Short Review on Combined Meibomian Gland Massage and Acupuncture Enhances Tear Film and Ocular Surface Health in Meibomian Gland Dysfunction

We were pleased to see the recent article by Ruiwen Wang and colleagues [1], which evaluated the benefits of combining meibomian gland massage with acupuncture in patients with meibomian gland dysfunction. Their results suggest that the combined approach leads to greater improvement in tear film stability, gland function, and ocular surface health than massage alone, without increasing adverse events. While the findings are promising, we do wish to raise several methodological and reporting issues that merit attention. 

First, the study is described in the Methods as a “retrospective analysis,” yet the text later indicates that “patients were assigned to two groups”—wording that suggests prospective group allocation. This inconsistency creates ambiguity about the study design and does not align with STROBE reporting guidelines for observational studies [2]. In a retrospective study, interventions are not “assigned,” and patients should instead be described as having been categorized based on treatment records. To strengthen the analysis, we would encourage the use of multivariate adjustment or propensity score methods to account for potential baseline confounding. If the study was in fact prospective and non-randomized, the authors should clarify the allocation process (e.g., by patient preference or order of enrollment) and discuss possible selection biases. 

Second, although the massage procedure is well described, key details of the acupuncture intervention are unclear. The term “pressing acupuncture” is ambiguous, leaving readers uncertain whether this involved needle insertion or simple acupressure. Moreover, the assessment of “deqi” sensation appears to rely on subjective judgment, with no standardized criteria provided. We recommend that the authors follow the STRICTA reporting guidelines [3] and include a supplementary acupuncture protocol. This would require clarifying whether needling or pressure was applied, specifying the location and depth of each acupoint, describing any needle manipulation (e.g., rotation speed and duration), stating the needle retention time, and offering an operational definition of deqi—including how it was assessed and described by patients or practitioners. 

Third, all outcome measures were assessed immediately after the 4-week treatment period, with no follow-up beyond that point. Given the chronic nature of MGD, short-term improvements do not necessarily reflect long-term benefit. We suggest that the authors explicitly acknowledge the absence of durability data as an important limitation. Future trials would be strengthened by including follow-up assessments at 3 or 6 months to determine whether the observed benefits are sustained—a key consideration for clinical adoption. 

Finally, the subjective symptom score used in the study appears to be a non-validated instrument comprising only five items, each rated 0–3. Such a scale may lack the sensitivity and breadth needed to fully capture treatment-related changes or the impact of MGD on patients’ daily lives. We recommend that future studies employ validated patient-reported outcome measures, such as the Ocular Surface Disease Index (OSDI) or Dry Eye Questionnaire (DEQ-5) [4]. These tools improve comparability across studies and better reflect outcomes that matter to patients, such as visual function during reading, driving, or screen use. 

We thank the authors for their valuable contribution and hope these comments prove helpful in refining the interpretation and presentation of their work.

1. Wang R, Guo K, Li J (2025) Combined meibomian gland massage and acupuncture enhances tear film and ocular surface health in meibomian gland dysfunction. Am J Transl Res 17: 7240-7248.
2. Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, et al . (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61: 344-349.
3. MacPherson H, White A, Cummings M, Jobst K, Rose K, et al. (2001) Standards for reporting interventions in controlled trials of acupuncture:the STRICTA recommendations. Complement Ther Med 9: 246-249.
4. Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, et al. (2017) TFOS DEWS II Diagnostic Methodology report. Ocul Surf 15: 539-574.