AN AYURVEDIC PERSPECTIVE On DIABETIC RETINOPATHY PRESENTED BY, GUIDED BY, Dr.PRASANTH.D Dr. PRASANNA AITHAL 2ND YEAR P.G SCHOLAR ASST PROFESSOR DEPARTMENT OF PANCHAKARMA ALVAS AYURVEDA MEDICAL COLLEGE MOODBIDIRI, KARNATAKA

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NEED FOR THE TOPIC Leading cause of blindness. More than 40 million diabetics in India. About 5.6 million suffer from DIABETIC RETINOPATHY Scope of Ayurveda in the management.

Diabetes mellitus Diabetes mellitus is a syndrome of disordered metabolism, usually due to a combination of hereditary and environmental causes, resulting in abnormally high blood sugar levels. Diabetes mellitus is a metabolic disease due to absolute or relative insulin deficiency.

Diabetic Retinopathy Retinopathy" is the medical term for damage to the tiny blood vessels (capillaries) that nourish the retina. The most common and most serious eye complication of diabetes is Diabetic Retinopathy, which may result in poor vision or even blindness It is related to the degree and duration of the DM Insulin dependent DM have more chance to develop DR than NIDDM.

EVENTS OCCURING DURING D.R Obstruction of small retinal vessels Retinal hypoxia Compensatory events

Diabetes mellitus Impaired glucose metabolism Retinal Ischemia Release of growth factor (VGEF) Cont..

Cntd… Micro vascular changes Increased vascular permeability Retinal edema Neo-vascularisation Diabetic Retinopathy

CLINICAL PRESENTATIONS Non Proliferative Diabetic Retinopathy- NPDR (Background Retinopathy) Proliferative Diabetic Retinopathy- PDR

N.p.d.r . stage Occlusion of retinal capillaries. Micro aneurisms - balloon like swellingss.

N.P.D.R. STAGE Dot and blot hemorrhages occur.

N.P.D.R. STAGE Cotton wool spots and hard exudates

N.P.D.R. STAGE Increased capillary permeability leads to retinal edema If the edema involves macula, visual acuity will be affected seriously

p.d.r. stage Fragile, abnormal blood vessels leak blood into the center of the eye, also affecting MACULA thereby causing blurred vision & Macular edema

P.D.R . STAGE Retinal hypoxia due to capillary occlusion.

P.D.R. STAGE. Neo vascularisation occurs.

p.d.r. stage Vitreal hemorrhage and Retinal detachment May lead to sudden loss of vision.

Diagnostic criteria Fundoscopy Fluorescein angiogram a special dye is injected into the arm. Pictures are taken as the dye passes through the blood vessels in retina. The test identify any leaking blood vessels and other changes in retina.

Treatment adopted Control of blood sugar, blood pressure, and blood cholesterol. Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment or Laser photocoagulation. It helps to shrink the abnormal blood vessels.

SCATTER LASER TREATMENT

viterectomy If the bleeding is severe, a surgical procedure is adopted called as vitrectomy. During a vitrectomy, blood is removed from the center of eye.

IN AYURVEDA Ig¶e§d£dd¦dda eUµ Qdy°ddPdd«dŠ ¯dTfTy §deT¥dd®d£dd«dŠ | SdÎd ±daœd: šd ®dz›dgPSdd£dŠ ®Sdde¥d: £dÎddy§d¡ddSd£dy || ±dg ±dg

Ÿd´dg¯£dy¡ddy«dSda £d±Sd e®d¯dy°dd£dŠ ¯¬dy°«d£ddy ªdSda | WHY EYE IS SUCCEPTIBLE ? EYE IS BLESSED / CURSED WITH A UNIQUE COMPLEX MICRO CIRCULATION. Ÿd´dg¯£dy¡ddy«dSda £d±Sd e®d¯dy°dd£dŠ ¯¬dy°«d£ddy ªdSda | A Umµ ±dg 3 ©dUgµQ„®d ¯¬dy°«d Qdy°de®d¯dy°dZ

Similarities between the nidanas of prameha and netra roga 1.AMLA RASA k-p prakopaka, rakta vidaha- netra roga kleda vriddi, drava vriddi, adya dhatu shaitilya- - prameha. 2.SHUKTARANALA amla vipaka, k-p prakopa-- netraroga drava-kleda vriddi-- prameha 3.MASHA guru-snigda, madhura rasa/vipaka-- prameha usna virya-- netra roga. 4.KULATTHA ‘ghnanti dristim’ (A H Su) 5.VEGA VINIGRAHA nidra-ashru vega— netra roga mootra vega-- prameha

In total ALMOST ALL prameha nidanas ALL ARE ACHAKSHUSYA

samprapti PRAMEHA NIDANA KSHIPRA SHLESHMA PRAKOPA e±dTd¦dg±ddeTeªdZ Qdy°dzZ e®d›dgPdzZ E¥®«dd‰›d£dzZ | ¡ddSd¦£dy ¦dyÎdªdd›dy°dg Tdy›dd: §dT«dQdèPddZ (SU.UT)

samprapti PRAMEHAµ Ady¡ddy ´dSd Ady¡dZ ´dfSd£dy ---------------- ®Sde¤d£dye¦Q„SdZ || A Umµ D 11 / 39

e®dI¶dTdPdda AIg¶¯d¬ddy ¦d e¡dZ̾ûSdd£dŠ I¶QdŸd¦d | FACT e®dI¶dTdPdda AIg¶¯d¬ddy ¦d e¡dZ̾ûSdd£dŠ I¶QdŸd¦d | ¦d eUµ ±d®d‰ e®dI¶dTdPda ¦dd«d£ddy Ae±£d ¥d‚g®dde±¤de£d: ±d H®dy Ig¶e§d£ddy Qdy°dZ ±d«dg¤dd¦d e®d¯dy°d£dZ | ±¤dd¦dda£dT ›d£dÜdz®d ¡d¦dSd£Sdd«dSdd¦dŠ ©dUjµ¦dŠ || Ÿd ±dg 18/45

Tridosha - factor Different dosha dominance in different clinical stages being a sannipathika pathology. Leakage,exudates,oedema Kapha Haemorrhage Pitha Terminal stage with retinal detachment Vatha

Srotodushtis Sanga Occlusion of retinal vessels Siragrandhi Aneurysms Athipravruthi Neo Vascularisation Vimargagamana Retinal Haemorrhage

IN TOTAL Kaphakopa in the site of Thejus Srothorodha in Rakthavaha srothus Malasanchaya in Nethra Srothorodha in sookshma Rakthavaha srothas of Nethra

CHIKISTA SIDDHANTAs THAT CAN BE ADOPTED Pramehahara Srothorodhahara Sophahara Vaatanulomana

Chikista based on clinical stage STAGE OF RETINAL VESSEL OCCLUSION SROTHOROTHARA CHIKISTA

STAGE OF MACULAR OEDEMA Sophahara chikitsa Kapha - Pithahara chikitsas

STAGE OF HEAMORRHAGE Urdwagatha – (Akshigatha) – Rakthapitha chikitsa Vasa Prayoga

SODHANA - VIRECHANA Koshta - Dhathu sodhana Kledanirharana Vathnulomatha in Pitha sthana Using Thrivrit / Triphala formulations

Other kriyakalpas that can be adopted Seka /Aschyothana Sookshma malachedana Srothosodhana Nethra prasadana

Anjana Kapha sravana Srothosodhana

MOORDHA TAILAS Shira Seka Pichu In Vata predominant conditions.

Tharpana Nethra Brimhana – Balya In Vatha dominant stage

RASAYANA PRAYOGA Drishti prasadana

pathya AAHARAS – AVOIDANCE OF KATU, AMLA, LAVANA, VIDAHA, KSHARA, GURU, ABHYISHANDA AAHARA PADARTHAS. VIHARAS – SHIRO ABHYANGA, SHIRO VESHTANA, PADA POOJA SHOULD BE PRACTICED.

CONCISED APPROACHES TO D.R Koshta sodhana Aschyothana/Anjana Moordha thaila Shirolepa Mukhalepa Tharpana Triphaladi Rasayana Prayoga Padabhyanga

CONCLUSION cɤÉÑU¤ÉÉrÉÉÇ xÉuÉïMüÉsÉÇ qÉlÉÑwrÉærÉï¦ÉÈ MüiÉïurÉÉå eÉÏÌuÉiÉå rÉÉuÉÌScNûÉ | urÉjÉÉåïsÉÉåMüÉåÅrÉÇiÉÑsrÉUȨ́ÉÌSuÉÉlÉÉÇ mÉÑÇxÉÉqÉlkÉÉlÉÉÇ ÌuɱqÉÉlÉå AÌmÉÌuɨÉå|| A. WÛû. E. 18

Towards the light….. ‘Thamasomajyothirgamaya…’