Introduction
Pathological myopia, also known as malignant, degenerative or progressive myopia, is a condition defined by refractive error in excess of -6.00D with an axial length greater than 26mm. In addition, the disease is characterized by “degenerative and progressive” changes involving a physical stretching of the sclera, choroid and retina. Progressive myopia, in simpler words is a refractive error that happens when the eye focuses incoming light in front of the retina, rather than directly on it, resulting in blurred distance vision. While an exact cause of progressive myopia is not known, most research indicates that a combination of environmental and genetic factors trigger the condition. First of all, there is evidence that a family history of near-sightedness is a contributing factor. Additionally, spending a lot of time indoors may play a role in myopia development, as studies show that children who spend more time outside have less incidence of myopia. Lastly, near point stress, which can be caused from looking at a near object for an extended period of time, can prompt the eye to grow longer and result in myopia.
The prevalence of progressive myopia varies greatly throughout the world. It ranges from 1.7% to 3.3%. In certain population, the prevalence rate is very high and in some, women tend to be affected more often.
Signs & symptoms
Near-sightedness (progressive)
Blurred vision,
Hazy vision,
Halos around lights,
Increased glare
Reduced vibrancy of colours.
Causes
Genetic predisposition is present in most of the cases, and elongation of the globe begins in early childhood. The precise etiopathogenesis of this disease is still unclear.
Progressive myopia often accompanies systemic disorders such as Marfan’s syndrome, Ehlers-Danlos syndrome, and albinism. It is widely found in kids who were born as premature babies.
Pathophysiology
Early research papers suggested such things as squinting secondary to under-corrected refractive error and systemic calcium deficiency. More recent theories suggest that neurochemical processes trigger a signal cascade based on a visual feedback mechanism, which induces choroidal and scleral remodelling. Changes in the sclera’s extracellular matrix result in decreased durability, with excessive susceptibility to stretching. This may reflect systemic disorders of connective tissue metabolism.
Some researches on the residual deformative changes developed as a result of sclera distraction during reading show some hint to the development of progressive myopia. The reason why the sclera capsule distraction during reading regime is that of the extraocular muscles and growth of the intraocular pressure influence the process. Because the sclera is fibrotic membrane, it is characterized with well-marked elasticity, stronger accommodation and the sigh load in the near distance causes sclera capsule distraction. After the contraction the residual deformation stays there. Accumulation of such residual deformations causes the sclera weakness and formation of myopia as a disease. Improvement of the sclera nutrition will slacken the residual changes in sclera, and this will significantly decrease the myopic disease advancing.
Diagnosis
Ophthalmoscopic examination of the posterior pole shows: myopic crescent, posterior staphyloma, flat & obliquely inserted discs, and patchy choroidal atrophy.
Extensive vitreous syneresis and posterior vitreous detachment are typical.
Peripheral retinal degenerations are also common.
Additional findings occur with some variability and may include lacquer cracks, subretinal neovascular membrane, Fuchs’ spot (subretinal neovascularization with overlying RPE hyperplasia), retinal breaks and retinal detachments.
Treatments
The management of progressive myopia is not easy. The earlier the treatment started, the better. When detected at an early age, most experts recommend full refractive correction.
The systemically-administered adenosine receptor antagonist 7-methylxanthine was shown to help normalize the growth of myopic eyes in children between the ages of eight and 13. It is believed that 7-methylxanthine increases the content of collagen and proteoglycans in the sclera, as well as the diameter of collagen fibrils.
Surgical intervention for progressive myopia is typically aimed at the specific pathological sequelae of the disease, such as subretinal neovascularization, peripheral retinal tears and retinal detachment.
A prophylactic procedure known as scleroplasty (sometimes referred to as “scleral strengthening” or “scleral reinforcement”) is there but the results are highly variable and not always promising.
Still, a recent study explains a chance for resurrecting scleroplasty, in a technique called posterior pole buckling.
Patients with progressive myopia should be screened carefully and regularly (once or twice a year) for peripheral retinal degenerations, retinal breaks and detachments, and referred for treatment if needed.
They should avoid dangerous or jarring activities such as contact sports, bungee jumping or high-thrill amusement park rides to prevent retinal damage. Also, there are treatments to slow or stop the timeline of progression of myopia like wearing glasses or specially designed contact lenses
Prognosis
Progressive myopia is usually a long term disease with bad prognosis. Early intervension can prevent progress and complications.
Complications
People with progressive myopia have more chance of developing:
Retinal detachment due to elongation of the eye causes stretching and thinning of the retina.
Macular degeneration due to retinal stretching and thinning.
Glaucoma
Greater risk of developing early cataract.
Disease & Ayurveda
Drishtigataroga – Timira when affects first and second layers and when the dosha is situated in the lower part, only near vision is possible
Nidana
Ushnabhitaptasya jalapravesaath – suddenly immersed into water after walking under sun/heat
Agnisooryadi tejasam avalokanaath-looking at sun or lights or bright screen
Swapna viparyaya-abnormal sleep habits
Samrodana-prolonged weeping
Kopa-anger
Shoka-grief
Abhighata-injury
Dhoomanishevana-exposure to smoke including cigarettes
Madyapana-alcohol abuse
Katu-amla-pittakara aahara- pungent, sour and Pitta vitiating food habits
Purvaaroopa
Avyaktadarsanam-Hazy vision
Samprapti
Due to causative factors, especially habits bad for eyes, vitiated doshas, predominantly Pitta go upwards through Sira’s(capillaries) to the head and then get lodged in the patalas of drishtimandala and produce timira.
Lakshana
As per the settling of the doshas in the lower part of eye, nearsightedness results
The person sees eye floaters like flies, mosquitoes, hairs, net, circles, flags, mirage, different movements of stars, rain from the sky and darkness.
Not able to see the hole in a needle
Divisions
Vaatika
Paittika
Kaphaja
Raktaja
Samsargaja
Sannipataja
Prognosis
Sadhyam only when affected on the first patala & without discolouraion
Kricchrasadhyam when affected second patala
Yaapyam when affected third patala
Chikithsa
Samana
Lepa
Seka
Anjana
Sodhana
Snehana
Raktamokshana
Virechana
Nasya
Murdhabasti
Asthapanavasti
Anuvasanavasti
Commonly used medicines
Thriphalachoornam
Vimalavarti
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Consuming natural and healthy balanced diet rich in Vitamin A,Vitamin C, omega 3 fatty acids etc.
External application of rose water
Intake of carrots. Amla, etc.
Intake of Triphala choorna
Intake of licorice(Yashtimadhu) powder
Diet
- To be avoided
Any hard item, tough to bite or chew.
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause a disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase Kapha and cause respiratory problems
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, honey, fruits and vegetables, cow’s ghee.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain, etc
Behavior:
Protect yourself from too much heat or cold.
Avoid head bath and tongue scraping.
Better to avoid exposure to excessive sunlight, wind, rain, or dust.
Maintain a regular food and sleep schedule.
Avoid stress.
Avoid holding or forcing urges like urine, faeces, cough, sneeze, etc.
Avoid sleeping late night and day sleep.
Yoga
- IN PERSONS WITH SEVERE INFLAMMATORY DISEASES AND EYE DISEASES, EXERCISE IS NOT RECOMMENDED
Yoga can maintain harmony within the body and with the surrounding system.
Nadisudhi pranayama
Suryanamaskara
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://pubmed.ncbi.nlm.nih.gov/25306595/
https://pubmed.ncbi.nlm.nih.gov/25802445/
Author information
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