With the exponential increase of interest in dry eye or ocular surface disease (OSD) among physicians and the industry, we are fortunate to have access to exciting new diagnostic and imaging technology as well as new treatment options and therapeutics for some of our most frustrated patients.
The use of these innovative instruments and therapeutics, coupled with advancing medical research, allows us to forge ahead attaining a new clinical understanding of OSD. However, we must not forget nor forgo our early evidence-based management options for dry eye.
Traditional methods to treat dry eye
Basic to overall health and well-being, nutritional balance should be considered as an integral part of every patient’s eyecare plan. It is fundamental that our bodies remain fueled with the appropriate and balanced intake. This ensures that each bodily microenvironment can access those nutrients necessary for peak performance.
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Dietary supplements are available to support most ocular disease states from dry eye to diabetes. For dry eye patients, the addition of GLA-rich omega products such as HydroEye (Science Based Health) may enhance quality meibom production and reduce ocular surface inflammation. Ocular inflammation and discomfort are part of the symptom spectrum of our ocular surface disease patients.
We can retreat much further into pain management when considering options for our OSD patients. Omni Eye Surgery in New York and New Jersey expanded its facilities to include a dry eye specialty care service. We are exploring acupuncture as a viable resource for our dry eye patients, especially for those who experience sensations of discomfort, including headache.
Treating dry eye with acupuncture and CAM therapies
Studies surrounding acupuncture and dry eye are by no means conclusive; however, the suggestion of even modest relief of symptoms should not be dismissed. A 2015 evidence-based meta-analysis concluded that acupuncture therapy is more effective than artificial tears for dry eye syndrome.1 Acupuncture was noted to increase tear break-up time and Schirmer measurements, as well as improve corneal staining scores as compared to artificial tear use.
Additionally, Fourier-domain optical coherence tomography (OCT) for monitoring the lower tear meniscus in dry eye after acupuncture treatment showed that acupuncture increased the low tear meniscus parameters for lipid-deficient and non-Sjögren’s dry eye patients.2
Of interest, dry eye symptoms appear to be extremely prevalent in chronic migraine patients. Migraine and dry eye are both thought to have an inflammatory pathogenesis, and dry eye may present in migraine patients with greater presence of auras and longer disease and attack durations.3 Additionally, Sjögren’s patients demonstrate more chronic tension-type headaches vs. controls.4
It is important to note that from a purely comparative effectiveness perspective, the evidence from clinical trials and meta-analyses makes a compelling case in support of a potentially important role for acupuncture as part of a treatment plan. Patients with migraine, tension-type headaches, and several different types of chronic headache disorders may benefit from such treatment.5
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Acupuncture is included in complementary and alternative medicine (CAM) with homeopathy, naturopathy, chiropractic, massage, yoga, and Ayurvedic medicine, among others.
Patients willing to try CAM therapies
According to the National Institutes of Health’s (NIH) National Center for Complementary and Integrative Health, more than one third of adults in the U.S. use CAM therapies. Usage is greater among women and people with higher levels of education and higher incomes.6
According to a 2007 government survey, U.S. consumer spending on CAM therapies is about $33.9 billion annually.7 It is clear that our patients embrace CAM in health and disease management.
I look forward to the outcomes of acupuncture for our select dry eye patients. I am eager to understand if this ancient practice, in conjunction with current therapy, effects positive change in our dry eye patients. I will keep you informed of our progress.
1. Yang L, Yang Z, Yu H, Song H. Acupuncture therapy is more effective than artificial tears for dry eye syndrome: evidence based on a meta-analysis. Evid Based Complement Alternat Med. 2015;2015:143858.
2. Lin T, Gong L, Liu X, Ma X. Fourier-domain optical coherence tomography for monitoring the lower tear meniscus in dry eye after acupuncture treatment. Evid Based Complement Alternat Med. 2015;2015:492150.
3. Celikbilek A, Adam M. The relationship between dry eye and migraine. Acta Neurol Belg. 2015 Sep;115(3):329-33.
4. Tjensvoll AB, Harboe E, Gøransson LG, Beyer MK, Greve OJ, Kvaløy JT, Omdal R. Headache in primary Sjøgren's syndrome: a population-based retrospective cohort study. Eur J Neurol. 2013 Mar;20(3):558-63.
5. Coeytaux RR1,2, Befus D3. Role of Acupuncture in the Treatment or Prevention of Migraine, Tension-Type Headache, or Chronic Headache Disorders. Headache. 2016 Jul;56(7):1238-40. doi: 10.1111/head.12857. Epub 2016 Jul 13. Accessed 9/12/16.
6. National Center for Complementary and Integrative Health. The Use of Complementary and Alternative Medicine in the United States. Available at: https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm#use. Accessed 9/12/16.
7. National Center for Complementary and Integrative Health. Americans Spent $33.9 Billion Out-of-Pocket on Complementary and Alternative Medicine. 2009 Jul 30. Available at: https://