Dry eye is a highly prevalent disorder, affecting 14% to 33% of the adult population worldwide, does not have an effective therapy, and causes significant loss of productivity at work [1–3]. It incurs significant socioeconomic burden in many societies and is more common in Asia [4]. Dry eye aetiology includes diminished tear production and increased evaporation of tears [5]. This may in turn result in decreased ability to perform daily activities thus having an impact on quality of life [6].
Current clinical treatments available for evaporative dry eye include tear supplements, for example, lubricants, tear stimulation and anti-inflammatory medication, oral supplements and tear retention methods: for example, punctal occlusion using cautery or punctum plugs, moisture chamber spectacles/shields, contact lenses, and tarsorrhaphy [7]. Essentially, dry eye can be a lifestyle problem [3]; prolonged gazing and reduced blinking due to activities such as reading and exposure to air-conditioning can result in instability of the tear film [4]. There is a need for more than one modality of treatment for mild-to-moderate dry eye patients, apart from the usage of topical eye drops. Indeed only a small portion of dry eye sufferers use artificial tears regularly [8]. These findings taken together suggest that a combinatorial holistic approach to the management of dry eye may be preferred.
Traditional Chinese medicine (TCM) is a system of health care originating from China. It views the human body as a microcosm of the world and aims to restore harmony and wholeness within the entity. TCM encompasses various treatment modalities, including acupuncture, herbal medication, tuina (massage), cupping, and moxibustion. With the migration of ethnic Chinese into Singapore in the 19th century, TCM practice has been integrated into local culture and tradition. In 2000, the TCM Practitioners Act was enforced to regulate the practice of TCM in Singapore, as well as to uphold professional conduct and ethics. All TCM practitioners must be registered with the board and pass a qualifying board exam in order to be licensed to practice. The control of Chinese Medicinal Materials is also overseen by the Health Sciences Authority of Singapore, the agency for regulating drugs in Singapore.
Recently, randomised controlled studies in the use of TCM in dry eye have been published, with some favourable results [15–21]. In one review of 6 randomised controlled trials, a meta-analysis showed that acupuncture significantly improved tear break-up times (P < 0.0001), Schirmer's test (P < 0.00001) and cornea fluorescein staining (P = 0.0001) [22]. Even more recently, a study showed that in the sham acupuncture group (n = 21), the tear break-up time changed from 3.71 ± 1.38 s to 4.00 ± 1.34 s (change not statistically significant) after 3 weeks, whereas in the acupuncture treatment group (n = 21), it significantly increased from 3.29 ± 1.01 s to 4.24 ± 1.26 [23, 24]. In a randomised placebo-controlled study, the drug Chi-Ju-Di-Huang-Wan was used to treat dry eye in 40 subjects, whereas 40 other subjects received a placebo of the same weight, color, and regime without the active drug [15]. In this study, the fluorescein tear break-up time was significantly improved compared to placebo at 4 weeks, whereas Rose Bengal staining, an indicator of corneal epithelial damage, was significantly at 2 weeks compared to placebo.
Despite the encouraging results of these modern, properly controlled studies in the treatment of dry eye by TCM, there has been no studies on the awareness of the use of TCM or the extent of practice of TCM in dry eye among TCM practitioners in Singapore. A previous evaluation of knowledge and attitude of TCM in Singapore studied only the parents of children who attended a TCM clinic and pediatricians, without any focus on specific disease conditions [13]. Therefore we aim to conduct a survey of knowledge, attitude, and practice of TCM in treatment of dry eye in institutional TCM practitioners in Singapore.
Source:
"Knowledge, Attitude, and Practice of Dry Eye Treatment by Institutional Chinese Physicians in Singapore"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3504406/
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