Avoidable Blindness - Target Disease Areas

One of the basic human right,is the right to see.We have to ensure that no citizen goes to blind needlessy or being blind does not remain so,if by reasonable deployment of skill and resources,his sight can be prevented from deteriorating or if already lost, can be restored.

National policy.

Science of ayurvedic ophthalmology goes hand in hand with this policy.There are some eye diseases,which leads to blindness.But if treated in time,with skill of experience,the sight can be protected.Atleast minimize the deterioration.

Ayurveda can help in following conditions

Macular degeneration

Macular degeneration is now one of the major causes of blindness. It is now in the first place among the causes of blindness in the working group of population. In most cases, the early stage of the disease will be missed by the patients, because there will not be any serious visual problem in the very early stage. Only when the vision is seriousely affected, the victim becomes aware of the condition. The usual symptoms are :

Clinically, it can be described under two heads :

1. Dry ARMD (atrophic type)
2. Wet ARMD (Haemorrhagic type)

Dry ARMD is usually gradual in onset leading to blindness. When examined, hard exudates will be seen on the retina. In the case of wet ARMD, the onset will be sudden and there will be haemorrhage in the retina.

According to ayurvedic theories, macular degeneration is Vata-pitta predominant. In the case of dry type, vitiation of vata is more. So, Vata-Samana chikitsa concentrating on the head and eye is necessary to manage the case. For this, Brimhana nasyam, siro vasthi, siro dhara, nethra tharpanam, etc. are beneficial. But the medicine for each of these procedure should be selected very carefully because the medicine varies according to the body constitution of the patient, age of the patient, mental status of the patient, etc. etc. If there are any other systemic diseases, that also should be considered seriousely while selecting the medicines. In the case of wet type, pitta is more predominant and so, the medicine should be selected accordingly. Pittasamana, chakshushya and rasayana drugs are suitable for this. The treatment procedures should be mainly ksheeradhara, netrasekam, vitalakom, etc.

Diabetic retinopathy

Even though it starts as a complication of diabetes mellitus, later, it turns to attain a separate identity. That means, after a level, even though even though diabetes is under control, diabetic retinopathy may progress in its own way. If not handled in time, in correct way, it is capable of leading to blindness. So, once the symptoms of diabetic retinopathy is manifested, it should be handled with extreme care.

We have a successful line of approach for prevention of retinopathy in diabetic patients and also treatment methods to protect the vision in a diabetic retinopthic patient.

Initial stage of diabetic retinopathy is missed in most cases since vision is not affected seriousely i n this stage because the patient will be concentrating only on the blood sugar level. It is t o be remembered that even though blood sugar level is within normal limits, there are chances of developing diabetic retinopathy in a diabetic patient. There are many factors influencing development of diabetic retinopathy :

1. Chronicity of diabetes
2. Severity of diabetes
3. Hereditary factor
4. Body constitution – Dosha prakrithi
5. Environmental and occupational factors
6. Stress and strain
7. Dietary and other habitual factors.



It is the duty of a diabetologist to direct a diabetic patient for consultation with a ophthalmologist even though there is no ophthalmic complaints. The very initial symptoms are mild headache, eye strain while reading, working in front of computer, watching T.V etc, fullness and heaviness of the head and eye, esp in the early morning, hypersensitivity to bright light, watering of the eye while straining, etc. Further development of the disease depends on the above said factors. The pathological changes are mainly dilation of the vessels, congestion of the retinal vessels, blockages in the microsvascular system in the retina, retinal oedema, haemorrhages, exudates formation, neovascularisation etc. In the later stage, there may be macular hole, retinal detachment ,and other degenerative changes.




According to ayuveda, the course of diabetic retinopathy can be classified into three stages :

1. Initial stage of kapha predominance (Nethrabhyshyanda) – Here, there will not be considerable ophthalmic symptoms. Only an experienced doctor can diagnose this condition. The line of treatment should be sira-sodhanam. Nasyam, Gandoosham, kabalam, etc are more preferable in this stage than ophthalmic applications.
2. Stage of pitta predominance – Usually, the patients come to an eye specialist in this stage. There will be considerable visual problems. The patient may experience blurring of vision, sudden decrease in vision, metamorphopsia, sometimes burning sensation in the eye, photophobia, etc. Here, pitta is the predominant dosha and pittasamana should be the line of treatment. Sirodhara, Netrasekam, vitalakam , Aschotanam, thalom, etc are preferable. Alongside, the patient has to follow strict dietary regulations. i.e, simple medication is not enough, the dietary factors, other habitual factos such as head bath, sleep, journey, oil application etc should be arranged according to the specific features of the particular individual. The factors should vary from individual to individual. Only an experience person can do this. If this stage is handled correctly, there is no chance of further complications and visual loss.
3. Third stage of tridosha predominance or stage of complications – If the second stage is not handled correctly, and the etiological factors continue, the disease turns to complications. Here, a strict line of treatment is not possible. The treatment varies according to the particular complication. For e.g., if it is detachment, vata predominant should be considered seriousely, if there is neo-vascularisation, pitta should be considered more, if there is fluid accumulation, kapha should be taken seriousely. The treatment should vary accordingly.

Glaucoma




It is a condition in which the intra-occular pressure of the eye increases and there are changes in the retina especially in the optic disc. These changes are enough to derange the functional system of the eye and if it progresses, it is capable of leading to blindness. Glaucoma is mainly of two types :


1. Open angle Glaucoma or simple chronic glaucoma – It seems to be a silent enemy. The onset is gradual and without considerable symptoms and hence most of the patients will be unaware of the development of the disease. In the very early stage, there will be no visual symptoms. Mild headache, heaviness of the head, feeling of fullness in the eye more in the morning or evening etc are the symptoms. Gradually, visual symptoms start to develop. Decrease in distant vision, and decrease in visual field, esp, peripheral are the main symptoms. As the symptoms increases, the patient moves towards blindness.
2. Closed angle Glaucoma or acute congestive glaucoma – Here, the onset is sudden. In most cases redness of the eye, congestion of the vessels, severe pain, photophobia, headache etc are the main symptoms. If not handled with care, there are chances of loss of vision within a few days.



In ayurveda, glaucoma comes under the head – Adhimandha. According to the predominant dosha, and the associated symptoms, adhimandha is classified as vatadhimandha, pittadhimandha, kaphadhimandha and rakthadhimandha. The treatment for each condition is different from one other. So, the signs and symptoms of a particular case should be analysed properly on the basis of tridosha theory and confirm the predominant dosha. Only after that, treatment can be started. That means, treatment may vary from one individual to another.




In vatadhimandha, vata samana and snigdha therapies are preferable. In pittadhimandha, pitta rakta sodhana therapy should be administered. In kaphadhimandha, kapha sodhana and siro virechana procedures are advised. In rakthadhimandha, rakthasodhana should be the first choice. Internal medicines, generally sodhana in nature also is compulsory. Appropriate dietary schedule and regulations in other habitual factors also is necessary.




Retinitis Pigmentosa




Retinitis Pigmentosa is a very dangerous degenerative condition of the retina. So itself, prevention of the disease is not an easy task. The disease has a long but slow progress and if not handled in time by an experience hand, it is capable of leading to blindness. Degeneration of the retinal cells, especially the rod photo receptors is the primary change and later, the cone photo receptors also get involved.




In most cases, night blindness will be the initial symptom. Later, there will be decrease in the peripheral visual field and also the patient becomes the victim of colour blindness. In some cases, the central vision may persist until the last stage of the disease.




According to ayurvedic theory, this condition can be described in three stages.


1. Stage of kapha predominance (kapha vidaghdha drishti) – In this stage, the predominant dosha is kapha and main symptom is night blindness. The treatment should be focused on kapha sodhana. If treated otherwise, the patient would be thrown into a dangerous situation.
2. Stage of pitta-predominance with kapha anubandha – Here, other visual symptoms starts. Pitta also comes into the picture. Decrease in vision, decrease in visual field, colour blindness, etc. will be the main symptoms. Here, pitta-samana treatment should be implemented. According to the prakriti of the patient, and his habits, the treatment schedule may vary. Habit of bath, oil application on head, sleep, journey, etc should be rearranged to support the treatment.
3. Third stage of tridosha predominance – In this stage, vata also get vitiated and symptoms of all the three doshas will be produced. There would be considerable decrease in vision, colour blindness, and also field loss. The patient will be in a stage where he cannot move freely. Only central vision will be persisting in most cases. Here, rasayana therapy should be the line of treatment. Vata-pitta samana, rasayana and chakshushya treatments are advised. Lifelong medications and treatments are necessary to prevent blindness once the disease has attained this stage.



Degenerative Myopia




Myopia, otherwise known as short sightedness is a common condition, known to almost everybody. But the term ‘Degenerative Myopia’ is unknown to most. Myopia is mainly of two types :


1. Physiological myopia or simple myopia
2. Pathological myopia or degenerative myopia



Among these, degenerative myopia is the most dangerous. Here, the vision will be decreasing gradually. It is not simply due to the anatomical variations of the structures (cornea, lens etc.), but there will be degenerative changes in the retinal layer in this condition. In the initial stage, there will be correction with glasses and so the patient will be unaware of its seriousness. Most often, glasses would be changed once in a year and sometimes once in six months (about -1 to -1.5 at a time). After a particular stage, it is seen that there is no further correction with glass. Only in this stage, the patient becomes aware of the seriousness of the condition. By the time, the ‘Power’ of the glass would have attained above -10 D. The patient start to think of alternative methods other than glasses in this stage. Other than decreased distant vision, there are symptoms such as eye strain, pain in the eye, headache, floaters (moving dark spots in front of the eye), watering of the eyes, difficulty to face bright light, etc. sometimes, there will be flashes of light in front of the eyes. After this stage, the disease may turn to a complicated stage in which there are possibilities for retinal detachment, optic atrophy, etc. These pathological changes are capable of leading to blindness. Ayurveda can offer good result in the management of degenerative myopia. According to the principles, it is vata-pitta predominant drishtigatha rogam. The line of treatment is rasayana and chakshushya. The procedures are selected to strengthen the sclera, and to arrest the degenerative changes in the retina. IIf handled correctly, the vision will be improved to a significant level.