Retinitis pigmentosa (RP)

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Definition: Retinitis pigmentosa (RP) is a type of progressive retinal dystrophy, a group of inherited disorders in which abnormalities of the photoreceptors (rods and cones) or the retinal pigment epithelium (RPE) of the retina lead to progressive visual loss. Affected individuals first experience defective dark adaptation or nyctalopia (night blindness), followed by reduction of the peripheral visual field (known as tunnel vision) and, sometimes, loss of central vision late in the course of the disease.

Symptoms : Since retinitis pigmentosa begins as rod degeneration, the patient first notices increasing difficulty in night vision, followed by difficulty seeing in the periphery. Slowly progressive constriction of the visual field leads to tunnel vision. A small area of central vision in both eyes usually persists for years. Generally night blindness precedes tunnel vision by years or even decades. Total blindness eventually ensues in most cases. The age of appearance of legal blindness ranges from as early as childhood to as late as the 40s.

Cause: Retinitis pigmentosa is an inherited condition which involves both eyes. If it starts in one eye, the other eye usually develops the same condition in a number of years. Most cases are familial, inherited in a variety of ways, including dominant, recessive, and sex-linked recessive. Some cases are sporadic and lack a family history of the disease. A thorough genetic pedigree, often with the aid of a genetic counsellor, is essential in determining risk of future generations acquiring the disease. Retinitis pigmentosa is usually diagnosed during the teenage years but may be present at birth. The latter congenital type is usually fairly stable and non progressive. Cases that are diagnosed later in life are often milder and may progress more slowly.

Tests and diagnosis

• Decreased vision at night or in low light

• Loss of side (peripheral) vision

• Loss of central vision (in advanced cases) Although the history (especially the possibility of retinitis pigmentosa appearing in other family members) and complaints of the patient may make one suspect RP, it is primarily diagnosed by examination. The patient may complain of difficulty seeing at night or in low light condition. At some point, the ophthalmologist observes relatively characteristic bone spicule pigment during the fundus examination (looking at the back layers of the eye with the ophthalmoscope, an instrument allowing the visualization of the back of the eye by looking through the pupil). (A similar pattern appears in congenital syphilis which is unrelated and must be ruled out). Two tests are essential in the diagnosis and the follow-up exams :- Visual field testing will find defects in the peripheral (side vision) with the degree of loss related to defects in relation to the damage occurring in this disease. Over time, the visual field may reduce to a small central island of vision causing “tunnel vision.” The final progression may be the complete loss of the remaining central vision. Electrophysiological testing by the ophthalmologist is often diagnostic . Responses to flashes of light are measured via electrodes placed on the surface of the eye. It is a painless test. Theelectroretinogram (ERG), in conjunction with the visual field exam, will usually make the diagnosis. This will also determine if there is any cone involvement. Recently, gene testing for defects is being done to clarify the basic cause for RP and assist in ultimately finding a treatment. Treatments and drugs in Ayurveda After the diagnosis, the doctor sets out to treat the patient in a very systematic manner. This would include a set of appropriate Panchakarma treatments and Rasayana therapies . The Panchakarma Treatments are meant to flush out the toxins, They are classified as pre-purification, main purification and post purification phases and include various types of therapies like oil massages, fermented liquid massages, medicinal enemas, herbal purification methods. After body purification rasayana therapies along with Netra Kriya-kalpa’s were started such as:

1.Sekam :- An eye wash using medicated kashayam.

2.Anjanam :- An application of medicine in the form of paste to he eye.

3.Aschotanam :- An adminestration of eye drops to the eye.

4.Tharpanam :- Keeping medicated ghee over the eye for a stipulated period, making concentric boundary around the orbit.

5.Puttapakam :- Keeping medicaments prepared out of plant extracts,Fats & certain minerals over the eye for a stipulated period, making concentric boundary around the orbit. *In all the above kriya-kalpa different types of drugs are selected by your doctor according to the doshas involved. Oral medication : The oral medicine used for treating the disease will be extracts of pure medicinal herbs, leaves, spices etc. These are prepared specifically to restore the lost balance and to provide the needed inputs to improve the condition of patient. kashayams and Arishtam – herbal decoctions and fermentations lehyams – semi solid formulation are commonly prescribed. Diet : Brinjal, Lady finger, Jackfruit, Curd, Pickles, Lemon, Oily-Spicy food should be avoided .

• Include a variety of colorful fruits and vegetables in your diet . The antioxidant vitamins in the fruits and vegetables contribute to eye health. Eating a variety of colors ensures that you’re getting a variety of vitamins.

• Choose healthy fats. Healthy unsaturated fats, such as the fats found in olive oil, may help protect your vision. Choose these healthy fats over saturated fats, such as butter, and trans fats, such as partially hydrogenated oils found in packaged foods.

• Choose whole grains over refined grains . Choose whole grains, such as whole-wheat bread, over refined grains, such as white bread. • Add fish to your diet. Fish contain omega-3 fatty acids that may help reduce the risk of vision loss related to macular degeneration. Fish that contain high levels of omega-3 fatty acids include salmon, sardines and tuna. Omega-3 fatty acids can also be found in supplements and nuts, such as walnuts.

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