1. 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

2. xÉuÉåïÇÌSìrÉÉhÉÉÇ lÉrÉlÉÇ mÉëkÉÉlÉÇ

3. 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.

4. 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.

5. 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.

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

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

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

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

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

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

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

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

15. 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

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

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

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

19. 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.

20. 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.

21. SCATTER LASER TREATMENT

22. 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.

23. IN AYURVEDA
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24. 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.
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A Umµ ±dg 3
©dUgµQ„®d ¯¬dy°«d Qdy°de®d¯dy°dZ

25. 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

26. In total ALMOST ALL prameha nidanas
ALL ARE
ACHAKSHUSYA

27. 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)

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

29. 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

30. 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

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

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

33. CHIKISTA SIDDHANTAs THAT CAN BE ADOPTED
Pramehahara
Srothorodhahara
Sophahara
Vaatanulomana

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

35. STAGE OF MACULAR OEDEMA
Sophahara chikitsa
Kapha - Pithahara chikitsas

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

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

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

39. Anjana
Kapha sravana
Srothosodhana

40. MOORDHA TAILAS
Shira Seka
Pichu
In Vata predominant conditions.

41. Tharpana
Nethra Brimhana – Balya
In Vatha dominant stage

42. RASAYANA PRAYOGA
Drishti prasadana

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

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

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

46. Towards the light…..
‘Thamasomajyothirgamaya…’