Visual evoked potential (VEP) testing is used frequently and is an important ophthalmologic physiological test to examine visual functions objectively. The VEP is a complicated waveform consisting of negative waveform named N75 and N135, and positive waveform named P100. Delayed P100 latency and greatly attenuated amplitude on VEP are known characteristics for diagnosing optic nerve disease. Acupuncture has been used to treat wide clinical symptoms with minimal side effects. The confirmation of the efficacy of acupuncture generally relies on subjective symptoms. There is not much scientific evidence supporting the acupuncture treatments for eye diseases up to today. However, the VEP test can evaluate objectively and numerically the efficacy of the treatment by the acupuncture. We analyzed 19 healthy subjects (38 eyes). The P100 latencies in the group of less than 101.7 msec (total average) before acupuncture stimulations were not different than those after treatment (98.2 +/- 3.0 msec, 98.2 +/- 4.0 msec, respectively, p = 0.88, n = 17), but the latencies in those subjects with longer or equal to 101.7 msec were statistically different after acupuncture (104.6 +/- 2.8 msec, 101.9 +/- 3.7 msec, respectively, p = 0.006, n = 21). These results show that the acupuncture stimulation contributes to the P100 latencies of pattern reversal (PR)-VEP to some subjects who have delayed latencies, and this electrophysiological method is a valuable technique in monitoring the effectiveness of acupuncture therapy in the improvements of visual functions. The purpose of this study is to evaluate the physiological effects by acupuncture stimulations using PR-VEP in normal subjects.

Context: Research of the effects of one acupuncture method for patients with glaucoma, focusing on intraocular pressure (IOP) and visual acuity.Objective: To explore the possibility of using acupuncture for patients with glaucoma.Design: Pilot study utilizing a one-group preintervention, postintervention design.Setting: Eleven patients with glaucoma were recruited through advertisement at the clinic for glaucoma.Intervention: Acupuncture was carried out twice a week over 5 weeks.Outcome Measures: IOP, visual acuity, and subjective symptoms were observed at 15 minutes before and after acupuncture once a week and in a four-week follow-up.Results IOP was significantly improved at 15 minutes after acupuncture, at one week, two weeks, and five weeks and tended to be lower weekly. Uncorrected visual acuity was significantly improved at three weeks, four weeks, and five weeks, and best corrected visual acuity was significantly improved at five weeks. However at the four-week follow-up, significance remained only in uncorrected visual acuity.Conclusions: Although these results should be interpreted cautiously, acupuncture can be used to supplement the conventional therapy for glaucoma.

To the Editor: Gait disorders in the elderly lead to injury,1 fear of falling, limitation of activity, and prolonged bed rest.2 An interdisciplinary approach may decrease the risk of falls and reduce functional impairment, but it needs inducible efforts.3 We recently reported that acupuncture on two acupoints (Zusanli ST36 and Taixi K3) restored the swallowing reflex in poststroke patients.4 These two acupoints and Shenshu (BL23, on the lower back, below the spinous process of the second lumbar vertebra, 1.5 fingerbreadth lateral to the posterior midline)5 have been used in Japan and Asian countries for acupuncture treatment of gait disorders, pain, and other symptoms of lumbar regions or inferior limbs. We examined acupuncture therapy on the acupoints (ST36, K3, and BL23) and observed whether simultaneous acupuncture at the three acupoints improve gait disorders in the frail elderly. For acupuncture, six disposable stainless steel fine needles (diameter 0.16 mm, length 40 mm) were inserted in three acupoints bilaterally and kept at a 10-mm depth for 15 minutes without any extra stimulation such as electrical or manual. The Timed Up and Go (TUG) test, which measures total time from when the subject stood up from an armchair, walked a distance of 3 meters, turned, walked back to the chair, and sat down again, was measured. A TUG test score of more than 16 seconds is one of the predictors of falls.6 Subjects were 27 outpatients (18 women, 9 men) with a mean age±standard deviation of 76±8 years and no cognitive impairment. They complained of gait disorders because of lumbago (n=10), stroke (n=6), Parkinsonism (n=3), and combinations of these diseases (n=8). They were selected randomly at the Tohoku University Hospital and participated in this study under written informed consent. The ethical committee of Tohoku University Hospital approved this trial. Participants were randomly assigned into two groups. At first, we practiced acupuncture on the intervention group (15 patients (11 women, 4 men), aged 75±8) and examined the TUG test before and 1 hour after the acupuncture. Twelve other patients were assigned to the control group and received usual care without acupuncture. The TUG test after the acupuncture (using three acupoints) improved significantly (18±8 vs 14±6 seconds, P<.001) (Figure 1). The TUG test without acupuncture after a 1-hour interval in the control group did not change significantly (17±7 vs 17±8 seconds, P>.10). Change in the Timed Up and Go test score before and after the initial acupuncture. Solid lines connect the same patients. Fifteen patients in the intervention group underwent acupuncture therapy once a week for 1 year. The therapy was completed in 11 patients (9 women, 2 men, aged 75±10). The control group (7 women, 5 men, aged 76±8) received usual care without acupuncture for 1 year. The intervention group maintained their improved scores on the TUG test compared with baseline values after 1 year of follow-up (15±4 seconds, P<.001), whereas scores declined in the control group (19±6 seconds, P<.05). Activities of daily living were assessed in both groups using the Barthel Index at baseline and after 1 year of follow-up. The Barthel Index has a 100-point scale in five-point increments for healthy people.7 A score of 0 represents the worst state. After 1 year of follow-up, the Barthel Index declined in the control group (81±6 vs 77±10, P<.05) but improved in the intervention group (77±10 vs 93±4, P<.005). There were no adverse effects related to the acupuncture therapy. We showed that acupuncture can be a safe and inexpensive way to improve gait disorders and activities of daily living in the frail elderly. We suggest that there are beneficial effects of acupuncture to prevent limitation of activity and reduce the risk of becoming bed-ridden.

6. Council for LTC. Nutrition. Potential geriatric anorexia offenders [On-line]. Available at www.LTCnutrition.org Accessed May 30, 2002. 7. Mowe M, Bohmer T. The prevalence of undiagnosed protein calorie undernutrition in a population of hospitalized elderly patients. J Am Geriatr Soc 1991;39:1089–1091. 8. Akner G, Cederholm T. Treatment of protein-energy malnutrition in chronic nonmalignant disorders. Am J Clin Nutr 2001;74:6–24. 9. Fiatarone MA, Bernstein MA, Ryan AD et al. The effect of oral nutritional supplementation on habitual dietary quality and quantity in frail elders. J Nutr Health Aging 2000;4:5–12. 10. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. Arch Intern Med 1997;157:1531–1536.