Abstract
Introduction
Myopia is an escalating public health challenge worldwide, with a particularly high burden in China. Although conventional treatments are available, their effectiveness is often limited by issues related to adherence, cost, or safety. Traditional Chinese medicine (TCM), specifically Tuina therapy, offers a preventive approach, with studies suggesting its potential efficacy in the management of pediatric myopia. However, clinical adoption is hindered by lack of standardized treatment protocols. This study aimed to assess the efficacy and safety of Tuina therapy for pediatric myopia and establish a standardized protocol based on the Zhi Wei Bing (prevention first) theory.
Methods
A multi-method, consensus-based approach was employed, comprising three stages: (i) Problem Identification: Semi-structured expert interviews; (ii) Evidence Retrieval and Synthesis: A systematic literature search (up to September 2023) across Chinese and English databases; and (iii) Recommendation Formulation: A two-round Delphi process, involving 203 ophthalmologists and 76 Tuina specialists, achieved predefined agreement (≥60% consensus) on procedures, acupoint protocols, and TCM pattern differentiation. Recommendations were developed using evidence-to-decision frameworks and Good Practice Statements. Evidence quality and recommendation strength were assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.
Results
Tuina therapy demonstrated favorable efficacy and safety in the prevention and treatment of low-degree myopia and pseudomyopia in children. A consensus was reached regarding five TCM patterns. A standardized acupoint protocol was established: 14 core acupoints for the preventive stage, 21 for progression management, and 25 for pattern differentiation. A combined strategy using both foundational and pattern-specific acupoints is recommended. The foundational protocol can be applied alone if no specific pattern is identified. Home-based eye exercises were endorsed as complementary strategies.
Conclusion
This study developed the first evidence-based standardized Tuina protocol for pediatric myopia, addressing a critical gap in non-pharmacological management. These findings suggest that Tuina is an effective and safe therapeutic approach.