| Objective1 To observe and evaluate the clinical efficacy of young and middle-aged asthenopia by dredging meridians in massage objectively,investigate the mechanism of action,explore the feasibility and validity of neck treatment and provide the basis for promoting the prevention and treatment of asthenopia in clinic,by the investigation of asthenopia symptoms,the examination related to xerophthalmia,the detection of accommodation and convergence parameters,and the analysis of color Doppler ultrasound flow imaging(CDFI).2 To summarize the clinical experience of treating xerophthalmia caused by video display terminal(VDT)syndrome with external therapy by my tutor,professor Jin-Ming.Methods1 Clinical research(1)Grouping120 patients(3 cases were lost)who met the inclusion criteria were randomly divided into periocular group(treatment group 1)with 38 patients,neck group(treatment group 2)with 39 patients and dredging meridians group(treatment group 3)with 40 patients.(2)TreatmentPatients in periocular group were treated by periocular massage and auricular point pressing vaccaria.Patients in neck group were treated by neck massage and auricular point pressing vaccaria.Patients in dredging meridians group were treated by periocular massage,neck massage and auricular point pressing vaccaria(the combination therapy of the first two groups).All patients were treated twice a week for 2 weeks.(3)Observed indicators and time pointsBefore treatment,all patients received routine ophthalmic tests,including the best corrected visual acuity(BCVA),intraocular pressure,slit-lamp examination,fundus and refractive examination,also the examination related to xerophthalmia,the examination of phoria,accommodation function,convergence function and the analysis of CDFI,then filled out questionnaires and scored symptoms.All the above tests were repeated after 2-week treatment to evaluate clinical efficacy.Main observed index included asthenopia symptom integral and BCVA score.Secondary observed index included the examination related to xerophthalmia,the examination of phoria,accommodation function,convergence function and hemodynamics parameters.(4)Follow-up visitAfter treatment,all patients were followed up to score symptoms once a week for 2 weeks,in order to observe the sustainability of treatment effects.2 The summary of professor Jin-Ming’s clinical experience on treating xerophthalmia caused by VDT syndromeI summarized my tutor’s theoretical innovation and clinical experience of traditional Chinses medicine(TCM)external therapy treating xerophthalmia systematically after studying theory and learning following my tutor for three yearsResult1 Clinical research1.1 General conditionIn this study,there was no statistically significant difference in sex,age,spherical equivalent and the average daily time of using eyes 3 months before treatment among three groups(P>0.05),concluding that baseline information kept good consistency.After the data of 177 patients analyzed,asthenopia symptoms with a positive rate above 50%included the intolerance of using eyes for long time(78.6%),the dryness of eyes(77.8%),the soreness of eyes(76.1%),the swelling of eyes(76.1%),neck and shoulder pain(72.6%),tiredness(69.2%),anxiety and irritability(58.1%),orbital pain(50.4%).1.2 The efficacy during treatment(1)Asthenopia symptom integralThe overall efficiency of treatment group 1 was 65.8%,group 2 53.8%and group 3 95.0%.There was statistically significant difference among three groups(P<0.05).Compared to the data before treatment,symptom integral,the time of using eyes for long time before tiredness and daily frequency of asthenopia in each group showed improvement after treatment(P<0.05).After treatment,there was statistically significant difference in symptom integral and the time of using eyes for long time before tiredness among three groups(P<0.05),group3 higher than the other 2 groups(P<0.05),but no statistically significant difference in daily frequency of asthenopia(P>0.05).(2)BCVA scoreCompared to the data before treatment,each group showed improvement with statistically significant difference after treatment(P<0.05).(3)The examination of xerophthalmiaCompared to the data before treatment,breakup time(BUT)and Schirmer’s I test(SIT)in each group showed improvement after treatment(P<0.05),except group 2(P>0.05).After treatment,there was statistically significant difference among three groups(P<0.05),group 2 lower than the other two groups(P<0.05)but no statistically significant difference between group 1 or 3(P>0.05).The comparison of corneal fluorescein staining integral had no statistically significant difference,neither among three groups nor comparing after treatment to before treatment(P>0.05).(4)The examination of phoriaCompared to the data before treatment,there was no statistically significant difference of distant phoria in each group after treatment(P>0.05).After treatment,near phoria degrees in each group were reduced(P<0.05),except group 2(P>0.05),and there was statistically significant difference of short-distance degrees among three groups(P<0.05),group 2 higher than the other two groups(P<0.05)but no statistically significant difference between group 1 or 3(P>0.05).(5)The examination of accommodation functionAmplitude of accommodation(AMP)and monocular/binocular accommodative facility(MAF/BAF):Compared to the data before treatment,each group showed improvement after treatment,with statistically significant difference(P<0.05).After treatment,group 3 showed maximum improvement,group 1 taking second place and group 2 coming last(P<0.05).Accommodative response:Compared to the data before treatment,the lag of accommodation in each group was reduced after treatment(P<0.05),except group 2(P>0.05).After treatment,there was statistically significant difference among three groups(P<0.05),which post hoc tests was not(P>0.05).Negative related accommodation(NRA)and positive related accommodation(PRA):Compared to the data before treatment,PRA in group 3 showed improvement after treatment(P<0.05).Nor did the other two groups(P>0.05).After treatment,there was statistically significant difference of PRA among three groups(P<0.05).In the post hoc tests of PRA,group 3 was higher than group 2(P<0.05),no statistically significant difference comparing group 1 to the other two groups(P>0.05).Compared to the data before treatment,there was no statistically significant difference of NRA in each group after treatment(P>0.05).(6)The examination of convergence functionCompared to the data before treatment,in group 1 and 3,the near point of convergence(NPC)decreased and the accommodative convergence per unit of accommodation ratio(AC/A)increased after treatment(P<0.05),but group 2 had no significant change(P>0.05).After treatment,there was statistically significant difference of NPC among three groups(P<0.05),group 2 higher than the other two groups(P<0.05)but no statistically significant difference between group 1 or 3(P>0.05),and there was no statistically significant difference of AC/A among three groups(P>0.05).(7)Hemodynamics parametersPeak systolic velocity(PSV)in anterior ciliary artery(ACA):Compared to the data before treatment,each group showed improvement after treatment(P<0.05),except group 1(P>0.05).After treatment,there was statistically significant difference among three groups(P<0.05),group 1 lower than the other two groups(P<0.05)but no statistically significant difference between group 2 or 3(P>0.05).End diastolic velocity(EDV)in ACA:Compared to the data before treatment,each group showed improvement after treatment,with statistically significant difference(P<0.05).After treatment,there was statistically significant difference among three groups(P<0.05).Group 3 showed maximum improvement,group 2 taking second place and group 1 coming last(P<0.05).Resistance index(RI)in ACA:Compared to the data before treatment,each group decreased after treatment(P<0.05).After treatment,there was statistically significant difference among three groups(P<0.05),group 3 lower than the other two groups(P<0.05)but no statistically significant difference between group 1 or 2(P>0.05).PSV,EDV,RI in ophthalmic artery(OA):Compared to the data before treatment,each group showed improvement after treatment(P<0.05),except group 1(P>0.05).After treatment,there was statistically significant difference among three groups(P<0.05),group 1 inferior to the other two groups(P<0.05)but no statistically significant difference between group 2 or 3(P>0.05).1.3 Changes of symptom integral during the follow-up visitWe analyzed symptom integral after treatment,one and two weeks follow-up,with the analysis of variance of repeated measures.During the follow-up visit,there was statistically significant difference of grouping effect and time effect(P<0.05).The two effects had interaction to each other(P<0.05),which explained that grouping effect existed and varied with time.Compared to the data before treatment,the integral of each group got lower after two weeks follow-up(P<0.05).1.4 The analysis of correlationAfter treatment,the change of AMP and MAF moderately positively correlated with the change of PSV and EDV in ACA(P<0.05).The change of accommodative response uncorrelated with the change of PSV and EDV in ACA(P>0.05).The change of symptom integral strongly positively correlated with the change of AMP(P<0.05),moderately with MAF(P<0.05)but not with accommodative response(P>0.05)2 The summary of professor Jin-Ming’s clinical experience on treating xerophthalmia caused by VDT syndromeThe causes of xerophthalmia were complex.For currently clinical treatment,it was difficult to fundamentally improve the quality and quantity of tears,making long-term efficacy poor and easily recrudescent.My tutor has been working on integrative Chinese&Western ophthalmology for nearly 40 years,on the principle of promoting lacrimal gland to tear,recover and maintain the stability of tear film actively,in order to minimize drug-related ocular surface damage.Professor Jin was also well-versed in xerophthalmia with TCM external therapy,which made the body absorb drugs through related acupoints by ocular aerosol fumigation and moxibustion.The therapy took advantage of propagated sensation along channel to promote the full use of drugs.Other advantages were simple operation,significant efficacy,safety without side effect and wide use in clinic.Conclusion1 Dredging meridians in massage can significantly improve asthenopia symptoms,better than the separate use of periocular massage and neck massage.2 Neck massage can relief the contracture,smooth qi and blood to moisten and nourish eyes,then increase the blood perfusion in OA and ACA to partly improve AMP and AF,and finally achieve the improvement of asthenopia symptoms.For asthenopia patients with neck pain,dizziness and headache,neck massage have therapeutic advantage.3 The mechanism of ocular and neck massage improving asthenopia may be related to the improvement of ocular perfusion.The improvement of ACA perfusion provides the basis for the recovery of ciliary muscle,which improves the accommodation and convergence function,and eventually reliefs asthenopia symptoms.The combination of the above two kinds of massage can enhance the improvement of blood flow.4 TCM external therapy has proven effects on xerophthalmia.With aerosol fumigation and local moxibustion,the self-made Chinese prescription by my tutor has accumulated rich experience on xerophthalmia,safely and without side effect,which is worth widely developing and applying to the clinic. |
PDF Full Text Request