What is Retinitis Pigmentosa (RP)?
Retinitis Pigmentosa is the blanket term for a group of genetic disorders which results in loss of vision in a person. It affects the retina which is the light sensitive tissue that lines the back of the eye. The condition causes slow-paced progressive degeneration of the retina and involves breaking down/loss of the photoreceptor cells in the retina. Even though it is a relatively rare eye disorder, it is found to occur in both men and women of all race and ethnicity.
Retinitis Pigmentosa mainly affects the photoreceptors of the retina. Photoreceptors are cells that gather light and convert them to electrical signals. Retina has two main types of photoreceptors – rods and cons. Rods are active in dim light (scotopic vision) and are responsible for night vision as well as peripheral vision. They are mostly around the outer ring of the retina and defines your side wise vision. Cones reside mostly in the centre of the retina and are active at higher light levels (photopic vision). They are responsible for the colour vision and other finer details of vision. In most cases during the initial stages of Retinal Pigmentosa, the rods in the peripheral are primarily being attacked and then the condition progresses slowly to the cones in the centre. According to the level of progression, the condition is categorised into different stages.
Retinitis Pigmentosa Stages
Stage 1- This is the initial stage wherein the rods have started getting affected and the person feels difficulty in seeing during dim light especially at night. Since you start losing night vision it takes longer to adjust to darkness and tends to trip over objects or have trouble driving at dusk and at night
Stage 2 – At this stage, along with night vision the peripheral vision also starts to get affected. This reduces the visual field i.e. the area of space that is visible at that instant without moving the eyes. As the condition progresses slowly more visual field/peripheral vision is lost, and tunnel vision (no side vision without turning of head) is developed. The effect of this stage is that you start bumping into things as one is not able to see objects below or around you.
Stage 3 – Loss of central vision (reading vision) and colour vision. In this stage the cones also get affected and it makes it harder for the person to do any kind of detailed work or trouble seeing/ differentiating colours. At this stage it become difficult performing essential day to day activities like reading, driving, recognizing faces, walking without assistance etc.
Stage 4 – By now the diseases progresses to the extreme and complete loss of vision occurs. This stage is non-curable and non-reversible.
It is very rarely that the cones get affected first. Being a genetic mutation a complete cure for the condition not possible especially once it has reached to stage IV. However, the aim of the treatment modalities would be to slow down the degeneration process and safeguard the photoreceptors as long as possible thereby improving the quality of life.
Retinitis Pigmentosa Symptoms:
The most prominent symptoms of retinitis pigmentosa are:
• Difficulty in adjusting to dim light
• Tendency to trip over objects in the dark
• Not able to drive at night
• Unable to see the sides without turning the head
• Bumping into things as you move around
• Finding it hard to do detailed tasks like reading, threading of a needle etc
• Feeling uncomfortable in bright light (photophobia)
Retinitis Pigmentosa Causes:
It is an inherited genetic disorder. It cannot be caused by any external factors like injury, infection or any other environmental factors. It is actually an action of the mutated genes which send wrong messages to the retinal cells and causes its degeneration in slow progression. The children born in the family having the defective gene can either be a victim of retinitis pigmentosa or a carrier of the same or may be completely free of RP also. If the child is affected, then the symptoms become visible from early childhood itself and progresses slowly often resulting in blindness in advanced middle age.
Retinitis Pigmentosa Diagnosis:
The condition can be diagnosed and measured through:
Visual Field Testing: A thorough clinical examination and visual field testing helps to determine the extend of peripheral vision loss and identify blind spots that may be developing. A map of the visual field and central vision is the outcome of the test.
Genetic testing: The presence of certain genes known to be associated with RP is checked through a blood and tissue sample test.
Electroretinography (ERG): This procedure measures the electrical activity of the photoreceptor cells. A person with retinitis pigmentation shows lower level of electrical activity and functionality of the cells.
Optical Coherence Tomography: A precise and detailed picture of the retina is produced using this imaging test. It helps in studying the impact of the condition on the retina.
Retinitis pigmentosa treatment in Ayurveda
Ayurveda one of the oldest medical system adapts a holistic approach to healing. According to Ayurveda a human body is made up of the five fundamental building blocks of nature- earth, water, fire, air and ether(space). These primary elements combine together to form the three bodily humors (Doshas) – Vata, Pitta and Kapha. These three Doshas along with the seven human tissues are present in everyone, but the ratio or balance among them are specific to each individual.
The treatment approach in Ayurveda focuses to bring the body, mind and soul to the balance state specific to the individual using natural means. Ayurveda has specific focus on eye disease and has clearly recorded the identification of 72 eye diseases and their treatment methods in one of the oldest text books of Ayurveda called Sushruta Samhita. According to this record retinitis pigmentosa is identified as one type of Kaphaja Dhrishtigata Roga. Kriya Kalpas (Ocular therapeutics methods) are found to be very effective in improving the visual functionalities of the eye and treating various diseases of the eye.
The different stages of retinitis pigmentosa are identified as Kapha Vishama Drishty (Stage I), Kapha Vidagdha Drishty (Stage II), Kapha-Pitha Vidagdha Drishty (Stage-III), Sannipathika Drishtyandyam (Stage-IV).
Ayurvedic prognosis of Retinitis Pigmentation involves systemic therapies as well as kriya kalpa therapies. Systemic therapeutic procedures performed includes Virechana (Medicated Purgation), Nasyam (Trans nasal medication), Sirodhara (Continuous stream of medicated oil applied on the forehead),Thakradhara (Application of continuous stream of medicated herbal decoction), Sirovasthi, Pichu, Thalam, Basthi etc . Along with this, the Kriya Kalpa (ocular therapeutic) procedures like Nethradhara (Sekam), Aschyothanam, Anjanam, Tharpanam, Putapakam, Pindi, Vidalaka etc are also performed.
The duration of Retinitis pigmentosa treatment in Ayurveda is 18 days in hospital for which the cost is in the range of 800-1000 USD.
It has been clinically proven that the ayurvedic treatment for retinitis pigmentosa was significantly effective in reducing the symptoms and slowing down the progression of the disease.
Living with retinitis pigmentosa
Since the condition is a progressive one, it is advisable to undertake some precautionary steps in the daily life activities which will - if not slower at least not speed up the degenerative process.
• Avoid Stress
• Exercise regularly
• Stop Smoking
• Eat food good for eye health
• Take nutritional supplements
• Get involved with support groups
• Explore options that can slow down the progress of RP
• Live the moment.