Author Affiliations: Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China (Drs Zhao, Zhang, and Lam); Department of Ophthalmology and Visual Sciences (Drs Chen, A. H. Fan, Zhao, D. S. P. Fan, and Lam), Institute of Chinese Medicine (Drs Leung and Lam), the Chinese University of Hong Kong, Hong Kong, China; Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York (Dr Ritch); and the Department of Ophthalmology, New York Medical College, Valhalla, New York (Dr Ritch).
We appreciate Dr Metheny's interest in our article.1 We agree that a sham acupuncture group is helpful for evaluating the effectiveness of acupuncture, similar to that of acupuncture for pain control.2,3 Although visual acuity testing is relatively objective, so that psychological effects could be less influential to our findings, the possibility of a placebo effect from acupuncture may be ruled out only if a sham acupuncture group is included. However, as pointed out by Dr Metheny, Chinese parents who believe in acupuncture would not risk their children's vision to sham acupuncture, substantially impeding patient recruitment if such a group were designed. In our follow-up randomized controlled trial, a nonacupoint acupuncture group is added at randomization, with an understanding that true acupoint acupuncture will be added if sham acupuncture is less effective in phase one of the study. Until the preparation of this reply, no parents refused randomization because of the design of a nonacupoint acupuncture group (unpublished data of our ongoing study). We believe that such a design might not be too problematic in the United States because every participant will have a chance to receive true acupuncture, though in different phases of the study.
Chen LJ, Fan AH, Zhao J, Fan DSP, Zhang M, Leung PC, Ritch R, Lam DSC. Acupuncture and the Placebo Effect—Reply. Arch Ophthalmol. 2011;129(8):1107-1108. doi:10.1001/archophthalmol.2011.232