Ayurvedic management of Retinitis Pigmentosa.

Introduction

Retinitis pigmentosa (RP), group of inherited retinal degenerations, global prevalence of apprx 1 in 4,000. Patients typically report night blindness, difficulty with mid peripheral visual field in adolescence. Condition progresses, they lose far peripheral visual field. Most patients have reductions in central vision by age 50 to 80 years. Results in severe visual loss may lead to legal blindness. Symptoms may become manifest during childhood or adulthood, and include poor night vision (nyctalopia) and constriction of peripheral vision (visual field loss).¹ Recognized as drstigata rogas & sleshmavidagda drsti² initial stage of RP culminating in Nakulandya as further stage - visual field has been reduced. Drsti roga is always a challenge to manage(3). Chakshushya dravyas and shodhan is recommended.(4)Considering Prakruthi, agni, satwa, satmya, kosta etc the management is usually planned.⁵

Materials and methods

Selection: Diagnosed cases of retinitis pigmentosa meeting the inclusion criteria in the age group of 18 to 50 have been selected. Cases with no systemic condition, (diabetes, hypertension, chronic renal diseases etc) ophthalmic conditions (dry eye syndrome, corneal dystrophies etc) and complications (vitreal bleeding or retinal detachment etc) have been included. Shodhana for drstigata roga has been followed by nasya, tarpana, rasayana and suitable eye drops.⁶

Assessment criteria: Subjective and objective parameters:

• Avyakta darshana.

• Night Vision

• Dark adaptation.

• Peripheral vision.

• Tubular vision.

• Visual acuity –distant and near vision Beforeduring and after without glasses, with glasses and added aids –BE,RE,LE.

• Colour vision –Ishihara chart.

• Fundal photos, field of vision and visual acuity checked before, during and after management.

Methods

Shodhana: deepana/pachana-ajamodha churna followed by virechana with trivruth lehya-10gms. Anupana ushna jala and diet as per shudhi was advised.

• Shirodhara with MahaVishnu taila and Matra basti with Yastimadhu taila for 7 days.

• Tarpana with Triphala grita for 5 days followed by Ropana putapaka for 2 days along with Anu taila (7) prathimarsha nasya.(2 drops into each nostril as per classical reference)

• After above procedures patient is advised to intake Sapthamrutha tab once a day along with vainetheya gritha and honey for 48 days.

• Kanapippali anjana (8) external application to both the eyes for 48 days

• All medicines procured as per KPTT act followed by quotation of standard procedures followed in Government hospitals

Results

No appreciable changes noted in fundus picture or perimetry in any of the cases. In six cases visual acuity showed minimal improvement and no deterioration. Two among seven cases showed improvement in color discrimination and visual acuity probably due to patients being of young age and not being chronic in manifestation. Visual acuity which was recorded as less than 3/36 before treatment improved to 6/9 after first set of treatment done. One patient did not record any changes in vision or fundal changes but remained constant. Nutritional improvement was seen in all cases. Among the seven cases accepted for trails all were diagnosed as ‘Kapha vidagda drsti’ and showed pale fundus (Image -1) and only two showed peripheral changes as bony spicules and excessive retinal changes. (Image 2)

Discussion

Each case showed improvement in visual acuity but not appreciable changes in fundal photos .But it is worthy to note that the fundal photos did not record deteriorating changes. Based on the following points results are analyzed;

1. Its a chronic degenerative condition either stationary or progressive. Among the seven patients one showed no objective or subjective improvement after two sittings of management, may be due to its chronicity and heena satwa of the patient.

2. Satwa, satmya, agni, vayah were considered

3. Consanguine issue. –all seven patients gave a history of consanguineous marriage of their parents.

4. Hereditary— Hereditary factor noted in two patients. Two patients who participated in this trail are siblings and one patient’s sister also had a history of RP. Since RP can be hereditary and is irreversible it can be maintained by this management.

5. Family support is an important role in slowing down the progression and helps the patient to develop pravara satwa which may help in subjective improvement.

6. Condition is manageable if diagnosed in the early stages.

7. Level of nutrition is also important which has been accomplished in our management inclusive of chakshusya basti and rasayana.

Mode of action: Kayashodhana followed by shira shodhana improved the status of agni and kosta and facilitated better absorption of medicaments. Shirodhara relieved stress and anu taila nasya improved circulation. basti enhanced nutritional assimilation of chakshusya dravyas. Anjana specifically formulated for naktanadyatha was advocated for 48 days which has greater impact as it is specially designed as topical application. Rasayana made up of chakshusya dravyas was advised only after anajana. Extensive research conducted previously utilizing9 Jeevantayadi gtra,madhu ansd saptamrutha loha on many eye conditions was advocated in these patients.

Conclusion

As it is a chronic degenerative retinal condition it is necessary to focus on many variables in a bigger sample study to come to decisive conclusions. Further study suggestions based on this pilot study:

1. A large scale study which is multi centric needs to be done for a period of not less than 10 years to evaluate the progression and arresting of the deterioration of the condition.

2. Variables based on shodhan, shamana and rasoushadha needs to be implemented.

3. Cases of RP based on progressive and stationary needs to be carried out.

4. Treatment protocols of various schools needs to be evaluated.

5. Latest investigative techniques needs to be adopted to check the fundas and OCT variation after therapies.