.
Biomedical Evidence Supporting Acupuncture’s Efficacy
Objective biomedical findings in the studies provide further evidence of acupuncture’s potential in AMD management:
- Serum VEGF Levels – A subset of trials reported a statistically significant reduction in VEGF concentration post-treatment, suggesting a role in controlling pathological angiogenesis in wet AMD.
- Macular Thickness Changes – Optical coherence tomography (OCT) scans demonstrated a measurable reduction in CMT following acupuncture, indicating reduced retinal edema and inflammation.
- Inflammatory Cytokine Modulation – A decline in pro-inflammatory cytokines, including interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), was observed in patients receiving acupuncture, supporting its role in reducing retinal inflammation.
Safety and Adverse Events
Acupuncture was well-tolerated, with minimal adverse events reported across the included studies. The most common side effect was minor bleeding at needle insertion sites, which resolved without intervention. No severe complications, such as retinal perforation or infection, were recorded, highlighting the safety profile of acupuncture when performed by trained professionals.
Conclusion
The findings from this meta-analysis suggest that acupuncture is a promising adjunctive therapy for AMD, demonstrating significant improvements in visual acuity, retinal structure, and inflammatory regulation.[1] Licensed acupuncturists can incorporate this treatment approach into clinical practice by following established protocols, ensuring accurate point selection, and employing precise needling techniques. Further large-scale RCTs are warranted to solidify acupuncture’s role in ophthalmology and establish standardized treatment guidelines for AMD.
The findings support acupuncture as a viable treatment for vision care. Prof. Jeffrey Pang, L.Ac., a HealthCMi author and department chair at Five Branches University, is widely recognized for his expertise in this field. Patients from diverse locations seek his acupuncture treatments for vision disorders, benefiting from measurable clinical results. Additionally, HealthCMi acupuncturists report that acupuncture enhances the effectiveness of ranibizumab treatments for macular degeneration. This integrative approach consistently yields positive outcomes for patients with wet AMD.
Lucentis (ranibizumab) is an anti-vascular endothelial growth factor (anti-VEGF) monoclonal antibody fragment used to treat neovascular (wet) age-related macular degeneration (AMD), diabetic macular edema (DME), and other retinal diseases. It works by inhibiting VEGF-A, a key factor in abnormal blood vessel growth and leakage in the retina, thereby reducing macular edema and preventing further vision loss. Administered via intravitreal injection, Lucentis has been shown in clinical trials to significantly improve best-corrected visual acuity (BCVA) and slow disease progression. However, repeated injections are often necessary, and potential side effects include intraocular inflammation, increased intraocular pressure, and a small risk of retinal detachment or endophthalmitis.
HealthCMi staff recommend research into an integrative medicine model combining acupuncture with ranibizumab for wet AMD treatment. They anticipate that findings may demonstrate improved clinical outcomes with fewer adverse effects associated with ranibizumab alone, highlighting the value of this research in advancing patient care.
Source
1. Li, X., Wang, Y., Zhang, H., et al. “Efficacy and Mechanisms of Acupuncture for Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis.” PLOS ONE 18, no. 3 (2024): e0283375.
