Abstract

Rod –cone dystrophy, also known as Retinitis Pigmentosa, is
highly heterogeneous group of IRDS characterized by progressive bilateral
degeneration of rods & cones. It poses a challenge in front of the medical
fraternity due to non availability of accurate management for this condition. Ayurveda
can provide a suitable answered through appropriate kriyakalpa & medicine
useful in Kaphaja vidagdha drusti/Ratra andhya/Nakula andhya. A diagnosed case
of Rod dystrophy with the complaints of diminished vision in day light & loss
of vision during night time approached the outpatient division of the hospital
and was managed by Vatahara, Rasayana, one sitting of  Akshi Tarpan with Go-ghrita and two sitting
of Nasya with Anutail and continuing pratimarsha nasya with Anu tail through
out the course of treatment of 3 months. There was improvement in visual acuity
in both eyes and significant improvement was noticed after the treatment.

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Introduction

Retinitis pigmentosa (RP) is an inherited retinal
dystrophy caused by the loss of photoreceptors and characterized by retinal
pigment deposits visible on fundus examination. Prevalence of non syndromic RP
is approximately 1/4,000. The most common form of RP is a rod-cone dystrophy,
in which the first symptom is night blindness, followed by the progressive loss
in the peripheral visual field in daylight, and eventually leading to blindness
after several decades. Some extreme cases may have a rapid evolution over two
decades or a slow progression that never leads to blindness. In some cases, the
clinical presentation is a cone-rod dystrophy, in which the decrease in visual
acuity predominates over the visual field loss. RP is usually non syndromic but
there are also many syndromic forms, the most frequent being Usher syndrome. To
date, 45 causative genes/loci have been identified in non syndromic RP (for the
autosomal dominant, autosomal recessive, X-linked, and digenic forms). Clinical
diagnosis is based on the presence of night blindness and peripheral visual
field defects, lesions in the fundus, hypovolted electroretinogram traces, and
progressive worsening of these signs. This includes the
development of (1) a mottled appearance of the retinal pigment epithelium (RPE)
caused by bone spicule formation, (2) a waxy appearance of the optic nerve, and
(3) the attentuation of blood vessels in the retina.3 Molecular diagnosis can be made for some
genes, but is not usually performed due to the tremendous genetic heterogeneity
of the disease. Genetic counselling is always advised. Currently, there is no
therapy that stops the evolution of the disease or restores the vision, so the
visual prognosis is poor. The therapeutic approach is restricted to slow down
the degenerative process by sunlight protection and vitamin therapy, treating
the complications (cataract and macular edema), and helping patients to cope with
the social and psychological impact of blindness. Recent investigations have
shown that proper vitamin A supplementation
can postpone blindness by up to 10 years (by reducing the 10% loss pa to 8.3%
pa) in some patients in certain stages of the disease.31

 However, new
therapeutic strategies are emerging from intensive research (gene therapy,
neuroprotection, retinal prosthesis).

 

This condition can be correlated to Kaphaja Bidgdha
dristi/Nakula andha/Ratra andhya manifesting the main features of RP i.e night
blindness.The genetic predisposition of RP can be considered as Congenital blindness
(Jatya andha). Wide range of treatment modalities have been mentioned in
Ayurveda that are effective in such manifestations.

Case report-

A  12 year female
patient had visited department of Shalakya Tantra ,AIIA with the chief
complaints of diminished distance vision in day time and loss of vision during
night time.

According to the patient’s mother ,since early childhood
patient had trouble in holding the objects & identifying them. Gradually
when she started going to the school, she could not read the blackboard &
had difficulties in vision during night. Then she had visited allopathic
hospital( the Astha eye center )for the management. At that time the vision of
the patient was