Ayurvedic approach to Macular Degeneration

Macular degeneration also called as Age related macular degeneration (ARMD) is an age associated chronic eye disease and is a very common cause of gradual loss of central vision among older individuals over the age of 50 years. The symptoms usually do not appear in people below 50 years of age. The deterioration weakens the ability to read, write, drive, and recognize faces, which are all activities requiring healthy central vision. Peripheral or side vision isn't damaged. Visual loss can occur within months, or over many years, depending on the severity of AMD.

Symptoms of Macular Degeneration

The symptoms of macular degeneration include blurred vision, distorted central vision (straight lines appear wavy or crooked, printed matter appears distorted), difficulty reading small print, distortion of the letters on a line, colour confusions, slow recovery of visual function after exposure to bright light, central scotomas (shadows or missing areas of vision), difficulty recognizing faces, colours may appear less bright, people may need bright light). This symptoms appear despite using one’s usual glasses. Visual hallucinations (also called Charles Bonnet syndrome) are common in people with severe visual loss of any cause. They can occur if there is severe AMD.

Risk factors

Risk Factors of ARMD include Atherosclerosis, Diabetes, Heart disease, High blood pressure, Nutritional deficiencies, Smoking, Tobacco, and Heredity.

People with ARMD are often deficient in a number of nutrients that are essential to eye health especially macula health such as lutein, essential fatty acids, zeaxanthin, taurine, antioxidants, zinc, bioflavonoids, selenium, and vitamin B-complex. Systemic inflammation, indicated by high levels of C - reactive protein has been tied to increased macular degeneration risk.

The Three Doshas in the Eyes

•  “Vision is a priceless gift from God to enjoy the beauty of the world”. Ayurveda explains that Pitta dosha governs our eyes. Specifically the sub dosha called “Alochaka pitta” element is present in the eyes, which is responsible to engross colour & images and allows us to grasp the visual representations. When Alochaka pitta is in balance, eyes are healthy, bright, clear, shiny, luminous, and we enjoy sharp eyesight. Impaired vision is caused mainly due to the imbalance activities of pitta. So, it is always advisable to maintain balanced Pitta dosha.
• Due to the cold and unctuous qualities of Kapha dosha, Tarpaka Kapha (one of the five types of Kapha) is used to keep the eyes lubricated, moist and cool always.
• Vata dosha is responsible for all types of movements in the body and Prana Vata (one of the five types of Vata dosha responsible for life force), is responsible for movement and blinking of eyes and sensory perception.

Ayurvedic Approach

There is a separate branch of Ayurveda known as Shaalakya tantra which deals with eye disorders. The Ayurvedic name for defective eyesight is ‘Drishti Dosha’. The pathogenesis of macular disorders and their treatments are mentioned in Ayurveda texts. And macular degeneration occurs due to imbalance of the three doshas either individually or in combination. In majority of cases, Ayurvedic treatment helps to control the progressive degeneration so that present vision status can be stabilized. Rasayana medicines in Ayurveda gives strength to the retina and improves vision.

Macular degeneration sometimes occurs as a complication of other diseases also and hence after thorough examination of the underlying causative factor, we should proceed with treatment. Treatment consists of internal medicines, external therapies like Tarpanam along with change in diet and lifestyle and yoga. While treating the macular degeneration, underlying causative factor should also be given importance in treatment.

ARMD is a nutritional and lifestyle responsive eye disease hence can be stabilized and possibly even vision can be improved with healthy lifestyle choices. Ayurvedic treatment for macular degeneration includes elimination of Ama (Metabolic toxins), detoxification, improving nutrition to eye by administration of Chakshusya Rasayana (Rejuvenation for the eyes). The Ayurvedic treatment modalities include Panchakarma, external therapies, internal medications, and advice on food and life style changes. Proper care for the eyes is one preventive measure that helps.

The major treatment procedures done for the treatment of Macular Degeneration are as follows

• Virechana (Therapeutic purgation) - 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.
• Nasya (Nasal medication) - It is the procedure in which medicated oil or fresh juice of herbs is instilled inside the nostrils after oleation and fomentation of the face and neck. Anu oil is commonly used for Nasya. However other liquid medium that can be used are fresh juice of durva, powder of Vidanga, Karpasasthyadi taila, Lakshadi taila, ghee, etc.
• Netra Dhara / Seka (Eye wash) – The procedure of pouring thin streams of herbal liquids over the closed eye from a height of 4 finger breath is Netra Dhara or Seka. This procedure is carried out during the day. Triphala decoction is generally used for this purpose. Other herbal decoctions mixed with honey can also be used. The herbal liquid is poured on the closed eyes through a funner and the medicines flowing out of the eye is collected by holding a bowl against the temporal region just below the outer canthus.
• Bidalaka or Lepa (Application of herbal paste) - Simple smearing of herbal paste on the skin surface of the eye lids avoiding eye lashes is Bidalaka or Lepa. It can be done with paste of Lodhra (Symplocos racemosa), Nimba (Azadirachta indica), Shigru (Moringa olifera), Amalaki (Emblica officinalis), Eranda (Riccinus communis) depending upon the doshas vitiated.
• Netra Tarpana (Eye rejuvenation in dry types) - Warm medicated ghee is poured into the eyes and retained inside an herbal paste boundary. Ghee is unctuous and cool hence helps mitigate Vata and Pitta doshas. Common medicated ghrita used for Tarpana are Mahatriphala, Triphala ghrita, Patoladi ghrita, Drakshadi ghrita and Jeevantyadi ghrita.
• Anjana (Collyrium) – The application of medicine to inner aspect of the lower eyelid from the inner canthus to the outer canthus is Anjana. It can be done with special rod or finger. Vimala Varti, Bhaskara churna, etc can be used for Anjana.
• Shiro lepa / Tala dharana (Application of herbal pastes on the vertex) – Common herbal paste used are Amalaki (Emblica officinalis), Arjuna (Terminalia arjuna), Kachoradi churna.
• Shiro Tarpana / Murdha Taila (Oiling the head) – Oiling the head is very effective in the management of stress, hypertension, improves vision and calms down Vata dosha. Oiling the head can be done in four methods – Shiro Abhyanga (Head massage), Shirahseka (Pouring medicated oil or liquid medium on the head in a rhythmic manner), Shiropichu (Placing cotton swab soaked in oil on the vertex), and Shirobasti (Retaining medicated oil on the vertex inside a leather cap boundary).
• Shirodhara - In this process lukewarm medicated oil (Sesame oil medicated with herbs like Brahmi, Shankhapushpi, Yashtimadhu, Chandana, etc.) or medicated liquids (Medicated buttermilk or milk or herbal decoction) is poured over the forehead in a rhythmic manner from a perforated pot suspended above forehead.

Diet guidelines

• Include more of Vitamin A in diet. Eat fruits and vegetables that have a deep orange or yellow colour like carrots, winter squash, sweet potatoes, pumpkins, apricots, peaches, cantaloupe, oranges, papayas, and mangoes.
• Non vegetarian foods like eggs, liver and fish are also conducive to eye health.
• Dairy products like cheese, fresh milk, butter also possess some fair amount of vitamin A in them.
• Green leafy vegetables such as kale, beet greens, Swiss chard, coriander, spinach, mustard and collard greens help to improve the vision.
• Include antioxidants like lemon and berries in your diet.
• Include more of fresh fruits and vegetables in your daily diet.

Lifestyle Recommendations

• Splash plain water in the eyes every one hour.
• Avoid watching television or using computer or reading continuously for long periods of time.
• Avoid improper postures while using computerm watching TV or reading.
• Avoid straining the eyes to read small letters.
• Practice Trataka yogic exercise daily.
• Put a teaspoonful of Triphala coarse powder in a glass of water and let it stay overnight. Next morning strain the water with a fine cloth or filter and wash the eyes with it.
• Go to sleep by 10pm. One of the main causes of eye problems is lack of sleep. Without proper rest, eyes become tired, red, itchy, puffy, bleary, and bloodshot.
• Palming is an excellent way to give the eyes some rest when they are overstrained. Eyes need a break if they have been in front of a computer or TV screen, reading, driving, or doing close-up work, for too long a stretch. Simply rub the palms together for a few seconds and gently place them over the eyes. This provides an unbelievable deep rest that blocks out outside stimulation and helps tired, blurry eyes.
• Placing cooling cotton pads dipped in rose water, aloe vera, cilantro, or cucumber juices over the eyes is beneficial.
• Application of sandalwood powder and water on the forehead can soothe eye strain.

Ayurvedic herbs and formulations

Ayurvedic herbs and compound formulations with a source of antioxidants are found to be beneficial in Macular degeneration.

• Triphala (Combination of three fruits) - Triphala is an important medicine for eye health, especially blurred or impaired vision or to prevent eye disorders. Triphala strengthens the muscles of the eyes and improves eyesight. It is for both internal and external use.
• Amalaki (Emblica officinalis) - Amalaki fruit (one ingredient of the Triphala) is an anti-aging tonic or Rasayana in Ayurveda, rich in vitamin C and anti-oxidents. Amalaki is wonderful in maintaining pitta balance, and supports cleansing. Amalaki is specifically known as a “Chakshushya”, which means “that which strengthens the eyes”.
• Yashtimadhu (Glycyrrhiza glabra) – Yashtimadhu mitigates Pitta dosha, promotes longevity and is good for the eyes.
• Bhringaraj (Eclipta alba) – Bhringaraj is Chakshushya (strengthens the eyes), Akshirogahrut (Useful in eye diseases), Rasayana (Rejuvenative) and balances Kapha and Vata dosha.
• Saptamrit lauh is an Ayurvedic medicine in powder form containing Iron calx, triphala and yashtimadhu, balances Pitta dosha and recommended in macular degeneration and other vision related eye disorders.
• Amalaki Rasayana is an Ayurvedic preparation with Amla as a main ingredient. Amalaki Rasayana is good for all the three doshas and is Chakshushya (Good for eyes, improves vision) and Rasayana (Rejuvenation).
• Triphala Ghrita nourishes the nerves and tissues of the eyeball, including the lens. Triphala ghee balances Vata and Pitta doshas and can be used internally and externally (as eye drops or in Tarpan treatment) as it is beneficial in eye diseases. Purana ghee (Old ghee) is also beneficial in eye disorders as its potency increases.