This work was supported by the Xinglin Scholar Research Promotion Project of the Chengdu University of TCM (MPRC2022012 and QJJJ2023004).

This protocol has been approved for clinical trial ethics in the Department of Ophthalmology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (ethics record number: KY2023001). Ensure that the environment is clean and pollution-free, with plenty of light and quiet surroundings. Informed consent was obtained from the patients to use and publish data shown in this paper.
1. Doctor preparation
<ol>
	<li>Check the basic information of the patient. Make sure the patient meets the diagnostic criteria for myopia in the Myopia Prevention and Control Guidelines and has dry eye: (1) Make sure that the patient has blurred vision at a distance, good near vision, often fluctuating distance vision in the early stage, and squinting when looking at distant objects; (2) Determine myopia by refraction and determine the degree.</li>
	<li>Exclude patients with the following conditions: (1) Patients with motion sickness; (2) Skin ulcers; (3) Patients with poor blood sugar control, poor blood pressure control, and dizziness; (4) Patients with coagulation dysfunction and severe cardiac insufficiency; (5) Rheumatic heart disease, congenital heart disease, kidney failure, liver failure, etc.; (6) Patients who do not cooperate with treatment.</li>
	<li>Wear a medical mask and medical hat</li>
	<li>Wash hands with soapy water and the seven-step handwashing method, keep them dry, and use hand sanitizer before taking the needle. 
	NOTE: Avoid touching other items after hand sanitization. Hand washing must be carried out before and after the procedure, and hands must be kept clean.</li>
</ol>
2. Patient examination
<ol>
	<li>Get basic patient information: ask for the patient&#39;s name, sex, age, doctor number, height, weight, past medical history, chief complaint, and other basic information.</li>
	<li>Test the patient&#39;s naked eye visual acuity.
	<ol>
		<li>Ask the patient to be 5 m away from the eye chart; cover one side of the eye.</li>
		<li>Identify the &#34;E&#34; on the eye chart and check it until it is no longer recognizable. Keep the direction of the label from top to bottom.</li>
		<li>Read the decimal notation on the left side of the eye chart and judge the patient&#39;s visual acuity based on the reading of the eye chart.</li>
		<li>The other eye is then evaluated using the same method. A score of less than 1.0 is considered myopia compared to the Universal Visual Acuity Chart (UCVA).</li>
	</ol>
	</li>
	<li>Test the patient&#39;s dry eye syndrome score.
	<ol>
		<li>Make sure the patient has one of the subjective symptoms such as dry eyes, foreign body sensation, burning sensation, fatigue, discomfort, eye redness, and vision fluctuations.</li>
		<li>Check the corresponding conditions against the ocular surface disease index scale (OSDI): Have you experienced photophobia, foreign body sensation, eye pain, eye irritation, blurred vision, or vision loss in the last week? Always appearing is 4 points, often appearing is 3 points, half of the time appearing is 2 points, sometimes appearing is 1 point, no appearance is 0 points.</li>
		<li>Calculate the score using equation: 0-12 is normal; 13-22 is classified as mild dry eye; 23-32 for moderate dry eye; 33-100 is severe dry eye. 
		Final score =&#160; &#160;<img alt="Equation 1" src="/files/ftp_upload/66727/66727eq01.jpg" style="margin: auto;" /></li>
		<li>If the patient&#39;s UCVA score is &#60;1.0 and the OSDI is &#8805;13 points, perform the next step of needle therapy; otherwise, suspend the needle administration. Make sure the skin is not damaged and ulcerated.</li>
	</ol>
	</li>
	<li>Measure the patient&#39;s blood pressure.
	<ol>
		<li>Let the patient relax and rest quietly for 5-10 min before the measurement.</li>
		<li>Prepare a mercury sphygmomanometer; have the patient sit with their feet flat and their elbows and forearms comfortably positioned approximately parallel to the heart.</li>
		<li>Turn on the blood pressure monitor and bring the mercury column down to zero.</li>
		<li>Tie the sphygmomanometer cuff above the elbow joint of the patient&#39;s upper arm; ensure that one finger can still be inserted between the cuff and the skin.</li>
		<li>Put the stethoscope in the elbow joint where there is an arterial pulse, and then slowly raise the pressure in the blood pressure monitor until the pulse of the blood vessels cannot be heard through the stethoscope. Now slowly deflate: systolic blood pressure is when the first sound of the pulse of the blood vessels is heard while diastolic blood pressure is when no sound can be heard.</li>
		<li>If the blood pressure is normal (systolic blood pressure is lower than 90-140 mmHg, diastolic blood pressure is higher than 60-90 mmHg), perform the next step of needle therapy; otherwise, suspend the needle application.</li>
	</ol>
	</li>
	<li>Detect the patient&#39;s pulse rate and oxygen saturation.
	<ol>
		<li>Prepare a clip-on oximeter, put the index finger of the left or right hand into the clip-on of the clip-on oximeter, and check that the infrared light in the clip-on is turned on.</li>
		<li>Keep the finger in full contact with the clip-on oximeter, showing the progress of the test on the display. After entering the detection state, keep fingers in a stable state.</li>
		<li>Once the test result is displayed on the display, take the finger out. The %SpO2 at the top of the display screen is the blood oxygen index, and the Min on the screen is the pulse rate.</li>
		<li>If the pulse rate is normal (60-100 bpm (times/min)), carry out the next step of needle treatment; otherwise, suspend the needle application.</li>
	</ol>
	</li>
	<li>Measure the patient&#39;s respiratory rate.
	<ol>
		<li>Ask the patient to be quiet, sitting or lying flat for calm breathing.</li>
		<li>Observe the person&#39;s breathing pattern (chest breathing or abdominal breathing) and place their hands on the chest or abdomen.</li>
		<li>Count with a watch or clock and judge the respiratory rate per minute by observing the rise and fall of the chest or abdominal cavity.</li>
		<li>If the respiratory rate is normal (12-20 breaths/min), perform the next step of needle therapy; otherwise, suspend the needle application.</li>
	</ol>
	</li>
</ol>
3. Identification and disinfection of acupuncture points
<ol>
	<li>Lay the patient flat on the treatment bed in a supine position. Remove glasses, if any, to expose the face. Let the doctor stand on the right side of the patient.</li>
	<li>Follow acupuncture point positioning: according to the standardized acupoint positioning, Cuanzhu (BL2), Yuyao (Ex-HN04), Sibai (ST2) (see Figure 2).
	<ol>
		<li>BL2: locate on the face, take the depression on the inner edge of the eyebrows (the middle of the eyebrows, the supraorbital notch).</li>
		<li>Ex-HN04: locate on the forehead, looking straight up, the pupil is straight up; take the middle of the eyebrows.</li>
		<li>ST2: locate on the face, the eyes are square, the pupil is straight down; take the depression of the infraorbital foramen. 
		CAUTION: Ask the patient if they have an alcohol allergy before disinfection. It should not be used by those allergic to alcohol and stainless steel.</li>
	</ol>
	</li>
	<li>Take 75% medical disinfection alcohol, spray 2-3x at the acupuncture point, and wipe with a disposable medical disinfection swab from inside to outside, from top to bottom; the diameter of the disinfection part is about 2-3 cm. Wait for the alcohol to evaporate and ensure that the operating part is dry.</li>
</ol>
4. Acupuncture procedures
<ol>
	<li>Check the press needle to ensure that it is within the shelf life, open the package, and check whether the press needle is complete, without damage or deformation.</li>
	<li>Acupuncture the BL2 acupoint: fix the skin with the thumb and index finger of the left hand, pick up the needle tape with tweezers with the right hand, keep the needle sterile, aim the needle tip at the acupuncture point, enter the skin at 45&#176;, press the needle tip completely into the skin, and press the fixed tape with the left hand (see Figure 3).
	<ol>
		<li>If touching the blood vessel, reduce the angle between the needle and the skin to avoid further insertion of the needle into the blood vessel.</li>
	</ol>
	</li>
	<li>Acupuncture the Ex-HN04 acupoint: follow the procedure outlined in step 4.2 (see Figure 4).</li>
	<li>Acupuncture the ST2 acupoint: follow the procedure outlined in step 4.2 (see Figure 5).</li>
	<li>Ask the patient how they feel: gently press the finger 3x to apply the needle, and ask the patient whether there is any sourness, numbness, swelling, pain, and other irritation. If there is any sensation, leave the needle; if there is no sensation, adjust the direction of the acupuncture until there is sensation, and then leave the needle.</li>
	<li>Remove the needle after 2 days, rest for 1 day, and apply the above acupuncture points again. A course of treatment lasts 2 weeks; administer a total of 2 courses of treatment. Perform compressions approximately every 3 h during the retention period, 3x a day, for ~1 min at a time.</li>
	<li>Take the needle: fix the skin with the thumb and index finger of the left hand, pick up the needle tape with tweezers in the right hand, take out the needle perpendicular to the skin, press the needle hole with a sterile cotton swab after removal, and disinfect it locally with an alcohol swab.</li>
	<li>After the needle is removed, keep the patient in the treatment room for 30 min before leaving.</li>
	<li>Efficacy evaluation: after 1 course (2 weeks), measure the patient&#39;s naked eye vision against the International Universal Visual Acuity Chart (UCVA), and assess the improvement of the patient&#39;s dry eye score before the next course of treatment.</li>
</ol>

Standardizing Press Needle Treatment for Myopia with Dry Eye

<ol>
	<li>Luo, Y., Zhang, H. Z., Yan, X. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+review+on+the+treatment+of+myopia.">A review on the treatment of myopia.</a> Clinical Journal of Chinese Medicine. 14 (13), 141-145 (2022).</li><li>Qing, L. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Research+advances+in+myopic+children+with+dry+eye.">Research advances in myopic children with dry eye.</a> Chinese Journal of Ophthalmology. 60 (02), 193-199 (2024).</li><li>Chang, C. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+effect+analysis+of+the+combination+of+point-to-point+acupuncture+from+Yingxiang+(LI20)+to+Bitong+(EX-HN8)+method+in+the+treatment+of+dry+eye.">Clinical effect analysis of the combination of point-to-point acupuncture from Yingxiang (LI20) to Bitong (EX-HN8) method in the treatment of dry eye.</a> China Journal of Chinese Ophthalmology. 33 (10), 916-921 (2023).</li><li>Cao, L. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+on+the+mechanism+of+action+of+treating+dry+eye+with+traditional+chinese+medicine.">Analysis on the mechanism of action of treating dry eye with traditional chinese medicine.</a> Asia-Pacific Traditional Medicine. 19 (06), 192-198 (2023).</li><li>Shi, Q. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+and+risk+factors+of+dry+eye+in+children+aged+7-14+years+in+myopia+prevention+and+control+clinic.">Prevalence and risk factors of dry eye in children aged 7-14 years in myopia prevention and control clinic.</a> International Eye Science. 23 (02), 339-344 (2023).</li><li>Liu, Y. X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+new+perspective+on+the+treatment+of+dry+eye+in+traditional+chinese+medicine+based+on+seeking+Yin+in+Yang+method.">A new perspective on the treatment of dry eye in traditional chinese medicine based on seeking Yin in Yang method.</a> Guangming Journal of Chinese Medicine. 38 (19), 3734-3736 (2023).</li><li>Yang, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+application+of+press-needle+in+ophthalmology.">Clinical application of press-needle in ophthalmology.</a> China Journal of Chinese Ophthalmology. 32 (03), 233-236 (2024).</li><li>Wang, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Clinical observation of Consolidating Root and Cultivating Source acupuncture method combined with 0.01% atropine eye drops in the treatment of juvenile pseudomyopia. , (2022).</li><li>Zou, Y. Y., Liu, J., Liu, S., Xin, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+observation+on+the+intervention+of+adolescents+with+low+myopia+by+combination+of+snap+needle+and+auricular+acupoint+pressure.">Clinical observation on the intervention of adolescents with low myopia by combination of snap needle and auricular acupoint pressure.</a> Jiangxi Journal of Traditional Chinese Medicine. 53 (11), 52-54 (2022).</li><li>Niu, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Mechanism research and clinical observation of &amp;#34; Consolidating Root and Cultivating Source &amp;#34; acupuncture method in the treatment of early myopia in adolescents. , (2022).</li><li>Li, Y. X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> A clinical study of acupuncture in the treatment of moderate dry eye &amp;#34;liver meridian depression syndrome&amp;#34. , (2023).</li><li>Zhou, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thumb-tack+needle+based+on+Consolidating+Root+and+Cultivating+Source+theory+for+dry+eye:+a+randomized+controlled+trial.">Thumb-tack needle based on Consolidating Root and Cultivating Source theory for dry eye: a randomized controlled trial.</a> Chinese Acupuncture &amp; Moxibustion. 42 (10), 1120-1128 (2022).</li><li>Liu, Y. L., Lu, X. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+research+status+of+special+acupuncture+therapy+in+dry+eyes+in+recent+five+years.">Clinical research status of special acupuncture therapy in dry eyes in recent five years.</a> Journal of Chinese Ophthalmology and Otorhinolaryngology. 12 (01), 37-40 (2022).</li><li>Gao, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Observation+of+the+efficacy+of+acupuncture+combined+with+traditional+Chinese+medicine+atomization+fumigation+in+the+treatment+of+dry+eyes.">Observation of the efficacy of acupuncture combined with traditional Chinese medicine atomization fumigation in the treatment of dry eyes.</a> Modern Journal of Integrated Traditional Chinese and Western Medicine. 32 (14), 1994-1997 (2023).</li><li>Fan, F. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Clinical observation of the efficacy of auricular pressure pills combined with acupuncture to prevent and control low-grade myopia in children. , (2023).</li><li>Zhao, Z. B., Zhang, Y. X., Yu, Y. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Compatibility+rule+of+acupoints+in+massage+treating+pseudomyopia+based+on+a+complex+network+analysis.">Compatibility rule of acupoints in massage treating pseudomyopia based on a complex network analysis.</a> China Journal of Chinese Ophthalmology. 32 (03), 212-216 (2022).</li><li>Cao, Y. J. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Discussion+on+law+of+acupoint+selection+of+acupuncture+and+moxibustion+in+preventing+and+controlling+myopia+in+children+and+adolescents+based+on+data+mining+technology.">Discussion on law of acupoint selection of acupuncture and moxibustion in preventing and controlling myopia in children and adolescents based on data mining technology.</a> Chinese Journal of Library and Information Science for Traditional Chinese Medicine. 47 (06), 77-83 (2023).</li><li>Ji, H. J., Sun, X. Y., Gao, W. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+review+of+acupoint+selection+rule+and+syndrome+differentiation+and+treatment+of+dry+eye+by+acupuncture.">A review of acupoint selection rule and syndrome differentiation and treatment of dry eye by acupuncture.</a> China Journal of Chinese Ophthalmology. 32 (12), 978-981 (2022).</li><li>Zou, D. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regular+pattern+of+acupoint+selection+in+treatment+of+dry+eye+by+acupuncture+and+moxibustion+based+on+data+mining+technology.">Regular pattern of acupoint selection in treatment of dry eye by acupuncture and moxibustion based on data mining technology.</a> China Journal of Chinese Ophthalmology. 30 (6), (2020).</li><li>Lam, H. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> A systematic evaluation of acupuncture in the treatment of myopia and the study of the rule of acupuncture. , (2021).</li><li>Wu, T. T., Luo, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+Analysis+of+Cuanzhu.">An Analysis of Cuanzhu.</a> Henan Traditional Chinese Medicine. 41 (08), (2021).</li><li>Liu, X., Gao, W. P., Zhao, N., Jie, R. P., Liu, C. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acupuncture+for+aqueous+deficiency+dry+eye:+a+randomized+controlled+trial.">Acupuncture for aqueous deficiency dry eye: a randomized controlled trial.</a> Chinese Acupuncture &amp; Moxibustion. 43 (11), 1235-1238 (2023).</li><li>Jiang, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+clinical+study+of+Fengchi+three-acupuncture+combined+with+eye+acupuncture+in+the+treatment+of+meibomian+gland+dysfunction-related+dry+eye+syndrome.">A clinical study of Fengchi three-acupuncture combined with eye acupuncture in the treatment of meibomian gland dysfunction-related dry eye syndrome.</a> Journal of Sichuan of Traditional Chinese Medicine. 41 (06), 195-197 (2023).</li><li>Wu, J. Y., Gao, J. J., Zhang, F. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Discussion+on+advantages+of+prevention+and+treatment+of+juvenile+myopia+by+pressneedle+from+perspective+of+preventive+treatment+of+disease.">Discussion on advantages of prevention and treatment of juvenile myopia by pressneedle from perspective of preventive treatment of disease.</a> China Journal of Chinese Ophthalmology. 32 (09), 724-726 (2022).</li><li>Xu, W. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Clinical study of acupuncture combined with thunder fire moxibustion in the treatment of juvenile pseudomyopia (heart and spleen deficiency type). , (2022).</li><li>Ma, H. J., Feng, L., Wang, J. L., Yang, Z. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+subcutaneous+embedding+of+thumb-tack+needle+on+tear+film+in+patients+with+dry+eye.">Effects of subcutaneous embedding of thumb-tack needle on tear film in patients with dry eye.</a> Chinese Acupuncture &amp; Moxibustion. 38 (03), 273-276 (2018).</li><li>Hou, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rhodiola+crenulata+alleviates+hypobaric+hypoxia-induced+brain+injury+by+maintaining+BBB+integrity+and+balancing+energy+metabolism+dysfunction.">Rhodiola crenulata alleviates hypobaric hypoxia-induced brain injury by maintaining BBB integrity and balancing energy metabolism dysfunction.</a> Phytomedicine. 128, 155529 (2024).</li></ol>

The authors have nothing to disclose.

As an ancient traditional treatment method in China, the efficacy of acupuncture has been verified in the long history of development, and various research results in recent years have further proved the effectiveness of acupuncture in improving the vision and dry eye symptoms of myopia patients. The effectiveness of this therapy depends mainly on the acupuncture points chosen. The studies of Gao Hui14 and others have confirmed that acupuncture therapy can significantly improve the symptoms of dry...

Myopia is a refractive error; when the eye is in a relaxed state of adjustment, parallel light rays are focused in front of the retina after passing through the refractive retina, resulting in a clear image on the retina, which is called myopia. The main manifestations of this disease are clear vision of near objects and blurred vision of distant objects1. When the normal eye adjusts to a relaxed state, the parallel light rays from 5 m away pass through the refractive system of the eye, and the focus falls on the retina, forming a clear image. However, when a myopic patient sees a distant object 5 m away, the parallel light rays are focused in front of the retina after passing through the refractive system of the eyeball, so the vision will be blurred. If you look at a near object within 5 m, the parallel light rays will be focused on the retina after passing through the refractive system of the eyeball, and it will be clearer. Due to the rapid changes in the socio-economic environment in recent years, the widespread use of electronic screens, and the increase of refined eye use methods, the incidence of myopia has increased rapidly, and it is showing a trend of younger age, which has a serious impact on social health.
According to statistics, the number of myopic people in the world will reach nearly 5 billion in 2050. With the spread of computers and smartphones, coupled with the impact of the previous novel coronavirus outbreak, more and more myopic patients are beginning to have comorbid dry eye symptoms2. Nearly 400 million people in China suffer from dry eye, and the prevalence of dry eye in myopia is significantly higher than that in emmetropia and hyperopia, and the incidence of dry eye in myopic adolescents is about 20%. Tear deficiency and tear film instability are key factors that lead to dry eye, and changes in the cornea and increased eyelid space during eye elongation in myopia patients can cause uneven tear film distribution, resulting in decreased tear film stability, which increases the risk of dry eye.
Dry eye syndrome is characterized by an imbalance of tear film and eye discomfort. It is a chronic inflammatory reaction of corneal conjunctival dryness, which is mainly manifested by sensitivity to the external environment, insufficient tear fluid, and foreign eye sensation. It can lead to corneal conjunctival lesions and visual impairment, and then affect the quality of life and vision of patients3. The etiology of dry eye is complex; the main cause is the abnormal quality, quantity, and dynamics of tears, resulting in tear film instability or imbalance of ocular surface microenvironment. The specific onset of the disease is related to the patient&#39;s ocular surface tear film osmotic pressure changes, immune inflammatory response, tear film hyperoxidation, neuroparesthesia, and apoptosis, and the pathological process involves MAPK, NF-&#954;B, Wnt, TLR, PI3K/AKT, and other signaling pathways4,5.
Traditional Chinese medicine believes that the main pathogenesis of dry eye in myopia patients is liver and kidney insufficiency. In the Yellow Emperor&#39;s Neijing-Su Wen, it is recorded that &#34;the five internal organs and six internal organs are infiltrated into the eyes&#34;, which shows that the dysfunction of the internal organs, the insufficient production of the fluid to moisturize the eyes, or the poor infusion are important pathogeneses. Yinhai Subtlety clearly states: &#34;Tears are less responsible for the deficiency of liver and kidney&#34;-the main blood of the liver is the outer part of the eye, the liver blood is enough, and the liver qi is regulated, and the subtle substances are injected on the surface of the eye for tears. The main water of the kidney is the source of the fluid, and the kidney is sufficient, the kidney qi is full, and the source of the whole body is sufficient. The liver and kidney essence and blood are homologous and interconnected, so liver and kidney insufficiency is an important pathogenesis6. At present, the clinical treatment of dry eye is mainly based on artificial tears, vitamins, nerve growth factor, and thermal pulse therapy, which has good short-term effects, but the long-term effects are still limited. Traditional Chinese medicine treatment is mainly based on the internal administration of traditional Chinese medicine, acupuncture, hot compress fumigation, auricular pressure pills, etc. The durability of the curative effect is good, but the operation is more complicated, and the patient&#39;s compliance is not strong.
Press needle is a kind of intradermal acupuncture, which is widely used in clinical practice, mainly used for the treatment of facial paralysis, insomnia, dysmenorrhea, and other diseases, and has gradually expanded to ophthalmic diseases in recent years, with the characteristics of long-lasting effect, easy operation, low cost, and good patient compliance7. Specifically, a special small needle (0.2-0.3 cm long) is inserted and fixed in the acupoint area or subcutaneously for a long period of burial. There is no need to immediately produce a sense of air when burying the needle, and the air can be adjusted only after the needle is buried. This therapy combines the theory of acupoints and the skin theory of traditional Chinese medicine, adopts the ancient idea of &#34;staying still for a long time&#34;, combines the advantages of traditional acupuncture and thread embedding, and has a long period of continuous stimulation of the skin, to achieve the purpose of preventing and treating diseases.
Press needles can improve unaided distance vision, improve the state of visual fatigue, reduce refraction, and delay the axial growth of myopia patients, which has been confirmed by clinical studies8,9,10. Press needle can improve dry eye and is better than sodium hyaluronate eye drops alone in improving the stability of the tear film, tear secretion, and the degree of corneal epithelial damage in patients with dry eye11,12,13. The effect of press needle combined with auricular pressure beans, traditional Chinese medicine atomization fumigation, and massage in the treatment of dry eye is more significant, which may be related to the regulation of multiple signaling pathways such as MAPK, NF-kB, Wnt, TLR, and PI3K/AKT.
Based on the theory of acupoints and dermatozoa in traditional Chinese medicine, this study was treated with a press needle (Figure 1), aiming to improve the symptoms of dry eye, improve visual function, and quality of life. A press needle is a long-lasting, easy-to-operate, and inexpensive traditional Chinese medicine treatment. To sum up, it is necessary to propose a standard scheme on how to correctly operate acupuncture for the treatment of myopia with dry eye. This article explains how to properly use a press needle to treat dry eye in patients with myopia.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
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			<td>75% Alcohol disinfectant</td>
			<td>Kangpai (Jiangsu) Medical Technology Co., Ltd.</td>
			<td>20230926</td>
			<td></td>
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		<tr>
			<td>Disposable surgical masks</td>
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			<td>Chengdu Mingsen medical equipment Co.,Ltd</td>
			<td>20230824</td>
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			<td>Fingertip pulse oximeter</td>
			<td>Jiangsu Yuyue Medical Equipment Co., Ltd</td>
			<td>20172201070</td>
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			<td>Qingdao Hairun Medical Technology Co., Ltd</td>
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			<td>Hunan Kefu Medical Equipment Co., Ltd</td>
			<td>P0402311003</td>
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			<td>Mercury sphygmomanometer</td>
			<td>Jiangsu Yuyue Medical Equipment Co., Ltd</td>
			<td>20152070947</td>
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			<td>Sterile medical disposable sterilized cotton swabs</td>
			<td>Hunan Kefu Medical Equipment Co., Ltd</td>
			<td>20210014</td>
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			<td>&#160;Sterile press needles for single-use</td>
			<td>Suzhou Medical Supplies Factory Co., Ltd</td>
			<td>233126</td>
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			<td>SPSS&#160;</td>
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press needle: a traditional chinese medicine therapy for myopia patients with dry eye

Most patients with myopia have dry eye, which has been shown to adversely affect ocular symptoms, myopia progression, and quality of life in patients with myopia. Needle prickling has been shown to be effective in providing symptom relief in patients with myopia and dry eye. Press needle is a long-lasting, easy-to-operate, and inexpensive traditional Chinese medicine treatment. The standard practice of needle insertion is very important for the treatment of myopia and dry eye. The specific steps include selecting the appropriate acupoints, piercing them with appropriate needles, and fixing them in the skin or subcutaneously at the acupoints, burying them for 2 days, resting for 1 day; the course of treatment lasts for 2 weeks. Specifically, the following indicators were assessed: uncorrected visual acuity and the ocular surface disease index. This article will explain how to standardize the operation of a press needle in the treatment of myopia and dry eye.

In this study, a total of 8 patients who met the criteria participated and completed the trial, and none of them were discharged or excluded during the process. The OSDI and UCVA scores were used as the primary evaluation indicators for this trial, with data derived from the scores on the scales completed by patients before and after treatment. Self-control before and after treatment was compared using a paired t-test.
The OSDI scores of patients before and after treatment were compar...

Read this Scientific Article Protocol about Author Spotlight: Exploring Press Needle Efficacy and Underlying Molecular Pathways at JoVE.com

Author Spotlight: Exploring Press Needle Efficacy and Underlying Molecular Pathways

Here, we present a protocol to standardize the operation of acupuncture in the treatment of myopia with dry eye.

Press Needle: A Traditional Chinese Medicine Therapy for Myopia Patients with Dry Eye

Most patients with myopia have dry eye, which has been shown to adversely affect ocular symptoms, myopia progression, and quality of life in patients with ...

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1.1K Views.  Eye School of Chengdu University of Traditional Chinese Medicine. Here, we present a protocol to standardize the operation of acupuncture in the treatment of myopia with dry eye. 

Video: Author Spotlight: Exploring Press Needle Efficacy and Underlying Molecular Pathways

Scleral Cross-linking Using Riboflavin and Ultraviolet-A Radiation for Prevention of Axial Myopia in a Rabbit Model

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal abnormalities. In addition, pathological myopia is a common irreversible cause of visual impairment and blindness1-3. Our study demonstrates the effect of scleral crosslinking using riboflavin and ultraviolet-A radiation on the development of axial myopia in a rabbit model. The axial length of the eyeball was measured by A-scan ultrasound in New Zealand white rabbits aged 13 days (male and female). The eye then underwent 360&#176; conjunctival peritomy with scleral crosslinking, followed by tarsorrhaphy. Axial elongation was induced in 13 day-old New Zealand rabbits by suturing their right eye eyelids (tarsorrhaphy). The eyes were divided into quadrants, and every quadrant had two scleral irradiation zones, each with an area of 0.2 cm&#178; and a radius of 4 mm. Crosslinking was performed by dropping 0.1% dextran-free riboflavin-5-phosphate onto the irradiation zones 20 sec before ultraviolet-A irradiation and every 20 sec during the 200 sec irradiation time. UVA radiation (370 nm) was applied perpendicular to the sclera at 57 mW/cm&#178; (total UVA light dose, 57 J/cm&#178;). Tarsorrhaphies were removed on day 55, followed by repeated axial length measurements. This study demonstrates that scleral crosslinking with riboflavin and ultraviolet-A radiation effectively prevents occlusion-induced axial elongation in a rabbit model.

We demonstrate the effect of scleral crosslinking with riboflavin and UVA on an axial elongation rabbit eye. Axial elongation was induced in 13 day-old New Zealand rabbits (male and female) by suturing their right eye eyelids (tarsorrhaphy).

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal ...

Second Harmonic Generation Signals in Rabbit Sclera As a Tool for Evaluation of Therapeutic Tissue Cross-linking (TXL) for Myopia

Methods to strengthen tissue by introducing chemical bonds (non-enzymatic cross-linking) into structural proteins (fibrillar collagens) for therapy include photochemical cross-linking and tissue cross-linking (TXL) methods. Such methods for inducing mechanical tissue property changes are being employed to the cornea in corneal thinning (mechanically weakened) disorders such as keratoconus as well as the sclera in progressive myopia, where thinning and weakening of the posterior sclera occurs and likely contributes to axial elongation. The primary target proteins for such tissue strengthening are fibrillar collagens which constitute the great majority of dry weight proteins in the cornea and sclera. Fortuitously, fibrillar collagens are the main source of second harmonic generation signals in the tissue extracellular space. Therefore, modifications of the collagen proteins, such as those induced through cross-linking therapies, could potentially be detected and quantitated through the use of second harmonic generation microscopy (SHGM). Monitoring SHGM signals through the use of a laser scanning microscopy system coupled with an infrared excitation light source is an exciting modern imaging method that is enjoying widespread usage in the biomedical sciences. Thus, the present study was undertaken in order to evaluate the use of SHGM microscopy as a means to measure induced cross-linking effects in ex vivo rabbit sclera, following an injection of a chemical cross-linking agent into the sub-Tenon&#39;s space (sT), an injection approach that is standard practice for causing ocular anesthesia during ophthalmologic clinical procedures. The chemical cross-linking agent, sodium hydroxymethylglycinate (SMG), is from a class of cosmetic preservatives known as formaldehyde releasing agents (FARs). Scleral changes following reaction with SMG resulted in increases in SHG signals and correlated with shifts in thermal denaturation temperature, a standard method for evaluating induced tissue cross-linking effects.

Second Harmonic Generation Signals in Rabbit Sclera As a Tool for Evaluation of Therapeutic Tissue Cross-linking TXL for Myopia

This protocol describes techniques for evaluating chemical cross-linking of the rabbit sclera using&#160;second harmonic generation imaging and differential scanning calorimetry.

Methods to strengthen tissue by introducing chemical bonds (non-enzymatic cross-linking) into structural proteins (fibrillar collagens) for therapy ...

Intense Pulsed Light for the Treatment of Dry Eye Owing to Meibomian Gland Dysfunction

Dry eye disease (DED) is an increasingly common condition and one of the most common complaints of patients. The vast majority of DED is caused by the so-called &#34;evaporative&#34; subtype, that is mainly caused by meibomian gland dysfunction (MGD). Intense pulsed light (IPL) devices employ high intensity pulses of polychromatic lights with a broad range of wavelength (515-1200 nm). IPL treatment has been utilized for years in the field of dermatology, and then its use was applied to ophthalmology for the treatment of MGD. Recently, a new device employing IPL was specifically designed for the periocular application. This procedure determines the thermal selective coagulation and ablation of superficial blood vessels and telangiectasias of the eyelids skin, reducing the release of inflammatory mediators and tear cytokines levels, and improving meibomian glands outflow. IPL treatment is noninvasive and easy to perform, lasts for only a few minutes and can be conducted in an office setting. In the present study, 19 patients underwent 3 sessions of IPL treatment. After treatment, both mean noninvasive break-up time and lipid layer thickness grade significantly increased, as a result of an improvement of tear film stability and quality, respectively. Conversely, no statistically significant changes were found for meibomian gland loss and tear osmolarity. Furthermore, the vast majority of the treated patients (17/19; 89.5% of the total) perceived an improvement of their ocular discomfort symptoms after IPL treatment. Although IPL treatment provides an improvement of both ocular surface parameters and ocular discomfort symptoms after one cycle of three sessions, regular repeated treatments are usually required to maintain the persistence over the time of its beneficial effects.

Dry eye disease is an increasingly common condition, which strongly impair patients&#39; life quality. Recently, a new device employing intense pulsed light, specifically designed for the periocular area, has been shown to improve tear film stability and ocular discomfort symptoms in dry eye disease owing to meibomian gland dysfunction.

Dry eye disease (DED) is an increasingly common condition and one of the most common complaints of patients. The vast majority of DED is caused by the ...

Platelet-Rich Plasma Lysate for Treatment of Eye Surface Diseases

Various ocular surface diseases are treated with blood-derived eye drops. Their use has been introduced in clinical practice because of their metabolite and growth factor content, which promotes eye surface regeneration. Blood-based eye drops can be prepared from different sources (i.e., whole blood or platelet apheresis donation), as well as with different protocols (e.g., different dilutions and freeze/thaw cycles). This variability hampers the standardization of clinical protocols and, consequently, the evaluation of their clinical efficacy. Detailing and sharing the methodological procedures may contribute to defining common guidelines. Over the last years, allogenic products have been diffusing as an alternative to the autologous treatments since they guarantee higher efficacy standards; among them, the platelet-rich plasma lysate (PRP-L) eye drops are prepared with simple manufacturing procedures. In the transfusion medicine unit at AUSL-IRCCS di Reggio Emilia, Italy, PRP-L is obtained from platelet-apheresis donation. This product is initially diluted to 0.3 x 109 platelets/mL (starting from an average concentration of 1 x 109 platelets/mL) in 0.9% NaCl. Diluted platelets are frozen/thawed and, subsequently, centrifuged to eliminate debris. The final volume is split into 1.45 mL aliquots and stored at &#8722;80 &#176;C. Before being dispensed to patients, eye drops are tested for sterility. Patients may store platelet lysates at &#8722;15 &#176;C for up to 1 month. The growth factor composition is also assessed from randomly selected aliquots, and the mean values are reported here.

Platelet lysates represent an emerging tool for the treatment of ocular surface diseases. Here, we propose a method for the preparation, dispensation, storage, and characterization of platelet lysate collected from platelet donors.

Various ocular surface diseases are treated with blood-derived eye drops. Their use has been introduced in clinical practice because of their metabolite ...

Assessing the Health of the Corneal Nerves in Ocular Surface Diseases

Corneal Sensitivity Testing Procedure for Ophthalmologic and Optometric Patients

The cornea is the most densely innervated structure in the human body, making it one of the most sensitive tissues. Changes in corneal nerve sensitivity can be observed in several ocular surface diseases. Nerve sensitivity may be increased, as is often seen in patients with a neuropathic component to ocular pain, or decreased, as is seen in patients with neurotrophic keratitis. Corneal sensitivity testing involves assessing a patient's reaction to brief corneal stimulation, yields insight into the health of the corneal nerves, and provides diagnostic value for evaluating the health of the nerves and the interplay with the ocular surface. Currently, there is limited published guidance on how to conduct corneal sensitivity testing in a clinical setting. This article presents a protocol for testing corneal sensitivity using easy-to-use, low-cost materials that are readily accessible to eye care providers (either a cotton swab, a piece of dental floss, or a finely tapered tissue). This protocol allows for qualitative assessment of corneal sensitivity in which responses to corneal stimulation are rated from 0 (no response) to 3 (hypersensitive response). This test can be performed quickly (in approximately 30 s). Given its diagnostic value and accessibility, corneal sensitivity testing should be included as part of the standard eye examination for any patient undergoing an ocular surface examination.

 Author Spotlight: Establishing a Practical and Cost-Effective Protocol for Corneal Sensitivity Testing in Clinical Settings

Corneal sensitivity testing provides insight into the health of the corneal nerves and helps diagnose ocular surface diseases. We present a concise protocol to qualitatively assess corneal sensitivity that can be readily used by eye care providers across clinical settings.

The cornea is the most densely innervated structure in the human body, making it one of the most sensitive tissues. Changes in corneal nerve sensitivity ...

Excimer Laser Multifocal Double Aspheric Ablation for Presbyopia Correction

Correction of Presbyopia by Monocular Bi-Aspheric Ablation Profile

The study aims to evaluate visual acuity and objective visual quality before and after the monocular bi-aspheric ablation profile for correction of presbyopia surgery. This prospective self-control study included 20 cases and 38 eyes of patients who underwent monocular bi-aspheric ablation profile correction of myopia with presbyopia at the Eye Hospital of Shandong University of Traditional Chinese Medicine from January 2023 to January 2024. These patients were selected for observation, and each patient's preoperative and postoperative uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), spherical aberration (SA) (within 6 mm), horizontal and vertical coma (within 6 mm), and corneal aspheric index (Q-value) (within 6 mm) were evaluated. Statistical data analysis was performed at different time points before and after the operation. There were statistically significant differences in UDVA between dominant and non-dominant eyes before and after surgery (Z = -3.784, p &lt; 0.001; Z = -3.817, p &lt; 0.001). Post-operatively, 90% of the non-dominant eyes achieved UNVA of J1 and above, and 95% of the bilateral eyes achieved UNVA of J1 and above. Significant differences were found in the SA of the dominant eyes, which showed a positive increase (Z= -3.784, p &lt; 0.001); however, compared with the dominant eye, the SA of the non-dominant eye was negatively increased, but the difference was not statistically significant (p = 0.08). There was a significant difference in the vertical coma of the dominant eye before and after the operation, but there was no significant difference in non-dominant eyes. There was no significant difference in the change of binocular horizontal coma before and after the operation. There were significant changes in the Q value of both eyes before and after the operation (Z = -3.923, p &lt; 0.001; Z = -3.51, p &lt; 0.001). After the monocular bi-aspheric ablation profile, the cornea of the non-dominant eye showed a prolate shape, negative SA increased, and the UDVA and UNVA improved after the operation.

Author Spotlight: Advancements in Refractive Surgical Correction for Presbyopia and Exploring Postoperative Visual Acuity

This article provides a step-by-step guide to correcting presbyopia with a monocular bi-aspheric ablation profile.

The study aims to evaluate visual acuity and objective visual quality before and after the monocular bi-aspheric ablation profile for correction of ...

Establishment of A Mouse Model of Aqueous Deficiency Dry Eye

Dry eye disease is a prevalent condition affecting 5%-50% of the global population. Animal model investigations play a crucial role in understanding its underlying mechanisms. Therefore, we developed a mouse model of dry eye disease by surgically removing both the extraorbital lacrimal glands (ELG) and intraorbital lacrimal glands (ILG) to investigate the ocular surface pathology in the context of aqueous deficiency dry eye. Two weeks post operation, the mice exhibited severe dry eye manifestations, including reduced tear secretion, corneal epithelial irregularities, positive fluorescein sodium staining, and neovascularization. Histological examination via hematoxylin and eosin staining revealed inflammatory cell infiltration and corneal epithelium dysplasia. Immunofluorescence staining and quantitative reverse-transcription polymerase chain reaction revealed decreased expression of the normal corneal epithelial biomarkers K12 and Pax6 and increased expression of Sprr1b in the corneal epithelium. These ocular manifestations indicated abnormal corneal epithelial differentiation. Furthermore, immunofluorescence staining of Ki67 revealed the increasing cell proliferation. In conclusion, the ELG plus ILG excision model proved suitable for studying changes in the ocular surface and elucidating the mechanisms underlying aqueous deficiency dry eye.

Here, we present a method to establish a mouse model of aqueous-deficient dry eye by excising the extraorbital and infraorbital lacrimal glands and evaluate the changes in the ocular surface in aqueous deficiency dry eye.

Dry eye disease is a prevalent condition affecting 5%-50% of the global population. Animal model investigations play a crucial role in understanding its ...

Performing Injection into Orbital Lobe of Superior Lacrimal Gland: A Technique for Inducing Dry Eye Disease in Rabbit Model

Apply medial pressure to the globe to cause the orbital superior lacrimal gland to protrude from the posterior incisure. Using closed curved forceps, indent the area until the bony opening in the skull is felt, and apply further modest pressure with forceps to leave an indentation in the skin to serve as the landmark for the needle placement.
Insert a tuberculin syringe equipped with a 27-gauge needle perpendicular to the skin over the indentation mark about a 1/4 inch into the incision, and redirect the needle posteriorly and externally toward the lateral canthus, aiming for the midpoint between the injection site and the bony orbital rim. Once the hub of the needle is reached, slowly inject 0.2 milliliters of a 1,000 microgram solution of conA.

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Performing Injection into Palpebral Portion of the Superior Lacrimal Gland: A Technique for Inducing Dry Eye Disease in Rabbit Model

For palpebral portioning of the superior lacrimal gland injection, after confirming sedation, shear off the fur in the pre-orbital and scalp area, and use depilatory cream to completely remove any residual fur.
After 2 minutes, remove the cream and apply 25 microliters of 1% preservative-free lidocaine to the appropriate eye. Evert the upper eyelid, and apply gentle medial pressure to the posterior orbital rim until the protuberance marking the palpebral portion of the gland is seen. Using fine-toothed forceps and a tuberculin syringe equipped with a 27-Gauge needle, directly penetrate the gland via a transconjunctival approach advancing the needle two millimeters into the tissue, and inject 100 microliters of a 500 microgram solution of concanavalin A or ConA.