Clinical Efficacy Evaluation Of Periocular Transcutaneous Electrical Acupoint Stimulation(Eye-TEAS) In The Treatment Of Children With Anisometropic Amblyopia

ObjectiveBased on the basic theory of traditional Chinese medicine and acupuncture therapy,the clinical efficacy and safety of periocular transcutaneous electrical acupoint stimulation（Eye-TEAS）in the treatment of anisometropic amblyopia were studied by giving amblyopia children’s eye Eye-TEAS treatment,and provided new ideas for the treatment of amblyopia in traditional Chinese medicine.MethodsAccording to the inclusion and exclusion criteria,anisometropic amblyopia children aged 6-13 years old were included in the ophthalmology outpatient department of our hospital from October 2019 to June 2021,and they signed the informed consent form and were randomly included.This study was divided into three groups:Eye-TEAS group,visual training group,and Eye-TEAS+visual training group.Eye-TEAS group was treated with Eye-TEAS therapeutic apparatus for acupoint electrical stimulation at once a day,30 min/per time.The children in the visual training group received visual perception network training,twice a day,at 15 min/per time.Eye-TEAS+visual training group was treated with acupoint electrical stimulation by Eye-TEAS therapeutic apparatus and visual perception network training at the same time.The above treatment was performed five days per week,with 4 weeks as a course of treatment,and observation for six courses.All the treatments in the three groups were performed on the basis of daily wearing of glasses and covering.Before treatment,12 weeks and 24weeks after treatment,we observed the best corrected visual acuity（BCVA）,stereo acuity,contrast sensitivity（CS）,accommodative facility（AF）,accommodative amplitude（AMP）,P-VEP P100 amplitude and latency,and changes in retinal and choroidal blood flow of the patients.At the same time,we recorded the adverse reaction events during the treatment to evaluate the efficacy and safety of Eye-TEAS in the treatment of amblyopia.Results（1）There was no significant difference in age,number of children,ratio of male and female,proportion of children with moderate and severe amblyopia and BCVA among the three groups（P>0.05）.During the use of the Eye-TEAS therapeutic apparatus,there were no allergic and obvious tingling symptoms in the eyes.（2）Comparison of BCVA values of amblyopic eyes among the three groups before and after treatment and the effective rate after treatment:BCVA values of the three groups were significantly improved after 12 and 24 weeks of treatment,and the difference was statistically significant as compared with that before treatment（P<0.05）.The effective rates of Eye-TEAS group,visual training group and Eye-TEAS+visual training group at 12 weeks of treatment were 65.12%,66.67%and84.84%,respectively.At 24 weeks of treatment,the rates were 76.74%,77.78%,and93.33%,respectively.There was no significant difference in treatment efficiency between the Eye-TEAS group and the visual training group at 12 and 24 weeks of treatment.Eye-TEAS+visual training group had the highest effective rate,and the difference was statistically significant as compared with the other two groups（P<0.05）.（3）Comparison of far and near stereoscopic visual functions before and after treatment:All three groups could significantly improve the far and near stereoscopic visual functions of amblyopia patients.Eye-TEAS+visual training group outperformed the other two groups in improving the far stereoscopic vision function,and the visual training group was better than Eye-TEAS group.（4）Comparison of CS of each spatial frequency in amblyopic eyes before and after treatment:After 12 weeks of treatment,compared with those before treatment,CS of each spatial frequency in the Eye-TEAS group were not significantly increased（P>0.05）;CS of 6.0 c/d spatial frequency in the visual training group were significantly increased（P<0.05）;CS of 3.0,6.0 and 18.0 c/d spatial frequency in the Eye-TEAS+visual training group were significantly increased（P<0.05）.After 24 weeks of treatment,compared with those before treatment,the spatial frequencies CS of the visual training group and Eye-TEAS+visual training group were significantly increased（P<0.05）,and the spatial frequencies CS of 3.0 and 12.0 c/d in the Eye-TEAS group were significantly increased（P<0.05）.After 24 weeks of treatment,each spatial frequency CS in the Eye-TEAS+visual training group was the highest,but the difference was not statistically significant as compared with the other two groups（P>0.05）.These results indicated that the Eye-TEAS+visual training group had the most significant increase in each spatial frequency CS,followed by the visual training group.（5）Comparison of accommodative facility（AF）of amblyopic eyes before and after treatment:After 12 weeks of treatment,compared with that before treatment,there was no significant increase in AF of Eye-TEAS group and visual training group（P>0.05）,and AF of Eye-TEAS+visual training group was significantly increased（P<0.05）.After24 weeks of treatment,compared with those before treatment,the AF of the three groups were significantly improved（P<0.05）.Eye-TEAS+visual training group had the highest AF at 12 and 24 weeks of treatment.Eye-TEAS group and visual training group could effectively improve the AF of amblyopic eyes,but there was no significant difference between the two groups（P>0.05）.（6）Comparison of the accommodative amplitude（AMP）of amblyopic eyes before and after treatment.After 12 weeks,compared with before treatment,the AMP of Eye-TEAS group did not increase significantly（P>0.05）,but the AMP of visual training group and Eye-TEAS+visual training group both increased significantly（P<0.05）.After24 weeks of treatment,compared with before treatment,the adjustment ranges of the three groups were significantly increased（P<0.05）.after the 12 and 24 weeks of treatment,there was no significant difference in AMP among the three groups（P>0.05）.（7）Comparison of P₁₀₀wave latency and peak value in amblyopia eyes before and after treatment:After 12 weeks of treatment,compared with those before treatment,the1.0 deg P₁₀₀wave latency in all three groups was not significantly shortened（P>0.05）,and the peak values were significantly increased（P<0.05）.The latency of P₁₀₀wave in15 min in the Eye-TEAS+visual training group was significantly shortened（P<0.05）,and the peak value was significantly increased（P<0.05）.The latency and peak of P₁₀₀wave at 15 min in the other two groups were not significantly changed（P>0.05）.Compared within 24 weeks of treatment before treatment,the wave latency of 1.0deg and 15 min P₁₀₀in the Eye-TEAS group and Eye-TEAS+visual training group were significantly shortened（P<0.05）,while the wave latency of 1.0 deg and 15 min P₁₀₀in the visual training group were not significantly shortened（P>0.05）.The 1.0 deg P₁₀₀wave peak value in the Eye-TEAS group was significantly increased（P<0.05）,while the P₁₀₀wave peak value at 15 min P₁₀₀not significantly increased（P>0.05）.The peak values of P₁₀₀wave at 1.0 deg and 15 min P₁₀₀the visual training group were not significantly increased（P>0.05）.The 1.0 deg and 15 min P₁₀₀wave peaks in the Eye-TEAS+visual training group were significantly increased（P<0.05）.At 24 weeks of treatment,the Eye-TEAS+visual training group significantly shortened the P₁₀₀wave latency by 1.0 deg and 15 min,and increased the P₁₀₀peak values by 1.0 deg and 15 min,compared with the visual training group.（8）Comparison of OCTA parameters in amblyopic eyes before and after treatment:After 12 and 24 weeks of treatment,compared with those before treatment,there were no significant changes in subfoveal choroidal thickness（SFCT）,area of foveal avascular zone,FAZ)and superficial retinal capillary plexus（SCP）blood flow density in the three groups（P>0.05）.After treatment with Eye-TEAS,the blood flow density of deep retinal capillary plexus,DCP)tended to increase,with the increase in the temporal side of the parafovea most significant.After treatment,the perfusion areas of choriocapillaris（CC）were increased significantly in the Eye-TEAS group and Eye-TEAS+visual training group（P<0.05）.ConclusionEye-TEAS is a safe and effective therapy for amblyopia,in that it can effectively improve the BCVA,stereoscopic vision function,contrast sensitivity,accommodative facility,accommodative amplitude and optic nerve conduction function of amblyopia patients.It was better than visual training in improving the optic nerve conduction function.Combined with visual training for better curative effect.At the same time,we observed that Eye-TEAS could improve retinal and choroidal blood flow.Therefore,Eye-TEAS is painless and atraumatic,and convenient to use,and is suitable for popularization and use in the treatment of amblyopia in children.