What is Diabetic Retinopathy?
Diabetic Retinopathy is a progressive degenerative condition of the eyes wherein the blood vessels and neurons of the retina gets damaged. The damage can cause the blood vessels to either swell and leak or close off. It occurs mostly as a comorbid condition to diabetes as indicated by the name Diabetic Retinopathy or Diabetic eye disease. If untreated, the condition may silently progress to loss of vision leading to complete blindness.
Diabetic Retinopathy Causes:
The main cause for Retinopathy is high blood sugar resulting from diabetes. This causes damage to the tiny blood vessels in the retina leading to diabetic retinopathy. Other supporting causes are high blood pressure, high cholesterol levels and tobacco abuse.
Risk Factors include:
• Body constitution (Predominantly Pitta) and hereditary factors
• Psychological stress factors like krodha (anger), soka (sadness) etc
• Time since the onset of Prameha (Diabetes) - As the time increases, greater is the risk to develop retinopathy.
• Type of Diabetes – Type 1 diabetes is riskier than type 2 diabetes
• Women who develop gestational diabetes.
Diabetic Retinopathy Stages
There are two stages of the condition. The first stage or initial stage known as Non-Proliferative Diabetic Retinopathy (NPDR) and the second or advanced stage known as Proliferative Diabetic Retinopathy (PDR).
Stage 1- Non-Proliferative Diabetic Retinopathy (NPDR): This is the initial stage of diabetes retinopathy which is generally a silent symptom stage wherein, in some cases, even a full vision is recorded. NPDR is categorized in three stages namely mild, moderate and severe. The associated vision loss also varies respectively. At any stage of Non-proliferative Diabetic Retinopathy, it can trigger a condition called Macular Edema which is a bulge in the macular region. For a person diagnosed of NPDR the vison loss and image distortions may no be the same in both the eyes for any stage.
Stage 2- Proliferative Diabetic Retinopathy (PDR). In advanced or second stage of diabetic retinopathy, blurred vision is often caused by bursting and bleeding of the fragile or abnormal blood vessels, mainly at the hind part of the eye. These new abnormal blood vessels are formed when the original blood vessels get damaged and close off, due to the many factors leading to the condition. The extend of blurring of vision in PDR depends on the extent of the bleeding or leakage from the blood vessels. In Pre-Proliferative Diabetic Retinopathy, the bleeding is not very severe and the may disappear easily.
Diabetic Retinopathy Symptoms:
As mentioned above, the early stages of diabetic retinopathy has no significant symptoms which leads to the identification of the condition. The prominent symptoms include:
• Spots or dark strings floating in the vision area.
• Blurred or fluctuating vision
• Vision loss
• Impaired colour vision or night vision difficulty
• Pain, pressure and redness in the eye
• Photophobia- a painful sensitiveness or intolerance to light
Diabetic Retinopathy Screening:
• Physical examination of the inside of the eye using a special lens. Normally the pupil is dilated using eye drops prior to the examination
• Fundus Photography: This is the only way to detect a Non-Proliferative Diabetic Retinopathy (NPDR)
• Fluorescein angiography: The procedure is done to identify the narrowing or blocks or leakages in a blood vessel or any new growth of abnormal vessels. This involves the injection of a yellow dye into the vein and the course of its travel is photographed through a special camera.
• Optical Coherence Tomography (OCT): A special scanner is used to scan the thickness of the retina along its walls. This helps to identify any swelling or any other abnormalities.
Diabetic Retinopathy Treatment in Ayurveda
In Ayurvedic tradition, each human body is believed to be made up of a specific combination of the Tridoshas (3 doshas- Vata, Pitta and Kapha), and Saptha Dhatus (seven human tissues- muscle, fat, bone tissue, bone marrow, blood, lymph/plasma, semen/ovum).
According to Ayurveda the vitiations of the pitta dosha along with toxins (Ama) mainly Agnimandya is the major cause for diabetic retinopathy. The affected dhatu is Rakta (blood) and vitiated dosha is Pitta. Other factors adding on to the aggressiveness of the condition are Ojas Kshaya(Loss of strength/immunity), Urdhwaga Raktapitta(bleeding disorders) etc.
To resolve the issues of Diabetic Retinopathy, the treatment approach in Ayurveda would be rectifying the Ama disorder, pacifying the Pitta dosha, correcting and managing the diabetes.
Ayurveda practitioner focuses more on observed symptoms and thorough clinical examination rather than the screening tests. Ayurveda considers the Roga (disease) as well as the Rogi(patient) while deciding on the treatment process, ie understanding the physical and psychological conditions of the person is very important in devising the case specific treatment plan.
The concept of a permanent cure is made possible by the principle of “Avoiding the Cause”, which means, not only driving away the disease symptoms and signs of the condition, but also the correcting the root cause ie the Prameha/ Diabetes. Prameha is treated for, along with the management of urdwaga raktapitta (bleeding disorders), prevention and rebuilding of Oja Kshaya as well as prevention of the weakening of digestive fire (agnimandhya). In the diabetic retinopathy treatment in ayurveda, the approach is bi-dimensional i.e., to control diabetes and also to treat diabetic retinopathy simultaneously.
The Internal and external therapeutic procedures included in treating Diabetic Retinopathy are:
• Netra Basti/Akshi pooranam –Warm medicated ghee is made to hold in a well-made around the eyes. This is used to reduce the stress and strain of the eyes.
• Virechana - Induced purgation using herbal medicines
• Nasya - Trans-nasal medication using warm herbal medicines
• Agni Chikitsa- Helio Therapy
• Netra Tarpanam- cleansing of the eye using pure medicated oils
• Sirolepanam/Lepanam-application of herbal medicated oil on the head/face
• Nethra dhara (pouring of medicated oil on the eyes)
• Anjana (applying special medicated kajal on the eyes)
• Talam,Thalapothichil- Applying herbal paste or oil on the head
• Kaya Chikitsa – administration of internal herbal medications like kashayam, choornam, etc
• Procedures that is most suited for treating the specific case is adapted.
Ayurvedic treatment of NPDR
Ayurveda has effective treatment for NPDR using both internal and external therapeutic procedures. External procedures like Sirolepanam, Nethra dhara, Tharpanam, Anjana etc along with kaya chikitsa are advised. Strict dietary restrictions are followed to keep diabetes under control during the treatment and thereafter.
Ayurvedic treatment of PDR
PDR being a more advanced stage, requires a more elaborate treatment process. The line of treatment includes netradhara, akshi pooranam, talam, thalapothichil, lepam, nasya, virechana, Anjana, rakthamokshana etc. Specific herbal-based medicines combinations are used for these procedures. Kaya chikitsa is also performed. Dietary changes for managing diabetes is introduced along with this. Post procedure follow up is required.
Duration and cost of Diabetic Retinopathy Treatment in Ayurveda
The duration of treatment is 18-19 Days and the cost of treatment ranges between 800 to 900 USD. The cost includes the hospital stay, doctor’s fees and medicines