針刺治療兒童及青少年近視之有效性：系統性回顧與統合分析

The effectiveness of acupuncture in treating myopia in children and adolescents: Systematic review and Meta-Analysis

背景：近視罹患人口節節上升，其盛行率以學齡期及青春期最高，而現今之近視治療主流為散瞳劑眼滴液、多焦點鏡片或角膜塑型鏡片。世界衛生組織於1991年認可以針灸治療兒童近視的方式，雖然曾有系統性回顧研究結果顯示針刺治療改善近視之總有效率高於耳針、戴眼鏡、眼滴液和未治療組，但目前未有文獻分析針刺治療是否可改善視力及屈光度，故進行此篇系統性回顧與統合分析探討針灸治療對於控制兒童和青少年近視的有效性。方法：經由搜尋PubMed、MEDLINE、EMBASE、Cochrane Library、中文電子期刋資料庫（CEPS）、中國期刊全文數據庫（CNKI），使用Cochrane偏差風險評估工具評估介入性研究的品質，並使用Review Manager Software（5.4.1）進行統計分析。結果：經由資料庫篩選260篇文獻，共納入13篇隨機對照實驗，整體風險偏中度至高度。針刺組治療近視的效果比對照組佳（RR = 0.42, 95% CI = 0.19 - 0.66, Random effects model），改善遠距離視力亦優於對照組（SMD = 1.17，95% CI = 0.91 - 1.42,Random effects model），皆具有統計上的差異；但是，針刺治療對於屈光度的改善不具統計上的差異（MD = 0.12, 95% CI = -0.02 - 0.26, Random effects model）。結論：針刺治療對於兒童和青少年之近視皆具有療效，但是屈光度無法因針灸改變。

Background: The population of people with myopia has been growing, particularly the school-age children and adolescent populations. Mainstream treatment of myopia involves the use of mydriatic eye drops, multifocal lenses, or orthokeratology lenses. In 1991, the World Health Organization confirmed acupuncture as a viable myopia treatment for children. According to a study that systematically reviewed the literature, the overall efficacy of acupuncture in treating myopia was higher than that of ear acupuncture, glasses, eye drops, and no treatment. However, no study has analyzed the effectiveness of acupuncture in improving vision and correcting refractive errors. Accordingly, this study conducted a systematic review and a meta-analysis of the literature to discuss the efficacy of acupuncture in controlling myopia in children and adolescents. Methods: The authors searched for relevant studies in PubMed, MEDLINE, EMBASE, Cochrane Library, Chinese Electronic Periodical Services, and China National Knowledge Infrastructure; used the Cochrane risk-of-bias tool to assess the quality of intervention studies; and employed the Review Manager Software (5.4.1) for statistical analyses. Results: 260 papers were screened from database, and a total of 13 randomized controlled trials were included in this study. Most of the included studies had moderate to high risk of bias. According to the analyses, the distance vision of the myopia (SMD = 1.17, 95% CI = 0.91 - 1.42, Random effects model) and total effectiveness rate (RR = 0.42, 95% CI = 0.19 - 0.66, Random effects model) experimental groups who received acupuncture was both significantly better than that of the control groups. However, in terms of correcting refractive errors, the difference was nonsignificant between the experimental and control groups (MD = 0.12, 95% CI = -0.02 - 0.26, Random effects model). Conclusion: Acupuncture is effective in treating myopia in children and adolescents but fails to correct refractive errors.