Diabetes Mellitus is associated with acute complications like Diabetic Coma and a number of chronic complications. Chronic complications like stroke, ischemic heart-disease, diabetic nephropathy, peripheral vascular disease (Vatarakta) and diabetic retinopathy are also the after effects of diabetic vasculopathy which starts early in a susceptible diabetic patient. Diabetic retinopathy affects 80% of all patients who have had diabetes for 10 years or more.
Diabetic retinopathy is the result of microvascular retinal changes that include hyperglycemia induced intramural pericyte death and thickening of basement membrane leading to incompetent vascular walls. These damages cause change in the formation of blood retinal barrier and also make the retinal vessels more permeable.
Small blood vessels in the eye are vulnerable to poor blood sugar control. These blood vessels get damaged due to over accumulation of glucose or fructose. During the initial stage, called non-proliferative diabetic retinopathy, most people do not notice any change in their vision. Early changes are reversible and do not threaten central vision. Some patients develop macular oedema due to damaged blood vessels, and leaking of fluid and lipids into macula which may cause loss of vision rapidly. Haemorrhages in the vitreous cause formation of fibrous bands in it and result in detachment of retina.
As new blood vessels form on the back of the eye as a part of proliferative diabetic retinopathy, they can bleed causing intraocular haemorrhages that occur more often during sleep.
If we take into consideration Samprapti (Pathology) of Prameha, Doshas involved are â Kledak Kapha, Pachak pitta, Saman Vayu, Apan Vayu.
Dooshyas involved here are - Meda Dhatu (fat, lipid exudation), Mamsa Dhatu (Muscles related to eye ball and their weakness), Majja Dhatu (Retina, Macula), Raktadidhatus except â Asthidhatu (Blood vessels in the eye ball).
There are two routes of treatment for Diabetic retinopathy viz. systemic and local. In both forms of treatment, the drugs used should have potential effect in controlling blood sugar as well as nourishing the tissues of the eye ball i.e. Chakshushya property.
Such Dravyas (Drugs) are - Triphala, Patol, Nimba, Guduchi, Haridra, Daruharidra, Asan, Arjun, Khadir, Loha Bhasma, Nag Bhasma, Jasad Bhasma, Vang Bhasma.
The Kalpas (combinations) include Vasantsukumakar Rasa, Lodhasava, Asanad vati, Chandraprabha Vati, Mehari Rasa, Mehantak Rasa.
Excess blood sugar reduces functional capacity of the eye due to ojakshaya and therefore local treatment in the form of Tarpan with Goghrita, Anjan, Shirodhara, Lepa are also useful.
Pathya (Doâs): Shrama (Exertion), Uddalak, Godhum (Wheat), Chanak (Gram), Shali, Madga, Kulattha, Yava, Tiktashak, Patol, Jangal Mamsa, Saindhava, Maricha.
Apathya (Donâts): Always in a sitting posture. Diwaswap (Day time sleep), nidra (too much sleep), navanna (new grains), daadhi (curds), mootraveg widharan (to suppress urination), dhoompan (smoking), swed (Steam), shonit mokshan (blood letting), sura, shukta (types of wine), tail (oil), kshar (alkali), ghrut, gudam (jaggery), amla ras (sour things), anup mamsa (Y.R.)
If the above convention is followed along with the modern treatment to control blood sugar, patients of Diabetic retinopathy will be in a much better condition.
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