E-ISSN:2456-3110

Review Article

Pigmentosa

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 8 August
Publisherwww.maharshicharaka.in

Retinitis Pigmentosa - An Ayurvedic View

P S1*
DOI: DOI:10.21760/jaims.8.8.25

1* Sandeep Anand P, Assistant Professor, Shalakya Tantra, Lal Bahadur Shastri Mahila Ayurvedic College And Hospital, Bilaspur, Haryana, India.

Retinitis Pigmentosa is a genetically determined dystrophy of the retina, almost invariably occurring in both the eyes. Beginning in childhood and often resulting in blindness in middle or advanced age. Night blindness is also one of the features of retinitis pigmentosa, Naktandya is seen in Kapha Vidagda Drishti, Nakulandya, Hriswajadya and Doshandya. The age of onset, rate of progression, eventual visual loss and associated ocular features are frequently related to the mode of inheritance. RP may occur as an isolated sporadic disorder, inherited as autosomal dominant (AD), autosomal recessive (AR), or X-linked. Retinitis Pigmentosa should be considered as Triteeya Patalagata Roga. The involved Dosha is Vata Pradhana Tridosha. Sodhana Karma and Kriyakalpas judiciously used not only improve the circulation but also provide micronutrients to the retina there by preventing the deterioration of retina.

Keywords: Retinitis pigmentosa, Naktandya, Kriya Kalpa

Corresponding Author How to Cite this Article To Browse
Sandeep Anand P, Assistant Professor, Shalakya Tantra, Lal Bahadur Shastri Mahila Ayurvedic College And Hospital, Bilaspur, Haryana, India.
Email: 		P S, Retinitis Pigmentosa - An Ayurvedic View. J Ayu Int Med Sci. 2023;8(8):167-172.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-06-14 2023-06-19 2023-06-26 2023-07-05 2023-07-17
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© 2023by P Sand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Sandeep Anand P. Retinitis Pigmentosa - An Ayurvedic View

Introduction

Eyes are one of the most important organs of the body. The retina is the innermost, light sensitive layer of the eye where the visual image of the world is created by eye optics. Light striking the retina initiates a cascade of chemical and electrical events that trigger nerve impulses. These are sent through the optic nerve fibres to the visual centre of the brain, resulting in visual perception.

Retinitis Pigmentosa is a genetically determined dystrophy of the retina, almost invariably occurring in both the eyes. Beginning in childhood and often resulting in blindness in middle or advanced age. The degeneration affects primarily the rods and cones, particularly the former, and commences in a zone near the equator of the eye gradually spreading both anteriorly and posteriorly. The macular region is not affected until a late stage.[1] Its prevalence rate is 1:5000.[2] 

Night blindness is also one of the features of retinitis pigmentosa, Naktandya is seen in Kapha Vidagda Drishti, Nakulandya, Hriswajadya and Doshandya.

Inheritance

The age of onset, rate of progression, eventual visual loss and associated ocular features are frequently related to the mode of inheritance. RP may occur as an isolated sporadic disorder, inherited as autosomal dominant (AD), autosomal recessive (AR), or X-linked.

 
  • Isolated, without any family history is common.
  •  AD is also common and has the best prognosis
  • AR is less common and has an intermediate prognosis.
  •  XL is the least common but most severe form which may result in complete blindness by the third or fourth decades.[3]

Prevalence and demography 

Prevalence - It occurs in 1 person per 5000 of the world population.

Age - It appears in the childhood and progresses slowly, often resulting in blindness in advanced middle age.

Sex - Males are more commonly affected than females in a ratio of 3:2

 

Laterality - Disease is almost invariably bilateral and both eyes are equally affected.

Pathogenesis[4]

Retinitis Pigmentosa conditions are characterized by death of rod photoreceptors. The molecular mechanism by which the genetic mutation eventually causes rod cell death are unclear, although apoptosis is involved in the final pathway of cell death. 

Clinical Features[5]

A. Visual symptoms

1. Night blindness

It is the characteristic and earliest feature and may present several years before the visible changes in the retina appears. It occurs due to degeneration of the rod cells

2. Dark adaptation

Light threshold of the peripheral retina is increased; though the process of dark adaptation itself is not affected until very late.

3. Tubular vision

Loss of peripheral vision with preservation of central vision occurs in advanced cases.

  

Jaims__2702_01.jpg
Fig. 1: 

4. Central vision 

Central vision is also lost ultimately after many years.

B. Fundus changes

1. Retinal pigmentary changes- These are typically perivascular and jet-black spots resembling bone corpuscles in shape. Initially, these changes are found in the equatorial region only and later spread both anteriorly and posteriorly.


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Sandeep Anand P. Retinitis Pigmentosa - An Ayurvedic View

2. Retinal arterioles are attenuated and may thread like in late stages

3. As the pigment from the retinal pigmentary epithelium migrates in to the retinal layers, the epithelium itself becomes visible and the fundus appears tessellated.

4. The disc exhibits the characteristics of primary optic atrophy.

5. Other associated changes which may be seen are colloid bodies, choroidal sclerosis, cystoid macular oedema, atrophic or cellophane maculopathy.

 C. Visual field changes

1. Annular or ring-shaped scotoma is a typical feature which corresponds to the degenerated equatorial zone of retina. 

Associations of Retinitis Pigmentosa[6]

Occular associations include myopia, primary open angle glaucoma, microphthalmus, conical cornea and posterior sub capsular cataract.

Jaims__2702_02.jpg

Fig. 2: Fundus changes in Retinitis Pigmentosa

Systemic association include-

1. Laurens moon bedle syndrome 

2. Cockayne’s syndrome 

3. Refsums syndrome

4. Ushers syndrome

5. Hallgrens syndrome

Diagnosis

The diagnosis of RP relies upon documentation of progressive loss in photoreceptor cell function by electroretinography (ERG) and visual field testing. 

Treatment[7]

1. Measures to stop progression, which includes vasodilators, placental extracts, transplantation of rectus muscles in to suprachoroidal space.

2. Correct any refractive error, prescribe glasses.

3. Low vision aids in the form of magnifying glasses and night vision device.

4. Rehabilitation of the patient should be earned out as per his socioecnomic background.

Ayurvedic View

Classical texts of Ayurveda have considered congenital blindness (Jatyandha) under Adibala Pravritta and Janmabala Pravritta diseases.

One of the main feature of Retinitis Pigmentosa is night blindness. This is seen in Dosandha, Nakulandhya, Dhumadarsi and Hriswajadya. Even in advanced Timira, similar clinical features are seen.

The line of treatment of RP involves mainly improving the function of Alochaka Pitta by providing Ghrita Pana, Sneha Virechana and Sneha Basti.

To normalise the functions of Vata by Vatahara and Rasayana measures. Various Kriya Kalpas helps to alleviate Vata. Tarpana and Putapaka play an important role in this. Nasya Karma, Sirobasti are also useful to achieve this.

Samprapti 

Abnormalities in Beejavayava

↓

Dosha Vaishamya

↓

Sanchaya of this Doshavaishamya in Drishtivahanaadi

↓

Sthanasamsraya of Prakupita Doshas in the Patalas of Netra

↓

Nakthandhya

Samprapti Ghataka

Dosha - Alochaka Pitta and Tarpaka Kapha 

 


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Sandeep Anand P. Retinitis Pigmentosa - An Ayurvedic View

Vyaktasthana - Netra Patala

Dushya - Rasa and Rakta 

Adhishtana - Drishti

Srotas - Rasavaha and Raktavaha

Agni - Jatharagni and Dhatwagni

Roga Marga - Madhyama

Doshandha 

In this disease the person sees things when the Dosas get move out of the path of vision due to the sun rays. So, the person sees only in the day time but difficult at night.

Nakulandha

By the aggregation of all the Doshas, the eyes of the person appears as that of mungoose. In this disease the person sees the objects in day time but difficulty of vision at night time.

It is a Tridoshaja Asadhya Vyadhi.

Dhumadarshi

Drishti gets vitiated by Shoka, Jvara, Ayasa, Shirashoola and person sees all objects smoky. It is a Pittaja Sadhya Vyadhi.

Hriswajadya

It is a Pittaja Asadhya Vyadhi. The patient of Hriswajadya will see the objects during the day with difficulty. Visualising all objects smaller than their normal size and hence the name Hraswa (smaller vision) Jadya (disease). This disease is one among the type of Nakthandhya according to sage Videha, whereas Acharya Sushruta and Acharya Madhava have described it as a defective vision only in day time.

General Treatment

1. Ghritapana

2. Nasya Karma

3. Anjana

4. Rasayana

5. Tarpana

6. Putapaka

7. Sirobasti

8. Basti 

1. Ghrita Pana

Old ghee preserved in an iron vessel should be used for 

  • Pana
  • Nasyakarma
  • Tarpana

Ghrita Yogas

Jeevanthydi Ghrita[8]

Mahatriphaladi Ghrita[9]

Patoladi Ghrita[10]

Kumbhayoni Ghrita[11]

2. Nasya Karma

Nasya is beneficial, when the symptoms of Dosha have just manifested and not involved the whole eye. 

Nasya Yoga

  • Jeevanthyadi Taila[12]
  • Sita Eranda Taila[13]
  •  Sahashwagandhadi Taila[14]
  •  Trivritam Taila[15]

3. Anjana[16]

  • Karanjikadi Varti
  • Kshaudra Jati Rasa Varti
  • Dwi Haridra Rasanjana Varti
  • Kauntyadi Varti
  • Kalanusariva Varti
  • Sukhavati Varti[17]
  • Chandrodaya Varti[18]
  • Chandanadya Varti[19]
  • Vasadyanjan[20] 

4. Rasayana[21]

  • If a person consumes Triphala, Satavari, Patola, Amlaka and Yava every day then the person will not have fear of dreadful Timira.
  • Payasa prepared from Shatavari alone or that prepared from Amlaki or Yavoudana mixed with ghee, followed by drinking Triphala Kashaya cures Timira.

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  • Leaves of Jeevanti, Sunisannaka, Tanduliyaka, Vastuka, Mulakapotika and meat of birds and animals of aired region are all good for eye sight.

5. Netratarpana

 Common Tarpana Yogas given below

  • Jeevanthyadi Ghrita
  • Triphaladi Ghrita
  • Mahatriphaladi Ghrita
  • Patoladi Ghrita

6. Putapaka[22]

Prasadana and Snehana type of Putapaka is beneficial for Vataja Timira. Snehana type of Putapaka is prepared with Medas-Majja-Vasa and Mamsa of Bhushayya, Prasaha, Anupa or Jivaneeya Gana drugs. Prasadana type of Putapaka should be done with liver, bone marrow, muscle fat, meat of animals and drugs of Madhura Gana mixed with Stanya or cow’s milk mixed with ghee.

7. Shirobasti[23]

Shirobasti means pooling the liquid medicines, especially medicated oils and or ghee in a chamber or compartment constructed over the head. Medicated oil prepared with Nata, Nilotpala, Ananta, Yasti and Sunishsannaka is ideal for Shirobasti. It can also be used in Nasya 

8. Basti

Common Basti Yogas for this condition

  • Sthiradi Yapana Basti[24]
  • Musthadiyapana Basti[25]
  • Madhutailika Basti[26]

9. Virechana[27]

Virechana is done with administration of medicines after internal and external oleation and sudation. This helps in removing toxins from the body and bring equilibrium of the Doshas especially Pitta. In Vataja Timira Eranda Taila mixed with milk should be administered.

Conclusion

Retinitis pigmentosa is inherited; degenerative eye diseases that cause severe vision impairment due to the progressive degeneration of rod photoreceptor

cells in retina. In Ayurveda the signs and symptoms of retinitis pigmentosa can be compared with Kapha Vidagdha Drishti, Naktandhya, Nakulandhya, Hraswajadya and Doshandhya. Retinitis Pigmentosa should be considered as Triteeya Patalagata Roga. The involved Dosha is Vata Pradhana Tridosha. Sodhana Karma and Kriyakalpas judiciously used not only improve the circulation but also provide micronutrients to the retina there by preventing the deterioration of retina.

References

1. Ramanjith Sihota and Radhika Tandon. Parsons Diseases of the eye 22nd edition New Delhi Elsevier- A division of Reed Elsevier India Pvt Ltd 2016 pg 327.

2. Clinical Ophthalmology by Jack J. Kanski. Butterworth Heinemann Publishers sixth edition chapter 18 pg 663.

3. Comprehensive Ophthalmology by A. K. Khurana/ Indu Khurana. 6th edition chapter 12 pg 287.

4. Comprehensive Ophthalmology by A. K. Khurana/ Indu Khurana. 6th edition chapter 12 pg 288

5. Comprehensive Ophthalmology by A. K. Khurana/ Indu Khurana. 6th edition chapter 12 pg 288

6. Comprehensive Ophthalmology by A. K. Khurana/ Indu Khurana. 6th edition chapter 12 pg 288

7. Comprehensive Ophthalmology by A. K. Khurana/ Indu Khurana. 6th edition chapter 12 pg 288

8. Ashtanga Hrudaya utharasthana of Vagbhatacharya with the commentary of sarvanga sundara of Arunadatta Chaukambha Varanasi chapter 13 verse 2 pg 818

9. Ashtanga Hrudaya utharasthana of Vagbhatacharya with the commentary of sarvanga sundara of Arunadatta Chaukambha Varanasi chapter 13 verse 12 pg 819

10. Ashtanga Hrudaya utharasthana of Vagbhatacharya with the commentary of sarvanga sundara of Arunadatta Chaukambha Varanasi chapter 13 verse 6-9 pg 819

11. Sushrutha samhitha Sutra Sthana with the nibandhasangraha comentary of Sri Dalhanacharya edited by Vaidya yadavji Trikamji Acharya chapter 46 pg 282


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12. Ashtanga Hrudaya utharasthana of Vagbhatacharya with the commentary of sarvanga sundara of Arunadatta Chaukambha Varanasi chapter 13 verse 51-54 pg 821

13. Ashtanga Hrudaya utharasthana of Vagbhatacharya with the commentary of sarvanga sundara of Arunadatta Chaukambha Varanasi chapter 13 verse 54 pg 821

14. Ashtanga Hrudaya utharasthana of Vagbhatacharya with the commentary of sarvanga sundara of Arunadatta Chaukambha Varanasi chapter 13 verse 34 pg 821

15. Ashtanga Hrudaya utharasthana of Vagbhatacharya with the commentary of sarvanga sundara of Arunadatta Chaukambha Varanasi chapter 13 verse 35 pg 821

16. Professor Udaysankar- Text book of Shalakya Tantra, Chaukambha Orientalia, Varanasi 1st edition 2012 pp 744, pg -599

17. Chakradatta edited and translated by Priya Vrat Sharma Chaukambha Orientalia, Varanasi. Chapter 59 verse 108 pg 497

18. Chakradatta edited and translated by Priya Vrat Sharma Chaukambha Orientalia Chapter 59 verse 112 pg 497

19. Chakradatta edited and translated by Priya Vrat Sharma Chaukambha Orientalia Chapter 59 verse 117 pg 498

20. Ashtanga Hrudaya utharasthana of Vagbhatacharya with the commentary of sarvanga sundara of Arunadatta Chaukambha, Varanasi chapter 13 verse 56 pg 821

21. Sushrutha samhitha Uttara tantra with the nibandhasangraha comentary of Sri Dalhanacharya edited by Vaidya yadavji Trikamji Acharya chapter 17 verse 48 pg 630

22. Ashtanga Hrudaya Sutrasthana of Vagbhatacharya with the commentary of sarvanga sundara of Arunadatta Chaukambha Varanasi chapter 24 verse 16 pg 309

23. Ashtanga Hrudaya utharasthana of Vagbhatacharya with the commentary of sarvanga sundara of Arunadatta Chaukambha Varanasi chapter 13 verse 76 pg 822

24. Charaka Sidhisthana with the ayurvedadipika

commentary by Sri chakrapanidatta chapter 3 verse 36-37 pg 695

25. Charaka Sidhisthana with the ayurvedadipika commentary by Sri chakrapanidatta chapter 12 verse 16 pg 732

26. Charaka Sidhisthana with the ayurvedadipika commentary by Sri chakrapanidatta chapter 12 verse 14-15 pg 733

27. Sushrutha Samhita Uttara tantra with the Nibandha Sangraha commentary of Sri Dalhanacharya edited by Vaidya Yadavji Trikamji Acharya chapter 17 verse 29 pg 627


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