Total number & the classification of Eye Disorders

Discussion with regards to classification of an eye disorders according to different scholars of Ayurvedic Opthalmology number of eye disorders mentioned according to different masters ( Acharyas) are as follows -

Sushrutacharya & Vagbhatacharya??? 76 types of Eye diseases

Charakacharya???? 96 types of Eye diseases

Madhav Nidanakar?? 78 types of Eye diseases

Different Approaches of the classification of an Eye disorders according Ayurveda.

• ?Based on dosha type
• Based on therapeutic approach
• Based on anatomical approach
  

Out ?of which the last option i.e. based on anatomical approach is still followed by contemporary ophthalmologist in their standard texts on ophthalmology (eg. Diseases of lids, disease of cornea, diseases of sclera etc.,)

A.? Classification of eye disorders according to dosha type

In this approach surprisingly a great efforts have been taken to sub classification of diseases ,according to their tentative prognostic values ,such as easily?? manaageble/completed curable ie. Sadhya, ?difficult as treat ie, Yapya & Untreatable ie. Asadhya apat from its doshik classification such as Vataj, Pittaj, Kaphaj etc.

B. ? Classification of eye disorders according to therapeutic approach

1) Cheddya (?? to be incised)???? - 11???? 4) Vedhya ( to? be punctured -15

2) Lekkhya (? to be scraped )??? - 9?????? 5) Asadhya ( Non treatable)?????? -24??

3) Bheddya ( to be punctured ) -5??? 6) Shamanarha (conservative line of therapy)-1????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? ??????????????????????? ??????????????????????????????????????????????????????????????????????????

Scope & Limitations of Ayurvedic Ophthalmology in current practice

Ayurveda has discussed in great details about various eye diseases such as ‘Abhishyanda’ (Conunctivitis), ‘Adhimantha’ (Glaucoma), ‘Pothaki’ (Trachoma), ‘Kaphaj Linganasha’ (Mature Cataract), ‘Arma’ (Pterygium), Vatahat vartma (Ptosis), & many more, even many disorders of eye which we can see today , although doesn’t have their mainstay in the Ayurvedic literature, we can still find number of similar symptomatologies? in the classical texts.

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Thus I am getting an opportunity to treat cases of Retinitis Pigmentosa (R.P.), Age related Macular degenerations (A.M.D.), Retinopathies of different origins like Hypertensive Retinopathies & Diabetic Retinopathies , Amblyopia , Increasing Myopia, Computer Vision Syndrome, Vitreous floaters, Vitreous haemorrhage with Ayurvedic treatment. At the same time we must not accept fresh & frank cases for surgeries, viz. mature cataract, glaucoma, retinal detachment, retinopathies having never treated before with lasers. Because if we refer these cases promptly to eye surgeons , not only we can save time but can also avoid further complications as well & perhaps can prevent that patient to become blind !!Only when these type of cases already been seen , operated by modern ophthalmologist when have poor prognosis, poor chances of regaining vision, then, yes, I think no one would have any difference of opinion for treating those cases with Ayurvedic ophthalmology !! At least that is what is my approach is!

Cataract Surgery as discussed in Ayurvedic Ophthalmology
Many a times there is a myth in a society that with Ayurvedic therapy we can bypass cataract operation, which is not true! In fact we will be surprised to know? that ever first operation for cataract has been discussed in Ayurveda by Sushrutacharya. Many people call it as non scientific procedure as a couching, but I strongly oppose that, because if you read the steps of operation mentioned by Acharya Sushruta carefully , one may realize that it shows a great similarity with the latest technique of ‘Phacoemulsification Surgery for the Cataract’.

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Kaphaj Linganash: Linganash is a term derived from two-wards Linga ie. Function & Nash –destruction . When there is? a?? destruction of a function of a lens when it becomes opaque , no light can pass through the lens, then it is termed as Linganasha . The same definition also holds true for Cataract. Opacification of (formation of opacities) the crystalline lens is known as Cataract.

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While discussing about treatment of Cataract (Kaphaj Linganasha), Sushrutacharya has specifically mentioned about surgical treatment. In detail discussion of surgical procedure, there is a mention of Pre operative procedures (Poorvakarma), Main Operative procedures (Pradhana karma), Post Operative procedures (Pashchat karma). In Pradhana karma, there is a reference of piercing a globe at a particular position, specifically at the intersection of 2/3^rd of the limbal side & 1/3^rd of the outer canthal side, where a shalaka has to be put inside, in such a way that it will not disturbs other important appendages of eye, or blood vessels of eye & can reach out straight a way to opaque lens, (Drushtimani), having this procedure done, one may hear a particular sound , & can see watery secretions of Linganasha dosha - Liquified lenticular matter (Thus this reminds somewhat similarity to the latest approach of Cataract Surgery – ‘Phacoemulsification’ as mentioned before).

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Then certain drugs are to be instilled in the eye such as breast milk of a mother (as a sterile medicament)& certain other combinations of the herbal drugs.Do the procedure in such a way that patient will able to see clear, objects like fingers (Anguli), threads (Tantu) etc. Then eye has to be covered with dressing(Kavalika) of medicated ghee & to be bandaged in a specialized way (Chinabandha).

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There are several references regarding usage of the instruments, about its 6 dosha (how it should not be- 6 points ), possibilities of committing mistakes by surgeon? while inserting shalaka inside patients eye (5 different conditions & their treatment), 5 possibilities of so called complications of Linganasha dosha while performing this operation, such as Sphootana- lens gets break off into several pieces just after when shalaka touches lens., or Avagalana or Utplavana (Subluxation of lens ), Leen ( Lens falling back into vitreous chamber), and also about the complications of Kaphaj linganasha, if not treated in time (6 types of drushtidosha as Avartaki, sharkara, rajimati, chinnaushuka, chandraki, chatraki ).

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Other operative procedures mentioned in Ayurvedic Opthalmology
There are mentioning about Agnikarma in the treatment of ‘Adhimantha’ (Glaucoma) which reminds us ‘Cyclodiathermy’ procedure mentioned in modern ophthalmic surgery. Operation for ‘Lagan’(Chalazion) specifies the treatment principle as Bhedan & Lekhan this reminds us Incise & Drain order in contemporary? Ophthalmology.Also in case of yet another ophthalmic conditions like ‘Pakshmakopa' (Triachiasis), according to ancient ayurvedic scripts these eyelashes have to be removed. Again there is a striking similarity to modern therapeutic approach of removing the eye lashes by the epilation force.

There is a mention of surgical procedure pakshmakopa (trichiasis) pakshmasankocha or antarvyavartana (entropion)? as discussed by various ayurvedic scholars. This surgical procedure reminds of ‘tarsorrhaphy’ operation mentioned in the management of entropion.

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Various treatment modalities utilized in the ayurvedic therapy of eye Disorders
There are various ways with which Ayurveda advocates to treat these eye disorders, these can be subdivided into basic two groups, viz. local therapies (Bahyopachara) & internal therapies (Abhyantar upachara). Internal therapies consists of various drugs/medicaments in the forms of Guggulu, Vati, Guti (tablets or pills), Choorna (mono herbal or polyherbal or herbo mineral combinations in the form of powders), Kwatha or Kashaya (Decoctions), Swarasa (fresh juices of medicinal herbs), Lehyam (Linctus) and Siddhda Ghritam (medicated ghee).where as Local therapy consists of various options those are to be performed on the diseased eye .

They are Ashchotana (eye drops), Anjan (to be applied on conjunctival bed), Nasya (medicine to be instilled inside nose), Tarpan ( liquefied medicated ghee to be retained over open? or rather blinking eyes for a specified period in a specific way), Netradhara (pouring of warm decoction over closed eyelids), Lepa (application of paste of medicated powders over closed eye) etc. These therapies are to be performed in different combinations for different ophthalmic disorders.

Some interesting Case studies & Research findings

?????? At different centers of ‘Centre for Ayurveda & Panchakarma Therapy and? Eye Care Clinics’, Mumbai & Navi Mumbai, author of this article has treated many cases of refractive errors, especially increasing myopia, high myopia, high hypermetropia, with oral & local ayurvedic therapy, with better patients compliance & with encouraging? results. The medication used were Saptamrut loha, Yashtimadhu ghruta,Shatavari ghruta, Punarnavadi Yoga, Pathyadi kwatha. (Dr.Phadke A.S.,Mumbai)(!998)

?????? An interesting study was undertaken on cases of refractive errors , whom apart from oral medication , netrabasti was performed & the result found out to be quite encouraging.( Dr. Garge, Mumbai)

?????? An interesting study was undertaken by dr. Padmawar, Dr. Tambwekar & colleagues on the therapeutic efficacy of ‘Madhu daryadi Eye drops’ on the cases of non specific allergic conjunctivitis at Mumbai.( Dr. Padmar , Mumbai)

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? In yet another study on blephritis (Klinnavartma), a clinical tria lwas conducted to see efficacy of Rasanjanadi Rasakriya (contains Daruharidra (Berberis aristata) processed in goats milk) in Anjan formulation, on 30 patients of blephritis. Acted as a healing agent (Vranaropaka), also showed to reduce oedema, discharge, itching & pricking pain within first week, & was found out to be statistically significant. (Padvi V.,Mumbai )(1989 )

Therapeutic efficacy of Shobhanjana (Drumsticks) Eye Drops in Trachoma (Pothaki) , Study on 30 patients of Trachoma, open prospective study, of which 22 patients were from pre follicular stage of trachoma & 8 patients were from follicular stage of trachoma. Drug was administered for the duration of 8 weeks. 25 patients (85 %) showed to have complete relief, 3 patients (!0 %) received moderate relief, whereas 2 patient (5 %) showed no relief. (Dr.Lahankar M. Mumbai)(1996)
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?? In open prospective study on 30 patients of Pterigyum with Marichyadi yoga, it contains Marich (Piper nigrum) triturated with the juice of Kesharaj (Eclipta alba), as mentioned in Sharangdhara Samhita .Conducted for 4 weeks. Reported result in around 75% cases. (Dr.Surve S.,Mumbai)(1997)

??? In one of such study on diabetic retinopathy, as a complication of diabetes mellitus, study was undertaken on 30 patients of diabetic retinopathy & 30 patients of diabetic neuropathy, a placebo controlled open type of study. Patients of diabetic retinopathy (15 on drug, 15 on placebo), screened for 12 weeks period, of which there was a good improvement in 7 cases , no change observed in 7 cases, & deterioration in the condition observed in 1 case.1 case out of those 7 (improved) cases, having background retinopathy initially, there was no evidence of the diabetic retinopathy at the end of the study.3 cases showed marked improvement, whereas 2 cases showed marginal improvement. There was no significant change noticed in the biochemical parameters at the end of the therapy. (Dr.Tamboli S.,Mumbai)(2001)

?????? In another study on reinitis pigmentosa, a clinical evaluation of cases of retinitis pigmentosa (R.P.) with the management of ayurvedic composite therapy was conducted. In open prospective study on 15 cases of R.P., having vision less than 3 ft.were accepted for the study. 2 cases screened with electroretinography (E.R.G.) & Visual Evoked Potential Studies (V.E.P.), pre & post therapy. 9 patients completed the study, of which in 4 cases there was a marked improvement in the visual acuity, 4 cases showed moderate improvement whereas 1 patient showed no change (Dr.Phadke Aashish , Mumbai )(2001) .