Health Information – 4

4. Glaucoma

Definition
Glaucoma is a group of eye conditions resulting in optic nerve damage, which causes loss of vision. Abnormally high pressure inside your eye (intraocular pressure) usually, but not always, causes this damage.
Glaucoma is the second leading cause of blindness. Sometimes called the silent thief of sight, glaucoma can damage your vision so gradually you may not notice any loss of vision until the disease is at an advanced stage. The most common type of glaucoma, primary open-angle glaucoma, has no noticeable signs or symptoms except gradual vision loss.
According to Ayurveda, glaucoma is best correlated with a condition known as Adhimantha and is of four basic type’s i.e. Vataj, Pittaj, Kaphaj & Raktaj. Generally speaking vata regulates retinal nerve function whereas kapha nourishes the eye and pitta acts to drain it in context with Adhimantha. A High intraocular pressure, due to accumulation of kapha dosha in the viscous fluid inside the eyeball, is called glaucoma. It will result in a loss of peripheral or side vision and ultimately permanent loss of vision. If on the other hand, timely treatment is made then the progress of the disease can be halted.

Symptoms :
The most common types of glaucoma — primary open-angle glaucoma and acute angle-closure glaucoma — have completely different symptoms.

Primary open-angle glaucoma signs and symptoms include:
• Gradual loss of peripheral vision, usually in both eyes
• Tunnel vision in the advanced stages

Acute angle-closure glaucoma signs and symptoms include:
• Severe eye pain
• Nausea and vomiting (accompanying the severe eye pain)
• Sudden onset of visual disturbance, often in low light
• Blurred vision
• Halos around lights
• Reddening of the eye

Cause:
An increased pressure within the eye (intraocular pressure) is usually associated with the optic nerve damage that characterizes glaucoma. This pressure comes from a buildup of aqueous humor, a fluid naturally and continuously produced in the front of your eye.
Aqueous humor normally exits your eye through a drainage system at the angle where the iris and the cornea meet. When the drainage system doesn’t work properly, the aqueous humor can’t filter out of the eye at its normal rate, and pressure builds within your eye.

Primary open-angle glaucoma
In primary open-angle glaucoma, the drainage angle formed by the cornea and the iris remains open, but the microscopic drainage channels in the angle (called the trabecular meshwork) are partially blocked, causing the aqueous humor to drain out of the eye too slowly. This leads to fluid backup and a gradual increase of pressure within your eye. Damage to the optic nerve is painless and so slow that a large portion of your vision can be lost before you’re even aware of a problem. The exact cause of primary open-angle glaucoma remains unknown.

Angle-closure glaucoma
Angle-closure glaucoma, also called closed-angle glaucoma, occurs when the iris bulges forward to narrow or block the drainage angle formed by the cornea and the iris. As a result, aqueous fluid can no longer reach the trabecular meshwork at the angle, so the eye pressure increases abruptly. Angle-closure glaucoma usually occurs suddenly (acute angle-closure glaucoma), but it can also occur gradually (chronic angle-closure glaucoma).
Many people who develop closed-angle glaucoma have an abnormally narrow drainage angle to begin with. This narrow angle may never cause any problems, so it may go undetected for life.
If you have a narrow drainage angle, sudden dilation of your pupils may trigger acute angle-closure glaucoma. Pupils become dilated in response to darkness, dim light, stress, excitement and certain medications.

Low-tension glaucoma
Another form of the disease, poorly understood but not uncommon, is low-tension glaucoma. In this form, optic nerve damage occurs even though eye pressure stays within the normal range. Why this happens is unknown. Some experts believe that people with low-tension glaucoma may have an abnormally sensitive optic nerve or a reduced blood supply to the optic nerve caused by atherosclerosis — an accumulation of fatty deposits (plaques) in the arteries — or another condition limiting circulation. Under these circumstances, optic nerve damage can occur even with normal pressure.

Pigmentary glaucoma
Pigmentary glaucoma, a type of glaucoma that can develop in young to middle-aged adults, is associated with a dispersion of pigment granules within the eye. The pigment granules appear to arise from the back of the iris. When the granules accumulate on and in the trabecular meshwork, they can interfere with the outflow of aqueous and cause a rise in pressure. Physical activities, such as jogging, sometimes stir up the pigment granules, depositing them on the trabecular meshwork and causing intermittent pressure elevations. This type of glaucoma can usually be easily diagnosed by your ophthalmologist.

Complications:
If left untreated, glaucoma will cause progressive vision loss, typically in these stages:

• Blind spots in your peripheral vision
• Tunnel vision
• Total blindness

Tests and diagnosis
These are some of the tests that can establish a diagnosis of glaucoma:

Measuring intraocular pressure.
Tonometry is a simple, painless procedure that measures your intraocular pressure, after numbing your eyes with drops. It is usually the initial screening test for glaucoma.

Test for optic nerve damage.
To check the fibers in your optic nerve, your eye doctor uses instruments to look directly through the pupil to the back of your eye. This can reveal slight changes that may indicate the beginnings of glaucoma.

Visual field test.
To check whether your visual field has been affected by glaucoma, your doctor uses a special test to evaluate your side (peripheral) vision.

Measuring cornea thickness (pachymetry).
Your eyes are numbed for this test, which determines the thickness of each cornea, an important factor in diagnosing glaucoma. If you have thick corneas, your eye-pressure reading may read higher than normal even though you may not have glaucoma. Similarly, people with thin corneas can have normal pressure readings and still have glaucoma.

Other tests.
To distinguish between open-angle glaucoma and angle-closure glaucoma, your eye doctor may use a technique called gonioscopy in which a special lens is placed on your eye to inspect the drainage angle. Another test, tonography, can measure how quickly fluid drains from your eye.

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. The Rasayana Therapies are meant to nourish the body, to bring the doshas back to balance and to regenerate the body.These comprise diet regulations, daily regimens, intake of oral medicines and ayurveda tonics, yoga and a stress free life. After the treatment the ayurveda doctors will advise you how to lead a healthy life. The beneifts and results of the treatment are shown only after the Rasyana Treatment is over and docotrs advise is strictly followed. The results will manifest itself normally after 3 to 4 weeks as the body takes time to regenerate itself.

Panchakarma for Glaucoma
Pre-purification therapies are the first ones applied to loosen the toxins, open up the circulation channels and get the body ready for discarding these wastes. These methods are highly relaxing for the body and mind.

The following pre-purification methods are usually adopted in curing glaucoma
Thalam
Retention of medicated paste or oil right on the vertex of a person for over 30 minutes is termed thalam. The therapeutic effects of herbs and oils pass on to the central and autonomous nervous system through the brain. Indian pennywort,staff tree,sida plant,etc are some of the medicinal herbs used in preparing the herbal paste. Thalam is highly recommended for the treatment of glaucoma.

Sirodhara
In this process herbal oil, medicated milk, medicated butter milk etc, are poured on the forehead in a specified manner for about 45-50 minutes. It is highly effective for glaucoma. Ingredients used in Sirodhara include goose berry, nut grass tuber and sandal wood etc.

Tharpanam
It is an ayurvedic therapy especially suitable for the eyes. In Ayurveda tharpanam or tharpan means retention of medicines over the eyes for up to 30 minutes or more a day. Tharpanam is effective in treating every type of eye disorder. It basically is an eye cleansing process and gives a cooling effect to the eyes. In tharpanam therapy, the eyes are bordered with a thick medical combination and the medicated oil is then retained over the eye.

Main purification therapies for Glaucoma
This is the phase of elimination of toxins that were loosened at the pre purification treatment stage. These therapies are highly potential methods and are usually overseen by doctors. The two commonly adopted Panchakarma treatments for glaucoma are Nasyam and Virechanam

Nasyam
is the pouring of herbal oil in drops in to the nostrils and inhaling the contents. This opens up the head channels and enables the herb extracts to act directly on the central nervous system. Nasyam treatment lasts for twenty to thirty minutes. The herbal oil is a blend of sesame oil mixed with herbs such as sida plants, bel, vitex etc. Nasyam is highly effective in the treatment of glaucoma.

Virechanam
consists of intake of safe herbal medicines leading to the elimination of the poisonous wastes through the anal route. This cleansing of the mid zone benefits the entire body system. The appetite and body strength increases making you a more active and energetic person.

Rasayana Therapies for Glaucoma
These are body nourishing therapies to rejuvenate the body and mind after the Panchakarma treatments. They keep the enzymes in the tissue cells in their normal functioning condition, restore and balance the body functions and maintain the overall health and well being of an individual for much longer periods after the Panchakarma course. Rasayana includes oral medicines and diet regulation.

Oral medicines for Glaucoma
It  used for treating glaucoma 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 cure glaucoma. kashayams and Arishtam – herbal decoctions and fermentationslehyams – semi solid formulation are commonly prescribed. Some of the herbs and spices used in the preparation of kashayams and lehyams for treating glaucoma patients include Aniseed, babul, carrot, coriander, Indian Gooseberry etc

Lifestyle
If you have elevated intraocular pressure or glaucoma, follow these lifestyle tips.

• Sip fluids frequently. Drink only moderate amounts of fluids at any given time during the course of a day. Drinking a quart or more of any liquid within a short time may temporarily increase eye pressure.
• Exercise safely. Regular exercise may reduce eye pressure in open-angle glaucoma. However, eye pressure may increase after exercise in one form of secondary glaucoma — pigmentary glaucoma, an inherited disorder marked by dispersion of pigment granules throughout the eye. With vigorous exercise, the pigment granules can become stirred up and deposit themselves on the trabecular meshwork causing an increase in pressure. With pigmentary glaucoma, it’s especially important to avoid head-down yoga positions and stretches, since these positions may increase intraocular pressure. Talk to your doctor about an appropriate exercise program.

If you don’t have pigmentary glaucoma, you needn’t restrict your physical activities.

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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