1. Definition & Classification
Optic atrophy refers to degenerative changes of optic nerve fibers triggered by multiple underlying etiologies. The hallmark manifestations are marked visual loss and constricted visual fields.
Clinically, it is categorized into primary optic atrophy and secondary optic atrophy in line with international ophthalmic classification standards.
- Primary optic atrophy: Characterized solely by degenerative lesions of optic nerve fibers without additional tissue proliferation. It is an early clinical sign of tabes dorsalis, affecting approximately one-third of patients with this condition. Retrobulbar neuritis ranks among its most common causes. Other triggers include optic nerve injury from skull fracture, optic nerve compression by tumors (e.g., pituitary tumors), drug or toxic poisoning, nutritional deficiencies, anemia, and central retinal artery occlusion.
- Secondary optic atrophy: Mostly develops as a sequela of optic neuritis. Besides optic nerve fiber degeneration, connective tissue hyperplasia is visible on the optic disc. It frequently occurs following optic disc papillitis, papilledema, or certain retinal and choroidal disorders.
2. Diagnostic Criteria & Clinical Manifestations
Main Symptoms
Visual acuity declines gradually or acutely, and in severe cases, only light perception remains. Patients present with visual field constriction or hemianopia, accompanied by dyschromatopsia. Color vision impairment typically starts with green color blindness, followed by red color blindness. Pupillary dilatation develops in the advanced stage.
Fundus Examination Findings
- Primary optic atrophy: The optic disc appears white, grayish-white or bluish-white, and is slightly smaller than normal. The physiological cup is prominent, and the lamina cribrosa is clearly visualized. The disc margin is distinct and regular, with absence of superficial small vessels on the disc surface. The adjacent retina remains intact, and retinal vessels are generally normal; retinal arteries may present mild thinning in individual cases.
- Secondary optic atrophy: The optic disc shows dense white or gray discoloration with blurred and irregular margins. The disc surface is covered by connective tissue derived from exudates, obscuring the lamina cribrosa and superficial disc vessels. Retinal arteries become narrowed, while veins remain normal or slightly tortuous. In some instances, vascular walls are surrounded by white lines formed by proliferative connective tissue.
3. Standard Acupuncture Intervention
All acupoints adopt WHO Standard Acupuncture Point Nomenclature. Traditional Chinese cun is uniformly converted to millimeters (mm) per WHO measurement specifications. Needle specifications, insertion depth and manipulations comply with international clinical acupuncture guidelines.
3.1 Acupoint Selection & Needling Technique (Affected Side Only)
- BL 1 (Jingming)
- Location: Depression slightly superior to the medial canthus on the face.
- Instrument: 1 piece of size 30 filiform needle, 38 mm in length.
- Procedure: Perform standard skin disinfection. Gently displace the eyeball laterally, then insert the needle perpendicularly to a depth of approximately 35.6 mm.
- Precautions: This acupoint is prone to bleeding. Do not perform twirling manipulation. Apply gentle compression over the needle hole immediately after needle removal.
- Sensation: Distending and aching sensation around the orbital region and within the eyeball.
- EX-HN 14 (Shangming)
- Location: Directly below Yuyao, between the superior orbital rim and the eyeball.
- Instrument: 1 piece of size 30 filiform needle, 38 mm in length.
- Procedure: Perform standard skin disinfection. Gently push the eyeball downward, then insert the needle perpendicularly to a depth of approximately 35.6 mm.
- Sensation: Fullness and heavy distending sensation inside the eyeball.
- EX-HN 5 (Taiyang)
- Location: Approximately 25.4 mm posterior to the midpoint between the lateral end of the eyebrow and the lateral canthus.
- Instrument: 1 piece of size 30 filiform needle, 38 mm in length.
- Procedure: Perform standard skin disinfection. Insert the needle at a 75° downward and posterior angle until contact with the bone surface.
- Sensation: Distending sensation radiating toward the posterior portion of the eyeball.
- EX-HN 13 (Yiming)
- Location: 25.4 mm posterior and parallel to TE 17 (Yifeng).
- Instrument: 1 piece of size 30 filiform needle, 50.8 mm in length.
- Procedure: Perform standard skin disinfection, then insert the needle perpendicularly to a depth of approximately 40.6 mm.
- Sensation: Local distending pain.
3.2 Treatment Protocol
Patients are treated in a seated position. Insert needles following the above protocols and retain them for 60 minutes. One gentle twirling manipulation is applied during the retention period.
- Treatment frequency: One session per day
- Treatment course: 10 sessions per full course
- Interval: Resume treatment after a 5-day rest between consecutive courses
4. Clinical Discussion
Optic atrophy is widely recognized as a refractory ophthalmic disorder in clinical practice. The above acupuncture regimen delivers favorable outcomes for patients in the early disease stage. A relatively long treatment course is usually required, and most early patients can regain partial or substantial visual function.
For cases with long disease duration, the therapy still yields certain therapeutic effects, yet the overall efficacy is inferior to that observed in early-stage patients. Long-term adherence to treatment is recommended to stabilize visual function.